Refugees with disabilities lose Medicaid as H.R. 1 takes effect

KFF analysis estimates 280,000 people will lose coverage in October

Mustafa Rfat has been hearing from refugees with disabilities who are losing their Medicaid coverage. The University of Nebraska at Omaha professor, who arrived in the United States as a refugee from Iraq in 2011, has researched the population for years and credits Medicaid with helping him build a life in the country.

“I spent these past two weeks just talking with so many of them, literally just terrorized by the reality that their children with disabilities are losing coverage,” Rfat said. “For example, a father is a refugee with disabilities, with two kids with disabilities, and he’s just confused how he’s going to get the medication.”

The coverage loss took effect on October 1 under changes to “Alien Medicaid Eligibility” in H.R. 1 — also called the One Big Beautiful Bill Act — the Trump administration’s major budget bill Republicans passed last summer. An estimated 280,000 people will lose coverage this month, according to a KFF Health News analysis.

The change eliminates a category of eligibility that had allowed refugees, asylum seekers and other immigrants admitted on humanitarian grounds to enroll in Medicaid while they wait for green card approval, according to Ben D’Avanzo, a senior strategist at the National Immigration Law Center.

“The people who are losing Medicaid and CHIP are among some of the most vulnerable immigrants — people who have experienced violence in their own homes or on their journey, who may have physical and mental conditions, who are fleeing persecution and war,” D’Avanzo said. “These are people who we have long, in the United States, welcomed, and populations who have had very strong, historic bipartisan support.”

Rfat’s own experience with the chronic inflammatory condition ankylosing spondylitis left him unable to walk when he arrived in the United States, he said. “I was in a very bad situation,” Rfat said. “I couldn’t walk. I was in so much pain. I missed my medications for a long time. I didn’t see a doctor. So it was a very, very difficult and vulnerable situation.”

As he moved from Alabama to Illinois to West Virginia trying to find housing and continue his education, Medicaid was a lifeline, Rfat said. “I had to climb this big mountain of acclimating into the culture here, learning English, dealing with the traumas of the war, the loss of family members, the challenges that I faced, being alone with a disability,” Rfat said. “I was determined and in this determination, Medicaid was the big factor that made my dreams come true.” One of the specialists who treated him wrote his first reference to apply for college, Rfat said. He has since become a U.S. citizen with a family, a doctorate, and a job as a professor.

Rfat’s research indicates that more than one-third of refugees have at least one disability. “By the time I arrived in the U.S., a lot of doctors told me, ‘You are one of the worst cases that we are seeing,’” he said. “And that is the case for a lot of refugees that come here.”

In a statement to NPR, the Centers for Medicare and Medicaid Services said the agency is “enacting the law passed by Congress” and working with states to implement the policy. The agency did not respond to a follow-up question about the effect of the policy on refugees with disabilities.

Drishti Pillai, director of immigrant health policy at the nonpartisan health research organization KFF, said the changes leave the affected population with few affordable alternatives. “Once these changes take place, these groups of immigrants will be left with very few options for affordable, comprehensive coverage,” Pillai said. “They could still buy full price coverage from ACA marketplaces, but that is often unaffordable.”

Employer-sponsored coverage is also an option, Pillai said, “but many immigrants, especially those who are on Medicaid, don’t work in jobs that don’t offer employer-sponsored coverage, such as jobs in construction, agriculture, food service.” A few states are creating their own coverage options for the affected groups, Pillai said, though many are facing even bigger Medicaid cuts in January. Most states have opted in to allow Medicaid to continue covering pregnant women and children who would otherwise lose coverage.

D’Avanzo said the long-term consequences could be severe. “So these are people who are going to put off preventative care, who are not going to treat their chronic conditions, who are going to forgo important medication,” he said. “And then when they are Medicaid eligible again in the future, once they’ve received their green card, they’re going to be needing much more specialized care and much more costly care.”

Rfat said he is heading to Washington University in St. Louis this weekend to meet with a few dozen refugees with disabilities and share his recent research. He said the loss of Medicaid and food benefits will weigh on the gathering.

“It’s a nightmare for the community,” Rfat said. He said he hopes Congress will reverse course. Rfat said he plans to use part of the event to teach attendees about civic engagement. “To understand the importance of voting when they become citizens, to understand the importance of being aware of the policies, being aware of who their representatives are, how to communicate with their representatives,” he said.

“These are new Americans,” Rfat said. “These people are going nowhere. By making their health and well-being worse, it’s not going to benefit anyone.”