More than 800 lawfully present immigrants in Washington who receive Supplemental Security Income (SSI) will keep their Apple Health coverage for now after a federal judge in Seattle blocked the Trump administration from cutting off their Medicaid funding. The ruling does not help most of the people affected by the new federal rule. About 10,000 refugees, asylees, and other lawfully present immigrants in the state lost coverage on Oct. 1, according to the Washington State Standard.
SSI provides monthly payments to people with very low incomes who are 65 or older, blind, or disabled, so the protected group includes many patients who depend on daily care and regular prescriptions.
The Seattle Order and Its Limits
In Neighborhood House v. U.S. Department of Health and Human Services, a Seattle nonprofit and its client Mariia Matsai challenged April 2026 federal guidance that ends federal Medicaid funding for immigrants in Washington who are eligible for both SSI and Medicaid. The guidance carries out provisions of H.R. 1, the 2025 federal budget law. The case, No. C26-3006 TSZ, names HHS and Secretary Robert F. Kennedy Jr.
In his Sept. 30 preliminary injunction, U.S. District Judge Thomas S. Zilly barred HHS from "terminating Medicaid healthcare funding for any qualified noncitizen SSI recipients in the State of Washington." He pointed to a 1997 amendment to federal welfare law that makes qualified immigrants receiving SSI eligible for Medicaid. Without daily-living assistance, he wrote, there is "a reasonably foreseeable risk of Matsai's health declining, potentially leading to permanent disability or death."
The order is not a final ruling. It remains in effect "pending further order of the Court," applies only in Washington, and can be appealed. Lee Che Leong, a senior policy advocate with Northwest Health Law Advocates, which represents the plaintiffs along with the law firm Barnard Iglitzin & Lavitt, called the decision a "crucial victory." When the lawsuit was filed in August, Neighborhood House Executive Director Janice Deguchi said, "With this lawsuit, we're standing up for our clients who were promised care in this country."
Washington Refugees and Asylees Left Outside the Ruling
Under the new rules, refugees, asylees, trafficking victims, and certain parolees, including some Afghans and Ukrainians, are no longer eligible for Apple Health, according to the Health Care Authority's H.R. 1 fact sheet. Lawful permanent residents who have met or are exempt from the five-year waiting period, Cuban and Haitian entrants, and Compact of Free Association (COFA) islanders remain eligible. Children, pregnant people, and those within 12 months after pregnancy also remain eligible regardless of immigration status if they meet other requirements.
Early projections showed about 14,000 people losing coverage, but state officials updated immigration records for roughly 3,000 people so they could stay enrolled, the Standard reported. The Health Care Authority projected about 11,000 losses on Oct. 1.
"Most of them cannot possibly afford to buy insurance on their own, so will be left with no coverage at all," Adam Glickman of SEIU 775 said Thursday. State lawmakers set aside nearly $20 million so affected immigrants could keep long-term care coverage, but the Standard reported that the money is not expected to go nearly as far as lawmakers expected.
Steps for Apple Health Enrollees and Caregivers
The Health Care Authority asks enrollees to update their applications if their immigration status changes, if they are pregnant or had a pregnancy end after October 2025, or if they receive cancer treatment, anti-rejection medication, or dialysis. People ages 19 to 64 can call 1-800-562-3022, and people 65 and older, on Medicare, or with disabilities can call 1-877-501-2233. Other options may include Alien Emergency Medical coverage, Apple Health Expansion (which is currently at its enrollment limit), and qualified health plans through Washington Healthplanfinder.
"While some people may qualify for other Apple Health programs or coverage through Washington Healthplanfinder, understanding those options now is critical to avoiding gaps in care," said Leanne Berge, CEO of Community Health Plan of Washington. Anyone running low on a prescription should talk with a pharmacist or clinician before stopping a medication. Chest pain, trouble breathing, and signs of stroke still call for emergency care.
Possible Appeal and More Coverage Losses Ahead
MedicalDaily previously reported that refugees and asylees began losing Medicaid on Oct. 1 as nine states and Washington, D.C., counted more than 281,000 people at risk. The Seattle ruling narrows those losses in Washington, but only for SSI recipients.
The federal government could appeal the order to the U.S. Court of Appeals for the Ninth Circuit. Gov. Bob Ferguson signed an executive order last month that created a committee of state officials to find ways to help people keep coverage, directed a statewide public awareness campaign, and called for a database to track coverage losses. Glickman and other advocates are urging Ferguson and state lawmakers to use state money to restore coverage for those cut off.
More losses are expected. Federal Medicaid work requirements take effect in January 2027, and at least 200,000 of Washington's more than 1.9 million Apple Health enrollees are projected to lose coverage by the end of 2027 because of H.R. 1, the Standard reported.
Key Questions Answered
What did the judge decide?
Judge Zilly issued a preliminary injunction blocking HHS from ending Medicaid funding for qualified immigrants on SSI in Washington, a group of more than 800 people.
Who is not protected by the order?
About 10,000 refugees, asylees, and other lawfully present immigrants in Washington who do not receive SSI.
Is the ruling final?
No. It lasts until the court orders otherwise, and the federal government can appeal.
Who still qualifies for Apple Health?
Eligible lawful permanent residents, Cuban and Haitian entrants, COFA islanders, children, pregnant people, and those within 12 months after pregnancy, if they meet other requirements.
What should affected enrollees do now?
Report immigration status changes, pregnancy, or cancer treatment, anti-rejection medication, or dialysis to the Health Care Authority. People ages 19 to 64 can call 1-800-562-3022, and those 65 and older, on Medicare, or with disabilities can call 1-877-501-2233.
Can people who lost coverage still get emergency care?
Yes. Hospitals must screen and stabilize emergency patients regardless of insurance, and some people may qualify for Alien Emergency Medical coverage.
Published by Medicaldaily.com
