Medicaid coverage cuts for legal immigrants have taken effect across parts of the United States, removing refugees, asylum seekers and victims of human trafficking and domestic violence from the publicly funded health insurance programme.
The changes, which came into force on October 1, are expected to affect hundreds of thousands of people who legally immigrated to the US, including many who work and pay taxes. Green-card holders were not included in the cuts.
The restrictions form part of wider changes to Medicaid introduced under President Donald Trump’s 2025 tax and policy law. The Congressional Budget Office has estimated that 7.5 million people could lose health insurance by 2034 as a result of the changes.
Immigration advocates say those who lose Medicaid will struggle to afford private insurance, forcing some to delay treatment or seek help in hospital emergency departments.
Ben D’Avanzo, a senior strategist at the National Immigration Law Centre, said: “This is about telling every immigrant in the United States that they are not welcome here and that they should leave.”
Lauren Bis, a White House spokesperson, said: “Immigrants must be able to support themselves without taking from overburdened benefits programs paid for by hard-working American taxpayers.”
Family faces loss of lifesaving medication
In Tucson, Arizona, María Chacon says her family has already felt the impact of the policy. Her son Jesus has needed a ventilator, feeding tube and daily medication since a car accident at the age of 17 left him unable to breathe independently.
The family, originally from Mexico, entered the US on a T visa for victims of human trafficking in 2018. Medicaid had been paying almost 25,000 dollars a month towards his care, including a small stipend for Chacon and her husband as long-term carers.
Chacon said one of Jesus’s medicines cost about 7,000 dollars a month and that their supply was due to run out in mid-October. She said the family did not know how they would continue paying for his treatment.
“Since that day I haven’t been able to sleep. We haven’t been able to eat or anything. We’re wondering what we’re going to do?” she said.
Chacon discovered only days before the cuts that her coverage was ending and contacted Arizona’s Medicaid offices to appeal. She is seeking a green card, but said Medicaid would not be restored until five years after approval.
Steven Camarota, research director at the Center for Immigration Studies, a right-leaning organisation that advocates lower immigration, said the administration was “trying to nibble around the edges” by finding piecemeal ways to curb immigration.
The administration has also revived a federal rule that could deny green cards to immigrants who use public benefits, potentially including food stamps, Medicaid and housing vouchers.
More Medicaid coverage losses expected
Medicaid is jointly funded by state and federal governments and has become a political focus during Mr Trump’s second term. The president has said he wants to tackle fraud in the programme; in July, the administration deferred more than one billion dollars in Medicaid payments to California and Minnesota over suspected fraud, a move critics said targeted Democratic-led states.
Healthcare research organisation KFF estimates that more than 281,000 immigrants in nine states and the District of Columbia are set to lose Medicaid coverage. Officials in Arizona put the number affected in the state at 29,000, while estimates in Florida are about 177,000.
Federal Medicaid spending is projected to fall by 911 billion dollars as more people are removed from the programme. Advocates warn that the reduction in coverage will not eliminate the need for medical care.
Carmen Feliciano, vice-president of policy and advocacy at Latino civil rights organisation UnidosUS, said people who delayed treatment could ultimately require more expensive emergency care.
“At the end of the day, it does raise the cost for the states because once you get these people in for something that could have been prevented, they could not go to the doctor because they were uninsured; they most likely will end up at a hospital in an emergency room,” she said.
Feliciano said community organisations helping people access healthcare were already overwhelmed and would not be able to support everyone who loses coverage.
“We are not going to have the capacity to serve all the people who need it,” she said.
