Roughly 15,000 documented immigrants in New England will lose full Medicaid coverage on Thursday, the most recent in a series of deep purges mandated by Congress’s Big, Beautiful Bill.
The people affected by the health insurance restrictions include refugees, asylum holders, and some groups of parolees and victims of human trafficking who do not yet hold green cards but may be eligible. Many fled war zones.
In Massachusetts, an estimated 7,300 people are expected to lose their benefits through MassHealth Standard. More than 8,000 in Connecticut, Maine, New Hampshire, Rhode Island, and Vermont are also expected to lose comprehensive coverage, officials in those states said.
This round of Medicaid expulsions is just a precursor. By 2034, changes to the Affordable Care Act and Medicaid restrictions, including work requirements and more frequent eligibility checks that go into effect in January, are expected to reduce the number of insured people in Massachusetts by somewhere between 200,000 and 300,000 by 2034. Hospitals and community health centers expect to see their revenue from Medicaid decline as their count of uninsured patients surges.
“All hospitals, especially those that are heavily reliant on Medicaid, are going to be threatened,” said Daniel McHale, a senior vice president with the Massachusetts Health and Hospital Association.
Pregnant and postpartum mothers and anyone under 21 are exempt from the restrictions. In Massachusetts, most people 65 and over and those with disabilities will have access to MassHealth Family Assistance, which also provides comprehensive coverage. All other healthy adults can get plans covering emergency-related care, but not services including primary care, most prescriptions, dental and vision care, or long-term care, such as home care.
They may benefit from the health safety net, a state fund that reimburses medically necessary care at hospitals and community health centers.
The Centers for Medicare & Medicaid Services did not answer questions about the reduced eligibility for immigrants, saying only that new standards protect taxpayers’ money and reduce the risk of abuse. Nationally, new Medicaid restrictions are expected to cut almost $1 trillion in spending through 2034. The restrictions specific to immigrants are expected to add 100,000 people to the ranks of the uninsured and save the federal government $6.2 billion by 2034, according to an analysis from the health news site KFF.
In Massachusetts, most refugees come from Afghanistan, the Democratic Republic of the Congo, Guatemala, Venezuela, and Syria as of fiscal year 2024, according to the American Immigration Council. Some of the newest parolees to arrive are from Ukraine.
“Here, every day I cannot sleep now, I cannot have normal life,” said one 55-year-old woman from Ukraine who now lives in a Boston suburb.
Despite having legal status in the country as a humanitarian parolee, she was afraid to identify herself for fear of federal authorities.
“Here, no stability,” she said outside her apartment, her arms held out in a plaintive gesture.
She fled Russia’s invasion of her country to the United States in 2022 with her daughter, then 12. Their city, Zaporizhzhia, is now being bombarded. Her father is still in Ukraine, as is her son, who serves in the Ukrainian military, she said.
The woman has faced depression since arriving in the United States. Last year, she suffered two micro-strokes that affected her memory and caused periods of light-headedness.
She recently lost her Medicaid coverage. She’s not sure why. Without the option to re-enroll, she will be without coverage that pays for antidepressants and quarterly visits with a neurologist.
She feels drained, she said, like a battery with no power left.
Under a different administration, many losing full Medicaid would have alternatives. Subsidized plans through the Affordable Care Act marketplace have become less accessible to immigrants, the Globe has reported, and more expensive for those who do qualify. Work authorization could allow people to get jobs that provide insurance. Green cards include eligibility for full Medicaid. The processing of both has stalled under the Trump administration, said Sarang Sekhavat, chief of staff at the Massachusetts Immigrant and Refugee Advocacy Coalition.
“You’re kind of in limbo,” said another Ukrainian parolee, a 37-year-old woman living in Boston.
She arrived in Boston in the summer of 2023, she said. She, too, was afraid being identified could draw unwanted attention.
Both Ukrainian women said they are waiting for the government to process annual work authorizations, which can cost around $500.
“You spend the money for those documents, then you are really not allowed even to work,” the 37-year-old said.
Immigrants have been further squeezed through more restricted access to SNAP and, for some groups, revocation of their temporary protected status.
While federal money cannot be used to cover Medicaid for this group of immigrants, the state could have dipped into its own coffers, said Andrew Cohen, lead attorney for the Access to Care and Coverage Practice at Health Law Advocates.
“Our state is not stepping up in the way that it really should to make sure these folks are really integrated into our communities,” he said.
Massachusetts is facing financial headwinds. MassHealth is already implementing cuts to existing programs, and the health safety net, the fund that covers costs for uninsured patients, faces shortfalls that have grown to roughly $200 million. MassHealth officials noted the state is losing $3.5 billion in health care funding per year due to federal policies.
“The state is not able to make up for all of this lost federal funding,” said Stacey Nee, a MassHealth spokesperson.
The consequences of this week’s cuts may not be felt immediately. Because the people slated to lose their eligibility are more likely to be healthy, many may not realize they’ve lost coverage until an unexpected bill shows up or they’re turned away from an appointment, Cohen said. For others, conditions that could be managed with routine care won’t get attention until they reach an acute stage, advocates said.
“This is going to make it much more difficult for people to survive,” Cohen said.
The health advocacy organization Health Care for All is attempting to communicate with immigrant groups about their coverage, but language barriers, cultural differences and the complexity of navigating MassHealth’s bureaucracy make outreach more difficult, said Hannah Frigand, Health Care for All’s senior director.
“We see some people who think their coverage will end and it doesn’t,” she said. “It’s kind of hard finding the right people who are affected.”
One refugee from the Democratic Republic of the Congo who asked to be identified as Jose (pronounced “Josie”), is losing MassHealth Standard but is eligible for MassHealth Family Assistance, which provides similar coverage.
Jose wasn’t sure why she qualified for a different plan, though she did note, without sharing details, that she may soon need surgery. She also didn’t know why she had to change plans.
“Maybe it’s because of the new president,” she said. “I don’t know.”
Jose, 23, was a teen when she left a nation embroiled in conflict.
“You can be sleeping, and you hear people running,” Jose recalled of her youth in DRC, when she would awaken to sounds of unrest. “You just run. You run for your life.”
Even when assistance workers explain American health insurance, she is often bewildered.
“You can feel bad because you don’t get them, you don’t understand what they are talking about,” Jose said.
The thousands losing coverage this week and through coming eligibility restrictions are likely to seek care through emergency departments or community health centers, which are mandated to provide treatment regardless of patients’ insurance status. For hospitals, caring for additional uninsured patients will come amid new restrictions on other sources of revenue.
The state’s community health centers could gain an additional 92,000 to 171,000 uninsured patients by 2034, according to one analysis from the National Association of Community Health Centers.
“I think this is just the tip of the iceberg for what’s coming in January,” said Shade Cronan, spokesperson for the Massachusetts League of Community Health Centers. “Health centers will have to make decisions about curtailing services and potentially closing sites.”
On Friday, Olga Yulikova, a Russian refugee who started the nonprofit Olga’s List three years ago to support Ukrainian refugees, visited the 55-year-old Ukrainian with a trunkful of dry goods, donations for the 1,000 immigrants her organization helps.
But that’s under threat now, too. On Wednesday, a $360,000 annual federal grant, 71 percent of her organization’s budget, expired.
“We’re going to have to cut significantly the services we’re currently offering,” she said.
Yulikova recalled coming to the United States in 1989 amid the Soviet Union’s collapse. “We were super welcome,” she said. “We had everything.”
As the Ukrainian woman talked about her situation, she became more upset. Yulikova tried to console her.
“I try to help other people, I have an open soul,” the woman said, “but yesterday, I start to die.”
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