Refugees, Asylum Seekers and Trafficking Survivors Lost Medicaid Eligibility Oct. 1 Under 2025 Budget Law

Since Congress passed H.R. 1, the One Big Beautiful Bill Act, in July 2025, most of its Medicaid changes have been a matter of projections. On Oct. 1, the first of them became real, and nine days in, the people it hit are starting to find out.

Refugees, asylum seekers, Afghan allies, Ukrainian parolees, and survivors of torture, human trafficking and domestic violence who are in the country legally are no longer eligible for Medicaid or the Children's Health Insurance Program, according to Global Refuge, a refugee resettlement group. Green-card holders were not affected.

The number of people cut off is an estimate: hundreds of thousands. No agency has published a count of actual disenrollments.

What the law changed

These groups were among the few categories of immigrants who had qualified for Medicaid, in some cases for decades under administrations of both parties. Congress narrowed the eligibility list, and the change kicked in this month.

The Centers for Medicare and Medicaid Services said in a statement that it is implementing rules set by Congress. The agency did not answer NPR's follow-up question about how the policy affects refugees with disabilities.

The immigrant provision is a small slice of a much bigger law. The Congressional Budget Office's 2025 estimate projects the law's Medicaid changes will leave 7.5 million more people without health insurance. Many of those provisions take effect early next year.

The administration's position

White House spokesperson Lauren Bis defended the change in a statement: "immigrants must be able to support themselves without taking from overburdened benefits programs paid for by hard-working American taxpayers."

That is a straightforward fiscal argument. Medicaid is funded by federal and state taxpayers, and the law's backers have framed eligibility limits as a way to keep a strained program focused on citizens and long-term residents.

What advocates and analysts say

Ben D'Avanzo, a senior strategist at the National Immigration Law Center, which has sued the administration over its immigration agenda, called the change part of a broader message. "This is about telling every immigrant in the United States that they are not welcome here and that they should leave," he said. The White House statement does not describe the policy in those terms.

D'Avanzo also made a cost argument. Many people in these categories eventually become green-card holders and regain Medicaid eligibility. In the meantime, he said, they will "put off preventative care," skip treatment for chronic conditions and "forego important medication." By the time they regain coverage, he argued, their health will be worse and the bill to hospitals and the government higher.

Drishti Pillai, director of immigrant health policy at KFF, said most people losing Medicaid will have no realistic fallback. They can buy full-price ACA marketplace plans, but those are often unaffordable. Employer coverage is an option on paper, but many immigrants work in construction, agriculture and food service, where it is often not offered. Pillai said a few states are building their own coverage options for this group.

D'Avanzo said many affected people will likely only realize they have lost coverage when they need care.

One family in Tucson

For some, the realization has already come. María Chacon of Tucson has cared for her son Jesus for almost five years, since a car accident at 17 left him unable to breathe on his own. He needs a ventilator, a feeding tube and daily medication, and must be turned every two hours to prevent sores.

The family is from Mexico and entered the U.S. in 2018 on a T visa, which is offered to trafficking victims. Chacon said Medicaid has helped cover almost $25,000 a month of his care, including a small stipend for her and her husband as long-term caregivers. Doctors have told her that even if both parents worked around the clock, they could not cover the cost.

"Since that day I haven't been able to sleep," Chacon said. "We're wondering what we're going to do?"

Another Nebraska voice

Mustafa Rfat, a social work professor at the University of Nebraska at Omaha, arrived in the U.S. as a refugee from Iraq in 2011 and relied on Medicaid to manage a chronic inflammatory condition. He is now a citizen. Rfat said that in the two weeks before the change took effect he had been fielding calls from refugees with disabilities who are frightened their children are losing coverage.

What comes next

Many of the remaining Medicaid provisions of H.R. 1 are scheduled for early next year, and the CBO's 7.5 million figure covers the law's Medicaid changes as a whole, not just the immigrant provision. Whether states step in with their own coverage for the affected groups, as Pillai says a few are doing, will determine how many of these households end up uninsured. The Chacon family's situation is a live test: no source has said whether any state program or other coverage will pick up Jesus's care.