A sweeping federal budget measure has begun stripping Medicaid coverage from legally present immigrants across the United States, and the consequences are already reverberating through refugee communities and the social workers who serve them.
As of October 1, many immigrants who are in the country lawfully are losing their Medicaid health insurance under H.R. 1, the wide-ranging budget bill that Republicans in Congress passed last summer with the backing of the Trump administration. The change marks a significant rollback of a benefit that has long functioned as a critical safety net for people who arrive in the U.S. fleeing war, persecution or other dangers.
The effects are being felt most acutely among refugees, a group that includes many people with chronic illnesses, physical disabilities and complex medical needs. For these individuals, Medicaid has served not merely as a convenience but as the difference between receiving treatment and going without it entirely.
Mustafa Rfat, an assistant professor of social work at the University of Nebraska at Omaha, said his phone has been ringing constantly in recent weeks with calls from panicked refugees. One father he described is himself living with disabilities and is raising two children who also have disabilities. That parent, Rfat said, cannot understand how he will obtain medication for his family once their coverage disappears.
Rfat does not approach this issue from a distance. His research centers on refugees living with disabilities, and he understands their circumstances intimately because he has lived them. He arrived in the United States as a refugee from Iraq in 2011, at a time when a chronic spinal condition had left him in severe pain and largely immobile.
Recalling those early months, Rfat said he was unable to walk, went extended periods without his medications and could not see a physician. He described the experience as an extremely difficult and vulnerable chapter of his life. Medicaid, he said, was the lifeline that eventually allowed him to receive care and begin rebuilding his life in a new country.
Now, more than a decade later, Rfat finds himself trying to help a new generation of refugees confront the possibility of navigating life in the United States without that same support. The calls he has received in the past two weeks, he said, have come from people who are genuinely terrified about what will happen to their children.
The policy change stems from H.R. 1, a broad Republican budget package that reshaped several areas of federal spending, including the social safety net programs that serve low-income Americans. Under the new rules, legal immigrants who previously qualified for Medicaid no longer receive that coverage as of the start of October.
The timing of the cutoff has left refugees and their advocates scrambling. Many affected individuals are not yet eligible for employer-sponsored insurance, and few have the financial resources to purchase private coverage on their own. For families managing ongoing medical conditions, the loss of coverage threatens to interrupt treatments that are essential to maintaining their health.
Advocates note that refugees are admitted to the United States through a formal resettlement process that subjects them to extensive vetting. Once resettled, they are expected to find work, learn English and integrate into their new communities. Health coverage is widely viewed as a prerequisite for that integration, particularly for those coping with disabilities or chronic illness.
Rfat's own trajectory illustrates what is at stake. After struggling without medical care in his first year in the country, he went on to earn a doctorate and build an academic career dedicated to studying the very population he once belonged to. His work at the University of Nebraska at Omaha examines the barriers that refugees with disabilities face as they adjust to life in the United States.
He said the current moment is unlike anything he has witnessed in his years of research and advocacy. The fear expressed by families is not abstract, he explained; it is tied to concrete questions about insulin, seizure medications, mobility equipment and therapies for children with developmental conditions.
Supporters of the budget bill argue that restricting Medicaid eligibility for legal immigrants is a matter of fiscal discipline and that the changes are necessary to curb federal spending. Critics counter that the savings come at the expense of some of the most vulnerable people in the country, many of whom were invited to resettle here through an official government program.
The practical effects may take weeks or months to become fully visible, as families exhaust whatever remaining supplies of medication they have and begin postponing appointments they can no longer afford. Public health experts have warned that when people with chronic conditions lose access to regular care, emergency rooms often become their only point of contact with the health system, driving up costs elsewhere.
For Rfat, the immediate priority is helping the families who have reached out to him understand what options remain. But he acknowledged that those options are limited. He described the situation as a nightmare for people who have already endured displacement, violence and loss, only to face the prospect of losing access to medical care in the country that welcomed them.
As the new coverage rules settle into effect, refugee resettlement agencies, community health centers and social work organizations are bracing for a surge in demand for assistance. The coming months will test whether charitable programs and state-level initiatives can fill a gap that, until this week, federal Medicaid funding had largely covered.
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