Hundreds of thousands of immigrants with legal status are at risk of losing government health coverage starting Oct. 1, state data shows, signaling that the impact of Medicaid changes may be greater than anticipated. The law will strip many more immigrants of their Medicaid coverage under congressional Republicans’ One Big Beautiful Bill Act, which is expected to cut spending by more than $900 billion through 2034 for the state-federal health program for people with low incomes or disabilities.
State records show the impact will be immediate and extensive. More than 281,000 immigrants across nine states and Washington, D.C., have already been flagged for disenrollment, according to state reports. Florida expects to drop nearly 177,000 enrollees, while Arizona, New Jersey, and North Carolina anticipate losing 28,000, 15,000–25,000, and 29,000 respectively. Washington state projects 11,000 will lose coverage, though final figures won’t be confirmed until later this fall.
The Congressional Budget Office estimated the law would push about 100,000 more immigrants into uninsured status by 2034. However, state-level data suggests the actual number could be far higher. The cuts extend beyond Medicaid: starting next year, roughly 1 million immigrants will lose Affordable Care Act subsidies, and another 100,000 will be barred from Medicare, according to CBO projections.
For everyone else—including refugees fleeing war, asylees escaping persecution, and survivors of trafficking—Medicaid coverage will disappear unless they qualify for Emergency Medicaid, which only covers acute care.
Refugees and families face dire healthcare gaps
Ahin, a 25-year-old Syrian refugee who arrived in the U.S. in October 2024 after years in Turkey, illustrates the consequences. She developed severe abdominal pain shortly after landing, requiring intestinal surgery and ongoing specialist visits—all paid for by Medicaid. With her green card application delayed beyond the typical six-month timeline, she now faces a critical decision: forgo necessary care or risk financial collapse.
“It’s truly a terrible situation,” Ahin said. She doesn’t know what she will do if she needs to go to the hospital; she wouldn’t be able to pay the bill. She lives in a small apartment in New Jersey with her mother. Medicaid has also been vital to her mother, who has asthma.
Trump has argued that taxpayer-funded programs should be reserved for American citizens. The White House initially claimed the law would target undocumented immigrants, a statement later corrected by lawmakers.
Some states are resisting the cuts. California, which faces losing 148,000 enrollees, has allocated funding to maintain coverage for affected immigrants. New York and Pennsylvania have similar state-funded programs. However, in Florida, Arizona, and New Jersey, states with large immigrant populations, advocates warn the notification timeline has been unusually tight. Many enrollees received letters in September, leaving little time to contest eligibility or explore alternatives.
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States scramble to fill coverage voids
Julianna Larsen, co-founder of the Arizona Refugee Center, said her organization has worked to connect clients with free clinics, but gaps remain. “We’ve just been scrambling trying to find free medical care,” she said.
Ahin applied for permanent residency shortly after arriving, but processing delays, now exceeding a year, have left her in limbo. “She is stuck in the middle and has no control,” said Colleen McCauley, policy and advocacy director at the Camden Coalition, a nonprofit that helps connect people to healthcare in southern New Jersey.
Under a change starting in January, the CBO estimates, about 1 million will lose eligibility for government subsidies to buy individual health coverage on Affordable Care Act marketplaces by 2034. The Congressional Budget Office estimates these changes will reduce federal spending on the health law by $170 billion over a decade. However, the impact on uninsured rates depends on whether states or employers fill the gaps. Unlike Medicaid, which serves low-income individuals, ACA subsidies help middle-income immigrants purchase private plans-but many will now face unaffordable premiums or deductibles. In states like Texas, where Medicaid expansion remains blocked, immigrants already ineligible for the program will have no safety net at all.
Tight deadlines and legal hurdles block appeals
Implementation deadlines vary by state, but notification timelines have been unusually compressed. Florida’s Department of Children and Families sent disenrollment letters in late September, giving recipients less than a month to appeal before coverage ends. Arizona and New Jersey followed, though some enrollees report receiving notices after their eligibility had already been flagged in state databases. Legal aid groups warn that language barriers and limited legal representation will complicate appeals. In New Jersey, Interfaith-RISE has fielded calls from immigrants who assumed their Medicaid would renew automatically, only to discover their cases had been marked for termination without explanation.
States resisting the cuts are doing so at significant cost. New York and Pennsylvania have similarly committed state funds, though their programs cover fewer enrollees.
The Trump administration has argued that the changes are a restoration of fiscal responsibility, citing more than $900 billion in projected savings from the One Big Beautiful Bill Act. However, the Congressional Budget Office’s late release of its impact analysis-a month after the law’s passage-left lawmakers and states scrambling to prepare. The delay also obscured how the Medicaid cuts interact with other provisions, such as work requirements set to take effect in January. The CBO estimates those rules alone will increase the uninsured rate by 5 million by 2034, a figure that does not account for the additional 281,000+ immigrants losing Medicaid this fall.
The law’s exemptions, green card holders, children under 19, and immigrants from Cuba, Haiti, or certain Pacific Islands, reflect long-standing immigration policy priorities. However, the six-month green card processing delay that has left thousands in limbo was not accidental. Under the Trump administration, USCIS processing times for permanent residency applications have stretched beyond 18 months in some cases, directly contributing to the current crisis. For Ahin, whose application was filed within months of arrival, the delay means she will lose Medicaid before gaining green card protections, a Catch-22 that advocacy groups say is intentional. The One Big Beautiful Bill Act does not address processing backlogs, leaving hundreds of thousands in a legal purgatory where neither citizenship nor coverage is assured.
