A federal policy change that took effect on October 1 has begun stripping Medicaid coverage from legally present immigrants across the United States, triggering panic among some of the country's most vulnerable newcomers and the advocates who work with them. The shift stems from H.R. 1, the sweeping budget legislation that Republicans in Congress passed and President Trump signed last summer. While the bill covered a wide range of fiscal priorities, one of its most consequential effects is the rollback of health coverage for refugees and other immigrants who previously qualified for the joint federal-state insurance program for low-income Americans.
Mustafa Rfat, a professor of social work at the University of Nebraska at Omaha, has spent the past two weeks fielding desperate calls from refugees with disabilities who are suddenly confronting the loss of their medical benefits. He described families consumed by fear as they try to figure out how to keep themselves and their children healthy without insurance. One father he spoke with, himself a refugee living with a disability and raising two children who also have disabilities, was at a loss about where he would obtain essential medication for his family.
Rfat's concern is not abstract. His research centers on refugees with disabilities, and he understands their circumstances intimately because he has lived them. He arrived in the United States as a refugee from Iraq in 2011 while coping with a severe chronic spinal condition. At that time, he said, his health was in steep decline. Walking had become impossible for him, he was in constant pain, and he went without his medications for an extended period. He recalled not seeing a doctor at all during that stretch, describing it as an extraordinarily difficult and defenseless period of his life.
Medicaid, Rfat said, functioned as a lifeline during that dark chapter. It gave him access to the medical care and prescriptions he needed to stabilize his condition and rebuild his life in a new country. Now he watches a new generation of refugees confront the possibility of navigating serious health conditions with no coverage at all. The phone calls he receives, he said, come from people who are genuinely terrified by the reality that their children with disabilities are losing the care that has kept them well.
The changes are part of a broader push by the Trump administration and congressional Republicans to reshape public benefits and reduce federal spending. By narrowing eligibility for legally present immigrants, the legislation marks a significant departure from longstanding practice. Refugees have historically been treated differently from many other immigrant groups, receiving expedited access to safety-net programs as part of the country's commitment to resettling people fleeing war, persecution and upheaval.
That access translated into tangible health outcomes. Medicaid covered checkups, prescription drugs, mental health treatment and ongoing care for chronic conditions, services that resettlement experts say are essential during the difficult early years after arrival. Without them, refugees are more likely to rely on emergency rooms, postpone treatment until conditions become acute, and accumulate medical debt that can derail their efforts to become self-sufficient.
For refugees with disabilities, the stakes are even higher. Many require continuous medication, specialized equipment, therapy or personal assistance that cannot simply be paused. Interruptions in care can lead to rapid deterioration, hospitalizations and, in severe cases, life-threatening complications. Advocates warn that withdrawing coverage from this population could ultimately shift costs to hospitals, emergency services and state programs rather than genuinely saving public money.
The timing of the change compounds the anxiety. Newly arrived refugees often have limited English proficiency, little familiarity with American bureaucracies and few financial resources. Rfat described spending much of his recent time simply talking with families, trying to help them understand what losing coverage means and what, if any, alternatives remain. For many, he said, the options are unclear or nonexistent, leaving them to hope that charity care or community clinics can fill the gap.
Rfat's own journey illustrates both the vulnerability and the resilience at the heart of this debate. After arriving from Iraq, he depended on public health coverage to manage a spinal condition that had left him unable to walk and in chronic pain. With treatment, he was eventually able to pursue an education and build a professional career dedicated to studying the very population now losing its safety net. His story, he suggests, is evidence of what early intervention and consistent care can make possible.
Researchers who study refugee resettlement note that health coverage is closely tied to broader integration outcomes. When refugees can treat chronic conditions and manage disabilities, they are better positioned to learn English, hold jobs, send their children to school and contribute to their new communities. When coverage disappears, those trajectories often reverse, producing long-term costs for families and the public alike.
The policy also raises difficult questions about fairness and the nation's obligations. Refugees are admitted to the United States through a formal legal process and are typically expected to become self-supporting over time. Cutting their health benefits shortly after arrival, critics argue, undercuts that goal by removing the very support that helps people get healthy enough to work and stabilize their lives.
For families like the ones Rfat has been assisting, the practical effects are already materializing. Parents are rationing prescriptions, canceling appointments and postponing procedures. Some are weighing whether to forgo treatment entirely so that their children can continue receiving care. The emotional toll, Rfat said, is palpable in every conversation, with many callers expressing a sense of betrayal after being welcomed into the country and then having their support withdrawn.
Rfat continues to advocate for the refugees he studies and serves, arguing that the consequences of the policy will extend well beyond the individuals immediately affected. He said he hopes policymakers will consider the human dimension of the change, including the children with disabilities whose access to doctors and medicine now hangs in the balance. For him, the issue is personal as well as professional: he knows what it feels like to be sick, uninsured and uncertain about the future, and he does not want others to endure that experience in a country that once offered him refuge.
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