A sweeping change to the nation's public health insurance system took effect on October 1, cutting off Medicaid coverage for many legally present immigrants, including refugees, and triggering alarm among advocates and families who rely on the program for essential medical care.
The change stems from H.R. 1, the major budget reconciliation bill that Republicans in Congress passed last summer and that President Trump signed into law. The legislation strips Medicaid eligibility from large categories of immigrants who previously qualified, including refugees admitted through the federal resettlement program. According to NPR, many immigrants who are in the country legally will lose their coverage as a result.
Mustafa Rfat, a professor of social work at the University of Nebraska at Omaha, said his phone has been inundated in recent weeks by panicked refugees with disabilities and their relatives. He described the volume and intensity of the calls as unprecedented in his years of work on the issue.
"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 told NPR. He recounted the case of a father who is himself a refugee with disabilities and who has two children with disabilities. The man, Rfat said, is struggling to understand how he will obtain medication for his family once coverage ends.
Rfat's expertise is not merely academic. His research at the university focuses on refugees living with disabilities, a subject he understands from direct experience. He arrived in the United States as a refugee from Iraq in 2011, at a time when a chronic spinal condition had left him in severe pain and largely immobile.
"I was in a very bad situation," he said, recalling that period. "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."
Medicaid, the joint federal-state health insurance program for low-income people, served as a lifeline during that period, according to Rfat. The program covered the medical care he needed to stabilize his condition and rebuild his life in a new country. Now, he said, he is trying to help other refugees facing the same kind of vulnerability without that support.
For refugees with disabilities, the stakes of losing coverage extend well beyond routine doctor visits. Many rely on prescription medications to manage chronic conditions such as epilepsy, diabetes, heart disease and severe mental illness. Others depend on ongoing therapies, mobility equipment, personal care assistance or specialized treatment that can cost thousands of dollars per month without insurance.
The loss of Medicaid also threatens access to preventive care, which can lead to more expensive emergency treatment down the line. Refugees who cannot afford medications may see their conditions deteriorate, potentially resulting in hospitalizations that hospitals are legally required to absorb as uncompensated care.
The timing of the change compounds the difficulty. Refugees are typically resettled with the expectation that they will become self-sufficient within a short period, often within months of arrival. The federal refugee resettlement program provides limited transitional assistance, but employment that offers health insurance is not guaranteed, particularly for people with significant disabilities or limited English proficiency.
Refugee resettlement agencies and disability advocates have warned that the coverage gap could push already vulnerable families toward financial ruin. The problem is especially acute for families in which multiple members have disabilities, as is the case for the father Rfat described, because the household's care needs and expenses multiply at the same time that its insurance disappears.
The policy change also raises questions about the broader role of Medicaid in the American health care system. The program, created in 1965, covers tens of millions of low-income Americans, including children, pregnant women, seniors and people with disabilities. It is jointly funded by the federal government and the states, and states administer eligibility under federal rules.
Because Medicaid eligibility rules are complex and vary somewhat by state, the practical effects of the new law may unfold unevenly across the country. Some states may move quickly to disenroll affected immigrants, while others may seek ways to soften the impact within the limits of federal law. Refugees and their advocates may also face confusion about deadlines, notices and appeal rights.
Rfat's research suggests that refugees with disabilities already confront steep barriers in the United States, including language access, unfamiliarity with the health system, transportation challenges and a shortage of providers experienced in serving people with both refugee and disability backgrounds. Removing insurance coverage, he argues, adds a barrier that many families cannot overcome on their own.
The professor said the situation has left him fielding desperate questions from people who never imagined they would lose access to care in the country that resettled them. Their concerns are practical and immediate: how to refill a child's prescription, how to keep a wheelchair in working order, how to pay for a specialist visit that was already scheduled.
For now, Rfat said he is doing what he can to connect families with whatever resources remain available, while also documenting the consequences for his research. He described the current moment as one of the most difficult he has witnessed for refugee communities since he arrived more than a decade ago.
The long-term implications remain uncertain. What is clear, according to NPR's reporting, is that as of October 1, refugees across the United States are losing Medicaid coverage, and families with disabilities are among those most immediately and severely affected.
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