About 8,000 lawfully present Pennsylvania immigrants face Medicaid health insurance terminations on Oct. 1

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A man who sustained serious injuries while aiding the U.S. military in his home country of Afghanistan; a math professor and his doctor wife from Algeria, who sought better support for their child with autism; a young refugee family fleeing the conflicts of political strife and war in their native land: These are just some of the lawfully present immigrants living in Philadelphia who will lose federal Medicaid health insurance on Thursday, according to local organizations that work closely with refugees, asylees and others.

Many ask the same question, said Christa Loffelman, director of health and social services at the Southeast Asian Mutual Assistance Association Coalition, one of the city's largest refugee aid organizations.

"Why? I don't understand why," Loffelman said clients ask her. "And then it's really hard to explain to them the political will that made this law go into effect, all this upheaval throughout the entire country."

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An estimated 8,000 immigrants across Pennsylvania are at risk of becoming uninsured because of new federal rules passed by Congress and President Donald Trump last year in H.R. 1, also known as the "One Big Beautiful Bill."

This group of Medicaid participants represents a small percentage of all residents who get their insurance through the program, which is typically paid for by both the federal government and states. But legal aid experts and immigration advocates say the new cuts could have a devastating impact on vulnerable people and families.

"Losing access to Medicaid … it puts their life in danger. It's huge," Maripat Pileggi, supervising attorney at Community Legal Services of Philadelphia, said of the impact. "And through absolutely no fault of their own. These are folks who have done absolutely everything right. It's really devastating to get these phone calls."

Legal support organizations are encouraging people to file appeals before Oct. 1 to retain coverage while caseworkers and attorneys determine whether they still qualify for some version of Medicaid insurance, either at the federal or state level.

Which immigrants qualify for federal Medicaid after Oct. 1?

Many immigrants with low incomes have, historically, been eligible for federally funded Medicaid benefits, including refugees, asylum seekers, humanitarian parolees, victims of domestic violence or trafficking and others granted conditional entry to the country.

"These are folks who've fled persecution and horrendous situations abroad, went through years and years of vetting outside of the U.S. before they were allowed to enter," Pileggi said.

But starting Oct. 1, federal Medicaid will be restricted to three main groups: green card holders who are exempt from the five-year wait period for federal public benefits, Cuban or Haitian entrants, and Compact of Free Association migrants.

Children, as well as women who are currently pregnant or within a 12-month postpartum period, will also keep federal insurance coverage.

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Immigrants who receive Social Security Income from the federal government will also keep health insurance, but their care will be covered and paid for by Pennsylvania's Medicaid program without matching federal funds.

All other immigrant adults 21 and older will no longer be eligible under the new federal policy. Federal Medicaid may still cover limited health care services provided in life-saving emergencies.

Appeals and state-based health insurance options for immigrants

Immigrants can appeal Medicaid terminations through the state Department of Human Services' County Assistance Offices, especially if their immigration status on file is out of date or if they potentially qualify for Pennsylvania's state-funded Medicaid program.

People who lose federal insurance benefits could qualify for state-only Medicaid if they meet certain income and asset limits.

They also need to fall into at least one of the following eligibility categories: parents of children under 21, people 59 and older, people who have a disability or need "health sustaining medications," a caregiver of young children or household members who are disabled or ill, people in addiction treatment, victims of domestic violence who are receiving protective services, and people who work at least 100 hours a month at minimum wage.

Eligibility for the state program is much broader than the federal one, so people shouldn't wait to file an appeal, Pileggi said, even if they don't know for certain it will get approved.

"Most of the time, an appeal has merit," she said.

People who submit appeals postmarked before or on Oct. 1 can keep their current federal Medicaid health insurance while their case is reviewed, which is the ideal scenario, Pileggi said.

But there will still be people who miss that deadline, said Kyle Fisher, managing attorney at the Pennsylvania Health Law Project, who expects many immigrants will have some lapse in coverage.

People may also hesitate because they don't understand the complex eligibility and documentation requirements for both the appeal and for state-funded Medicaid reviews, including income limits, he said.

"No one's figuring that out without help from legal aid, right?" Fisher asked.

DHS officials said they will review everyone affected by the federal changes to see if they qualify for state-funded Medicaid, but legal experts said the decisions won't be immediate.

Impact of federal Medicaid limits on local families

Program leaders and caseworkers at the Southeast Asian Mutual Assistance Association Coalition said they anticipate demand for social services and support in immigrant communities will rise as federal changes leave families with fewer resources.

Teams there have held workshops, education classes and webinars about upcoming changes to Medicaid and other programs for over a year to best prepare clients.

But the changes are undoing years of progress in helping refugees and immigrants overcome barriers and find stable footing in Philadelphia with the help of public programs like Medicaid, said Thoai Nguyen, CEO of the coalition.

"These people are not here for a handout. They're willing to work to their bone to support themselves, but they're not always given the opportunity to make gainful employment," he said. "So, that's why they're in these situations. Most of them are very embarrassed that they have to use public benefits at all because they have such pride in who they are."

Notifying families that they will likely lose Medicaid coverage has been heartbreaking, said Tammy Lam, coalition community resources coordinator.

She's been working with a refugee family who came to the U.S. from Algeria, where the father was a math professor and the mother a doctor. One of their children has autism and needs full-time care.

The father now drives for a ride-share company and the mother stays home to care for their children. Lam helped the family get Medicaid insurance, but she recently had to tell the father that he and his wife would likely lose federal coverage.

They cried together, Lam said.

"He looked at me, and he was like, 'But why?' He was like, 'Why did I even come here? I did everything right. I'm just asking just for medical care because I get sick often; my kid needs help,'" she said. "It was very defeating."

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