Multiple groups of lawfully present immigrants, including refugees and asylum seekers without a green card, will become ineligible for Medicaid and CHIP, the Children’s Health Insurance Program, starting Oct. 1. The changes take effect following the “One Big Beautiful Bill Act” that President Donald Trump signed into law last year.
Health policy experts and organizations that work with immigrants in Mississippi warn the changes will worsen a culture of fear that could compel immigrants to delay seeking medical attention. Downstream, this can lead to costlier care of potentially preventable illnesses and create more strain for an already burdened healthcare system.
“These immigrants will be left with very few affordable coverage options,” said Drishti Pillai, director of Immigrant Health Policy at KFF, a national nonpartisan health policy organization. Pillai pointed to upcoming restrictions on subsidized Affordable Care Act Marketplace and Medicare plans. Starting in January, these options will be limited to only the three groups of immigrants that also retain Medicaid eligibility.
Who is and isn’t eligible
Green card holders, also known as lawful permanent residents, will still be eligible for Medicaid, the joint federal and state program that provides free or low-cost health insurance to low-income individuals. Immigrants from Cuba, Haiti and Pacific Island nations in the Compact of Free Association, an international treaty with the United States, also will remain eligible for such benefits.
Several groups of immigrants with vulnerable backgrounds, however, will lose access to Medicaid coverage. Refugees and asylees, who fled their home countries for fear of persecution and have received humanitarian status in the U.S., will no longer be eligible. Neither will survivors of domestic violence with approved or in-progress applications for a green card under the Violence Against Women Act. The act created a pathway to lawful permanent resident status for women whose green card sponsors abused them.
Refugees in the U.S. are fleeing terror and violence in their home countries, said Lorena Lewis-Quiroz, executive director of the Immigrant Alliance for Justice and Equity, a Jackson-based immigration advocacy group.
“You’re already coming from that and then losing access to care. I just can’t believe that this is happening, you know?” she said. “This is chipping away at this system of healthcare for immigrants.”
Similarly, immigrants who will lose eligibility include victims of human trafficking, such as sex and labor trafficking, and those who have an approved or pending T visa. This temporary status allows immigrants to apply for permanent residency. Other groups losing Medicaid are:
Immigrants granted humanitarian parole to stay in the U.S. for at least one year; Immigrants who have been granted a withholding of deportation; Canadian-born members of a federally recognized Indian tribe or American Indians; Older individuals who were granted conditional entry before the Refugee Act of 1980 (including people who fled communist countries in the Soviet Union and Eastern Europe as well as some refugees from Southeast Asia).In Mississippi, children and pregnant adults who have legal status will also lose Medicaid eligibility. Some states have opted to continue offering coverage for these groups under the 2009 Immigrant Children’s Health Improvement Act, which waives the five-year period many immigrants wait between gaining their green card and being able to enroll in Medicaid. Since January, 38 states have chosen to provide health coverage for legally present immigrant children, and 32 states have done so for people who are pregnant. Mississippi has not chosen to cover either group.
“The changes to Medicaid are harsh and could prevent coverage for eligible children, if the parents can no longer file on their citizen children behalf due to the parent’s immigration status,” wrote El Pueblo Executive Director Kathy Sykes over email. The statewide organization provides free legal and social services to immigrants.
“There are so many changes coming down from the federal government it gets quite confusing and may scare away those who are eligible from ever applying for needed services,” she said.
Impacts beyond losing insurance
Pillai worries about the broader impact of losing eligibility and verification processes — even for immigrants who are still eligible for Medicaid.
States will need to verify the immigration status of people being disenrolled through the Department of Homeland Security’s database, Systematic Alien Verification for Entitlements (SAVE) and social security databases. If the state Medicaid agency can verify eligible status, enrollees will maintain their Medicaid coverage. If officials are unable to verify status with that information, they must request additional information from the person affected, and give them 90 days to respond.
Khaylah Scott, program manager at the Mississippi Health Advocacy Program, said the rules around Medicaid eligibility have been in place for 30 years, since the 1996 Welfare Reform Act.
“When you’re facing few or little communication from the Division of Medicaid and the first time hearing about this may be receiving that letter, it is pretty sudden,” she said. “I’m just imagining the confusion, the fear that some could experience just receiving this letter in the mail and knowing at the heart of it is your immigration status.”
This verification process may be confusing for immigrants, especially those with low-English proficiency. Pillai said past research has shown that when disenrollment occurs, it can also affect people who changed their address or otherwise weren’t able to fill out the required paperwork.
“All of these could lead to disenrollments, not due to eligibility, but for administrative reasons,” she said.
The Mississippi Division of Medicaid did not respond to Mississippi Today’s request for comment on how these changes will be implemented. A Sept. 14 public notice for a proposed Medicaid state plan change notes that the amendment “is anticipated to be budget neutral due to a low number of effected individuals” but does not provide an estimate on how many immigrants will be affected.
Immigrants who no longer qualify for Medicaid or the Children’s Health Insurance Program can still receive coverage under Emergency Medicaid in specific circumstances, such as sudden onset of severe symptoms that, if left untreated, could result in serious harm. A pregnant person entering labor, for instance, is covered in all states. Because Mississippi has not expanded Medicaid, eligibility is limited to a narrower group of categories. A low-income undocumented adult who is not pregnant, not a qualifying parent, and does not qualify through a disability category cannot rely on Emergency Medicaid even if they have a qualifying event.
In the long term, Pillai said, this loss of eligibility could lead to worse health outcomes as people wait until their conditions become unbearable.
“If individuals don’t have coverage and they’re not getting routine care, it’s likely to increase reliance on emergency rooms,” she said. “It could further strain community health centers, since those treat patients regardless of immigration status, regardless of ability to pay.”
Lewis-Quiroz sees a similar impact looming: “It’s just gonna be another case of, ‘Well, you know what? I will just wait until I have that stroke.’”
This story was produced with support from the Sarah Yelena Haselhorst Fund for Health Journalism.
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