Refugees and asylum seekers lose Medicaid eligibility as 2025 law provision takes effect

Refugees and asylum seekers lost eligibility for Medicaid on Oct. 1, when a provision of the 2025 budget law known as H.R. 1 took effect, NPR reported. The network described it as the first wave of Medicaid changes from the Republican-passed law, and said the groups affected are among the few categories of immigrants who had been eligible for the program.

Under the law, Medicaid and the Children’s Health Insurance Program are now limited to lawful permanent residents, Cuban and Haitian entrants, people living in the United States under the Compacts of Free Association, and, in states that choose to cover them, lawfully residing children and pregnant people, according to a September KFF analysis. The same analysis says refugees and asylees without a green card are among the groups that no longer qualify. Undocumented immigrants were already ineligible for federally funded coverage before the law passed.

What the numbers show

The Congressional Budget Office estimates that the eligibility restrictions in Medicaid and CHIP will reduce federal spending by $6.2 billion and leave an additional 100,000 people uninsured by 2034, KFF reported. KFF also noted that people who remain eligible could lose coverage because of administrative barriers, particularly if they have difficulty understanding or responding to notices that ask for documents. States will face added administrative work to carry out the changes, the organization said.

The Centers for Medicare and Medicaid Services released guidance and an implementation toolkit for states, according to KFF. In a statement to NPR, the agency said it was implementing rules set by Congress. It did not respond to NPR’s follow-up question about how the policy affects refugees with disabilities.

Voices from affected communities

Mustafa Rfat, a professor of social work at the University of Nebraska at Omaha, told NPR he has spent the past two weeks fielding calls from refugees with disabilities. “I spent this past two weeks just talking with so many of them, terrorized by the reality that their children with disabilities are losing coverage,” he said. Rfat arrived as a refugee from Iraq in 2011 and is now a U.S. citizen. He told NPR that Medicaid was a lifeline while he brought a chronic inflammatory condition under control.

Drishti Pillai, director of immigrant health policy at KFF, told NPR that most of those losing Medicaid will have no other options. They could buy full-price coverage through Affordable Care Act marketplaces, she said, but that is often unaffordable. Employer-sponsored coverage is also possible, but she noted that many immigrants work in jobs that do not offer it, such as construction, agriculture and food service. Pillai said a few states are creating their own coverage options for this group.

Ben D’Avanzo of the National Immigration Law Center told NPR that some of the immigrants being cut from health coverage and food benefits now will eventually become green card holders who are eligible again. In the meantime, he said, they are likely to put off preventive care, leave chronic conditions untreated and go without medication. When they regain Medicaid, he told NPR, their health will be worse, which will cost hospitals and the government more.

Emergency care and hospital costs

Emergency Medicaid, which reimburses hospitals for emergency care they are obligated to provide to people who meet other Medicaid requirements but lack an eligible immigration status, is exempt from the new restrictions, KFF reported. The state option to cover lawfully residing children and pregnant people without a five-year waiting period also remains in place, as does the option to provide prenatal care and pregnancy-related benefits regardless of a parent’s immigration status.

The immigrant eligibility changes are one part of a larger package. The Commonwealth Fund estimates that about $1.3 trillion is set to be cut from Medicaid, the Affordable Care Act marketplaces and the Supplemental Nutrition Assistance Program, the Daily Yonder reported. Rep. Jill Tokuda, a Hawaii Democrat who co-chairs the House Rural Health Caucus, told the outlet that when people lose coverage, hospitals do not stop treating them. “They absorb the cost,” she wrote, adding that for hospitals already operating on thin margins, that can mean cutting services or closing.

Under the 1996 welfare law, KFF noted, many lawful permanent residents must still wait five years before they can enroll in Medicaid, and the 2025 law does not change that rule.