Medicaid's Oct. 1 eligibility cut drops an estimated hundreds of thousands of legal immigrants

Medicaid had been paying almost $25,000 a month toward Jesus Chacon's care, his mother told Fortune, and that figure includes a small stipend for her and her husband as his caregivers ^[7]. That comes to about $300,000 a year ^[19]. Maria Chacon separately estimates his medication at $7,000 a month, and the supply runs out in mid-October ^[8]. Doctors told the family that even if both parents worked 24 hours a day, they could not cover his care ^[16].

When eligibility ends, a bill of that size moves to someone else. Medicaid is funded jointly by the states and the federal government ^[15]. The saving is split between those two budgets, and the cost moves to the family and to whichever provider treats the patient next. Advocates cited by Fortune say people dropped from the program cannot afford private insurance and will delay care or end up in emergency rooms ^[21]. Ben D'Avanzo, a senior strategist at the National Immigration Law Center, said many will likely only realize they have lost coverage when they need medical care ^[22].

The Oct. 1 group is small next to the law's projected total. An estimate of hundreds of thousands means fewer than a million people. That is at most about 13% of the 7.5 million fewer insured people in the Congressional Budget Office's 2025 estimate ^[1][4][20]. The two counts measure different things, or rather, different ends of the same process: one is people dropped from Medicaid, the other is people left with no insurance at all. Fortune describes many of those dropped as working and paying taxes ^[1]. The report does not say how many of those jobs come with health benefits, and it does not put a dollar figure on the care hospitals will now write off.

The route back to coverage is long. Chacon is applying for a green card, but Medicaid would only start five years after she is approved ^[9]. The administration has also revived a rule that could deny green cards to immigrants who use public benefits, Medicaid among them ^[13]. A family in her position faces a five-year wait on the green-card route, and using benefits in the meantime could cost them the card ^[13].

Steven Camarota, research director at the Center for Immigration Studies, a conservative think tank that favors reducing immigration, said the administration "is trying to nibble around the edges" with the Oct. 1 cuts ^[11]. He would screen legal immigrants for income potential and education before they cross the border ^[17]. "You need immigrants who are unlikely to need welfare," he said ^[12]. The Oct. 1 cut works on people who have already immigrated legally ^[1].

White House spokesperson Lauren Bis said in a statement that "immigrants must be able to support themselves without taking from overburdened benefits programs paid for by hard-working American taxpayers" ^[6]. D'Avanzo, whose group has pursued litigation against the administration over its immigration agenda ^[18], said: "This is about telling every immigrant in the United States that they are not welcome here and that they should leave" ^[5].

The cost can land in a few places. If most of the people dropped find job-based or private coverage, the shift to providers stays small. If they go uninsured, as the advocates expect ^[21], hospitals take on the sickest cases at prices on the order of the Chacons' $300,000 a year ^[19]. Lawsuits could also restore some coverage ^[18]. We think the uninsured route carries most of the dollars even if it is not the most common outcome. Patients who cannot be moved, like Jesus Chacon, are the ones whose care costs most. That view is wrong if emergency-room and charity-care spending in states with large refugee and asylum populations stays flat after the law's next Medicaid changes take effect.