For many legal immigrants in the United States, Oct. 1 brought a new financial worry: the loss of federal Medicaid and Children’s Health Insurance Program access.
The end of coverage for refugees, asylum seekers and victims of human trafficking and domestic violence — many of whom work and pay taxes — was part of President Donald Trump’s sweeping changes to Medicaid under the One Big Beautiful Bill Act, which passed last year.
It’s expected to cut federal Medicaid spending by more than $900 billion through 2034.
“ People have come through long journeys to come to the United States in hopes of a better future for their families, and they are working hard,” said Jessica Shih, director of Preferred Communities at the International Rescue Committee (IRC), which helps with resettling refugees who have been impacted by conflict and disaster.
In an interview with WLRN, Shih recounted the story of one family from the Democratic Republic of Congo that the IRC has assisted. She said the father is having to decide between feeding his family, making sure his three children have the medical care that they need, or choosing who in his family has to go without medical care.
“[His children] have seizure disorders, developmental delays, cerebral palsy, and they've been in and out of the hospital since they arrived,” said Shih. “Even though he's working full time, he cannot afford his health insurance premiums through his work.”
According to KFF Health News, nearly 177,000 immigrants in Florida alone are at risk of losing Medicaid coverage. Shih said the nationalities in Florida largely impacted include refugees from Venezuela, Colombia and Nicaragua.
Certain immigrants from the Democratic Republic of Congo, Afghanistan, Iraq, and Ukraine also lost Medicaid access in Florida. Permanent U.S. residents, often known as green-card holders, are not impacted.
WLRN spoke with Shih about the scope of Medicaid and CHIP coverage loss for certain immigrants, and what people should know.
This interview has been lightly edited for clarity and brevity.
WLRN: What kinds of health coverage and health care access are these immigrants losing?
Many of them are losing preventive care and routine care, which is especially important. There are federally qualified health centers that are able to make up for some of the gap, but some of our biggest concerns are around clients or individuals and families who have those elevated concerns, such as diabetes, where they now have to pay out of pocket for their insulin; or asthma, where they have to pay out of pocket for an inhaler when it's 100% preventable for them to not be in an emergency situation.
And then, of course, for our families and individuals who have terminal illnesses, the federally qualified health centers, they can't provide specialized care. They cannot provide prosthetics. They cannot provide chemotherapy. They cannot provide dialysis. And so those are the clients that we are highly, highly concerned about.
If people are listening and they're asking themselves if they've been impacted, how can they verify if their Medicaid or CHIP coverage was impacted?
There's information on the Florida Medicaid eligibility website that you can check your eligibility. There's lists of the reasons that further explain why you may have been denied Medicaid.
And so we highly recommend familiarizing yourselves with the information that's on there and reaching out to either an organization such as IRC that can support you in trying to navigate the very complicated healthcare system or reaching out directly to Florida's Department of Social Services so that they can help clarify your eligibility for the program.
However, even those who are qualified and eligible for Medicaid do have to renew their eligibility every six months. In addition to that, they also have to submit the appropriate documentation in order to maintain their Medicaid eligibility. So it's not only more challenging, of course, for those who are no longer eligible for Medicaid, but also more challenging for those who do qualify for Medicaid to keep their Medicaid coverage.
Now that many immigrants across the US, and including in Florida, have lost this kind of medical care as of Oct. 1, what kind of support is out there for them?
The federally qualified health centers, they can cover basic routine primary care, prenatal sometimes, and postnatal care. However, outside of that, the resources are very, very limited.
At IRC, we do provide virtual services as a way to provide support to those families and individuals who need it. And there are many organizations on the ground as well who are providing these services, so we highly recommend reaching out. If you have a piece of mail that you're unclear about what it states or what it doesn't state, please bring that to someone as soon as possible so they can assist you.
The timing is incredibly important as well. You only have a limited amount of time to redetermine your Medicaid if you do qualify. And then for those of you who no longer qualify for Medicaid, at the very least it's really helpful to know that you no longer qualify so you can get ahead of looking for other coverage options before an emergency occurs.
What are you hearing from the immigrants and refugees that you work with or that the IRC works with, about this change and how that will affect them?
If I had to use one word, I would say despair. Many of our clients and individuals and families have come here to escape war, persecution, and many, many traumatic events.
The refugees and humanitarian immigrants that we're referring to came at the invitation of the U.S. government to escape war and persecution, so they were invited to come to the United States. Starting with the loss of SNAP benefits, and then now with the loss of Medicaid, there is no sustainable solution to this.
And so unfortunately, we are seeing a lot of despair among those who were asked to come to the United States to be offered a safe haven.
The compounding impact of [the One Big Beautiful Bill Act], starting with the loss of SNAP benefits, and then now with the loss of Medicaid, and with the increase in housing prices and many of the other challenges that all of us, including Americans, are facing, has made it incredibly difficult for our humanitarian immigrant families.
Without a sustainable solution, what IRC would advocate for is a return to what Medicaid looked like prior to the implementation of the law. We do believe that would lead to better outcomes for entire communities as well as for humanitarian immigrants that have come to the United States.
