Full Breakdown
Trump-Era Medicaid Changes Threaten Coverage for Refugees and Other Immigrants
By Drooid · · How we work
Core Policy Shift Strips Medicaid from Certain Immigrants
The Trump administration’s budget bill, House Resolution 1—also called the “One Big Beautiful Bill” Act—was enacted last summer and took effect in October. The law revises “Alien Medicaid Eligibility,” limiting Medicaid (or state-run equivalents such as Washington’s Apple Health) to U.S. citizens, nationals, lawful permanent residents with more than five years in the country, Compact of Free Association islanders, and certain Cuban-Haitian immigrants. Refugees, asylum-seekers, victims of trafficking and other humanitarian-status immigrants are now ineligible, although children, pregnant people and those within 12 months postpartum retain coverage if other criteria are met.
Scope and Numbers
- KFF Health News estimates about 280,000 people nationwide will lose Medicaid coverage in October.
- In Washington, roughly 11,000 refugees, asylum-seekers and other lawful immigrants will lose Apple Health coverage, down from an earlier projection of 14,000.
- HealthPoint reports 1,600 patients slated to lose Apple Health; about 75 % have already scheduled appointments before the deadline.
Background & Context
Before the amendment, refugees and asylum-seekers were among the few legal-immigrant groups eligible for Medicaid. The change follows a broader Republican effort to tighten federal spending on health programs. Advocates note that refugees historically receive bipartisan support because of their vulnerability and contributions to U.S. communities.
Official Statements & Responses
- CMS said it is implementing the law with states but declined comment on the specific impact on refugees with disabilities.
- Ryan Moran, director of Washington’s State Health Care Authority, described the situation as “understandably scared and fearful” for those losing coverage and called the law’s effect “the very harsh reality” that removes individuals from Medicaid “overnight with no other option.”
- Ben D’Avanzo, senior strategist at the National Immigration Law Center, stressed that the people losing Medicaid and CHIP are among the most vulnerable immigrants—individuals who have endured violence, persecution, and serious health conditions.
On-the-Ground Reports
- Mustafa Rfat, a refugee-turned-professor of social work, recounted how Medicaid enabled him to manage a severe spinal condition and pursue higher education.
- HealthPoint’s regional director of clinical care, Dr. Liza Perpuse, devoted a full day to see patients slated to lose insurance, issuing 90-day prescriptions and encouraging sliding-scale payment options.
- Omranna Sahak, refugee and immigrant coordinator at HealthPoint, highlighted the added hardship of losing insurance while newcomers are still learning English and rebuilding their lives.
Data & Statistics
- 280,000 nationwide Medicaid losses projected (KFF).
- Over one-third of refugees have at least one disability, according to Rfat’s research.
- 2 million lower-income Washington residents are currently enrolled in Apple Health.
What’s Next
- In January, Washington will implement new work-requirement rules that will affect over 600,000 residents, requiring re-application for coverage twice annually beginning in 2027.
- The State Health Care Authority is creating an internal “verification hub” to identify exemptions (e.g., pregnancy) that could preserve coverage for roughly 400,000 of the at-risk members.
These developments mark a significant shift in Medicaid eligibility, with immediate consequences for refugees, asylum-seekers and other vulnerable immigrants across the United States.