Science1 publisher2 min readPublished
Nine states and D.C. expect more than 281,000 legal immigrants to lose Medicaid in October
Nine states and D.C. expect over 281,000 lawfully present immigrants, refugees and asylees among them, to lose Medicaid in October. CBO's estimate of 100,000 more uninsured by 2034 is a net figure for years out, so the gap depends on how many find other insurance.
The Scientist · Science desk
What happened
- Those losing eligibility include refugees, asylees, sex-trafficking victims and Afghan interpreters who aided U.S. troops, while green card holders keep their coverage.
- Florida alone identified nearly 177,000 immigrants who no longer qualify, after checking their status against government databases and mailing notices.
- The CBO published its estimates for noncitizens on Medicaid only a month after Congress passed the bill and the president signed it.
- People who lose coverage are likely to lose access to doctors and prescriptions, though Emergency Medicaid can still pay for emergency care.
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Why it matters
- exposure Immigrant rights advocates say some states did not mail notices until September, so enrollees flagged by mistake have little time to prove they still qualify before coverage ends.
- cost Outside emergencies, care Medicaid used to pay for becomes the patient's own bill, and Ahin said she could not pay one if she needed a hospital.
- precedent The October cut is the first of several for this group, with the CBO expecting about 1 million to lose eligibility under a further change in January.
The October count and the CBO estimate answer different questions. The state figure counts people whose Medicaid eligibility ends in a single month. It comes from agencies in nine states and the District of Columbia that answered KFF Health News [5]. The CBO figure is a net change measured years out: how many more immigrants will be uninsured by 2034 because the law ends Medicaid eligibility for many noncitizen adults with legal status [4]. Covering only part of the country, the state tally is already 2.8 times the national estimate [1]. The CBO declined to comment [7].
Most of that tally comes from one state. Florida's count is about 63% of the total [2]. Add Arizona's nearly 28,000, North Carolina's about 29,000, Washington's 11,000 and New Jersey's range of 15,000 to 25,000 [9], and five states account for roughly 260,000 to 270,000 [3]. These are projections. Final numbers on how many enrollees were actually terminated will not be available until later this fall [10].
How many of those people end up uninsured depends on how many find other coverage. The KFF Health News report accepts that some may, and still concludes that the state numbers put hundreds of thousands of immigrants nationally at imminent risk of becoming uninsured [6]. Some of the other options are being cut too. The law strips many more immigrants of Affordable Care Act plan subsidies and Medicare coverage next year [18]. The report does not estimate how much unpaid care the lost coverage will leave with hospitals and clinics.
Ahin left war-torn Syria in 2011 and reached the U.S. in October 2024 as a refugee [14]. Medicaid paid for her intestinal surgery and her follow-up visits to specialists [15]. "I came here to live a better life," she said [14]. "I'm really worried about this," she said. "It's truly a terrible situation." [15]
Lawfully present immigrants are among the first to lose coverage under the law [2]. In the CBO's accounting they are a small share of its effect. The agency expects Medicaid work requirements starting in January to add about 5 million uninsured Americans by 2034 [12], fifty times its immigrant figure [4]. The law as a whole is expected to cut Medicaid spending by more than $900 billion through 2034 [1].
What to watch
- Final state counts of terminated enrollees, due later this fall, set against the projected 281,000.
- Whether the CBO revises or explains its 100,000 figure once state termination data exist.
- How many October enrollees find other coverage before ACA subsidy and Medicare losses for immigrants take effect next year.