Refugees, asylees, and survivors of human trafficking started losing Medicaid eligibility on Oct. 1 as a provision of the 2025 federal budget law took effect. More than 281,000 immigrants in nine states and the District of Columbia are expected to lose coverage, according to state counts gathered by KFF Health News.
The people affected are in the country legally. Many fled war or persecution, and some are interpreters who risked their lives helping U.S. service members in Afghanistan. Without coverage, many are likely to lose regular access to doctors and prescriptions, though emergency care remains available through a separate program.
For these households, the change is immediate. A parent managing diabetes, a person in cancer treatment, or someone on daily psychiatric medication now has to find a way to keep that care going, often in a new language and an unfamiliar health system.
Families Losing Coverage and Those Who Keep It
The law, known as H.R. 1 or the One Big Beautiful Bill Act, limits federal funding for full Medicaid and CHIP benefits to U.S. citizens and nationals, lawful permanent residents, Cuban and Haitian entrants, and people from Compact of Free Association nations, Becker's Hospital Review reported.
That means green card holders keep coverage. The law also leaves in place an existing option that lets states cover lawfully residing children under 19 and pregnant women, so children and pregnant women keep coverage in states that use it, according to an analysis in Health Affairs.
Those losing coverage include refugees, asylees, trafficking survivors, and other lawfully present immigrants who do not have green cards. Refugees and asylees can still qualify for Emergency Medicaid, which covers emergency care but not routine visits or most prescriptions.
MedicalDaily reported in June on how H.R. 1 ends Medicaid and Medicare for some immigrants. That explainer focused on the timeline. What is new now is that the Medicaid cutoff has arrived and states have released counts of the people they identified.
State Counts and the Federal Estimate
Florida reported the largest number, nearly 177,000 people. North Carolina identified about 29,000 and Arizona nearly 28,000. New Jersey estimated 15,000 to 25,000, according to KFF Health News.
Washington's numbers show how counts can differ by source. KFF Health News reported about 11,000, while OPB reported that about 14,000 Washington residents will no longer be eligible for Apple Health, the state's Medicaid program.
The figures are not a single national tally. Each state identified enrollees through its own records. Florida's Department of Children and Families, for example, verified immigration status through government databases and sent notices asking people to provide more information if they believe they are still eligible.
The Congressional Budget Office estimated that the Medicaid provision would leave about 100,000 more immigrants uninsured by 2034. That figure measures something different from the state counts. It projects the long-term rise in uninsured people, not the number of enrollees removed in October, and some people may find other coverage.
More changes are coming. Starting in January, other provisions take effect that the CBO estimates will cost about 1 million immigrants their eligibility for subsidized Affordable Care Act marketplace plans by 2034, and about 100,000 their access to Medicare.
Strain on Families, Clinics, and Hospitals
Officials and advocates worry the burden will shift to emergency rooms. Ryan Moran, director of the Washington State Health Care Authority, told OPB that people without coverage may turn to the emergency department as their only access point to care. "We worry about the strain and stress on the hospital system," he said.
People with chronic conditions face the greatest risk. Those who rely on insulin, blood pressure medication, HIV treatment, or mental health care can see their conditions worsen quickly if refills stop. For many immigrants on Medicaid, losing access to prescribed medications "is a life-or-death situation," Andrea Mendez Perez, a director at the New Jersey refugee resettlement group Interfaith-RISE, told KFF Health News.
Some states are filling part of the gap. California, which identified about 148,000 affected residents, is spending $365 million on a separate program to keep them covered until July 2027. New York and Pennsylvania also have state-funded coverage for many of the immigrants affected, KFF Health News reported. Residents of other states have fewer options.
Community groups are also feeling pressure. "We've just been scrambling trying to find free medical care," said Julianna Larsen, co-founder of the Arizona Refugee Center.
Practical Steps for Affected Households
Anyone who received a notice should read it closely and respond by the deadline if they believe it is wrong. People who have a green card or recently adjusted their status should confirm their eligibility with the state Medicaid agency. Parents should also check whether their state still covers lawfully residing children.
Before coverage ends, it helps to ask doctors for 90-day prescription refills where allowed, request copies of medical records, and write down medication names and doses. Federally funded community health centers charge on a sliding scale based on income. Local refugee resettlement agencies and legal aid groups can help with eligibility questions.
People should not avoid the emergency room in a true emergency. Emergency Medicaid remains available to refugees and asylees, and hospitals must screen and stabilize anyone with an emergency medical condition.
Next, watch for state decisions on whether to fund replacement coverage and for the January 2027 changes to marketplace subsidies and Medicare. MedicalDaily will track how many people lose coverage as states finish processing.
Key Questions Answered
Who loses Medicaid on Oct. 1? Refugees, asylees, trafficking survivors, and other lawfully present immigrants who do not have green cards lose eligibility for full Medicaid under H.R. 1.
Who keeps coverage? Citizens, green card holders, Cuban and Haitian entrants, and Compact of Free Association migrants. States can also keep covering lawfully residing children and pregnant women.
How many people are affected? More than 281,000 in nine states and DC are expected to lose coverage, according to state counts gathered by KFF Health News. Florida reported the largest number, and California separately identified about 148,000.
Can refugees still get emergency care? Yes. Emergency Medicaid remains available, and hospitals must screen and stabilize emergency patients.
Why do the numbers differ? States counted enrollees using their own records, and the CBO estimate projects long-term uninsured numbers rather than people removed in October.
What should affected families do now? Read any notice, confirm status with the state Medicaid agency, refill prescriptions, and contact community health centers or resettlement agencies for low-cost care.
Published by Medicaldaily.com
