Starting Oct. 1, refugees across the country lost access to Medicaid, a change that researchers and advocates say is hitting some of the newest and most vulnerable members of the U.S. population. The coverage change stems from H.R. 1, the Trump administration's sweeping budget bill that Republicans passed last summer, which restricts health coverage for many people who are in the United States legally.
Mustafa Rfat knows the policy change intimately, because he has lived it. A professor of social work at the University of Nebraska at Omaha, his research centers on refugees with disabilities — a topic that is personal for him, not merely academic.
Rfat arrived in the United States as a refugee from Iraq in 2011, and by the time he got here, the chronic condition affecting his spine was debilitating. He recalls being in what he describes as a very bad situation: unable to walk, in significant pain, and without reliable access to medication or a doctor. For a long stretch, he went without his prescriptions and without seeing a physician.
"That was a very difficult and vulnerable period," he said. Medicaid, he has said, became a lifeline during that time — the coverage that connected a newly arrived refugee with the medications and medical appointments his body required.
Now, as the federal policy change takes effect, Rfat says he has spent the past two weeks fielding frantic calls from refugees with disabilities who are trying to understand what the loss of coverage means for them and their families. He described many of them as terrified by the prospect of their children losing health insurance.
One case stayed with him: a father who is a refugee and lives with disabilities, whose two children also have disabilities and depend on medication. The father, Rfat said, is simply confused about how he is going to obtain the drugs his kids need now that the coverage that paid for them has ended.
That single example captures a broader pattern disability advocates say is playing out in communities nationwide. Families who arrived abroad fleeing persecution or conflict often arrive with untreated or undertreated health conditions, and many of them end up in the United States with a complicated mix of chronic illness, injuries and rehabilitation needs. Removing their coverage, advocates argue, does not simply add inconvenience; it removes access to the medications, specialist visits and therapy that keep those conditions from worsening.
The people most exposed are also among the least equipped to navigate the paperwork that replaces coverage. New arrivals frequently face language barriers, unfamiliarity with U.S. medical systems and limited knowledge of where to turn when a prescription runs out. The role of medical interpreters at clinics serving refugee communities — work that can be as routine as helping someone book a doctor's appointment — becomes even more consequential when insurance no longer covers the visit.
Photo captions from NPR's reporting illustrate that on-the-ground reality: at the Valley Health Center TB/Refugee Program in San Jose, California, Mohammad Attaie and his wife, Deena, newly arrived from Afghanistan, worked with medical translator Jahannaz Afshar to make a doctor's appointment in December 2021. Scenes like that — an interpreter bridging the gap between a refugee family and a clinic — are exactly what Medicaid enrollment typically supports, and what many families say they can no longer count on.
The timing is what makes the change so abrupt. The budget bill was passed last summer, but the coverage losses do not phase in gradually; they arrive with the start of the fiscal year. For families whose health needs are immediate and continuous, there is no transition period, no grandfathering and no automatic bridge to alternative coverage in many cases. Medication refills and specialist appointments that had been scheduled simply become expenses the household has to absorb or forgo.
Rfat, whose own turnaround depended on receiving care after years without it, is now trying to help other refugees navigate a system that, until recently, offered them a floor. He says the burden on individual researchers, social workers and clinic staff is rising as more families come looking for help finding alternatives to coverage that has been withdrawn.
The broader implications extend beyond individual medical crises. Clinics and public health agencies that serve refugee populations may see more uncompensated care, more delayed treatment and more avoidable complications as conditions that were being managed go unmanaged. Public health researchers have long warned that gaps in coverage for newly arrived families produce higher costs later, when problems that could have been treated cheaply become emergencies.
For Rfat, the policy debate is abstract; the phone calls are not. He says the people calling him describe a system that has suddenly stopped working for them, and that many are frightened by what comes next.
"I call it a nightmare," he said. "These are families who came here already vulnerable, and now the one piece of support many of them relied on is disappearing."
The Oct. 1 changes represent one of the most immediate consequences of H.R. 1 for millions of legally present immigrants, including refugees and other newly arrived people. Advocates are urging officials to consider the effect on medically vulnerable populations as the debate over the law's implementation continues.
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