A sweeping change to federal health policy has begun stripping Medicaid coverage from legally present immigrants across the United States, leaving refugees and their advocates scrambling to understand the consequences. As of October 1, many immigrants who are in the country legally are no longer eligible for the government health insurance program that has long served as a critical safety net for newly arrived populations. The change stems from H.R. 1, the Republican budget bill passed last summer during the Trump administration.
The impact has been immediate and deeply personal for Mustafa Rfat, a professor of social work at the University of Nebraska at Omaha whose research focuses on refugees with disabilities. In recent weeks, Rfat said, his phone has been flooded with frantic calls from refugees who are losing their health coverage and do not know where to turn.
"I spent these past two weeks just talking with so many of them, literally just terrorized by the reality that their children with disabilities are losing coverage," Rfat said. He described one case involving a father who is himself a refugee with disabilities and who has two children with disabilities. The man, Rfat said, is confused about how he will obtain medication for his family.
Rfat's connection to the issue is not merely academic. He arrived in the United States as a refugee from Iraq in 2011, and at that time the chronic condition affecting his spine was severe. Speaking about his early days in the country, he recalled being unable to walk and enduring constant pain. He went without his medications for an extended period and did not see a doctor. He described that chapter of his life as an extremely difficult and vulnerable situation.
Medicaid, Rfat said, served as a lifeline during that period. The program provided him with access to medical care when he had few other options, and it helped stabilize his health as he adjusted to life in a new country. Now, he spends his time trying to assist refugees with disabilities who are confronting the challenge of navigating life in the United States without that same support.
The policy change is broad in scope. Starting October 1, refugees across the country are losing access to Medicaid under the provisions of H.R. 1. The bill, a major budget package, was passed by Republicans last summer and signed into law by President Trump. Its Medicaid restrictions represent one of the most significant shifts in immigrant health policy in recent years.
For refugees with disabilities, the stakes are especially high. Many depend on consistent access to medication, specialized care, and ongoing treatment for chronic conditions. Without insurance, advocates warn, these individuals may be forced to skip medications, forgo doctor visits, and rely on emergency rooms for care that could have been managed through routine treatment.
Rfat's research at the University of Nebraska at Omaha has focused specifically on this population, examining the unique barriers that refugees with disabilities face as they rebuild their lives. His work has given him insight into how policy decisions ripple through families, particularly those in which multiple members have disabling conditions. The calls he has received in recent weeks reflect that reality, with parents expressing fear and confusion about how they will manage their children's health needs.
The loss of coverage also raises questions about what alternatives, if any, will be available to those affected. Refugees who lose Medicaid may find themselves uninsured or underinsured, depending on their employment situation and whether they qualify for other programs. For those with disabilities, however, the options are often limited, and the transition can be abrupt.
The broader context of the policy shift is a long-running debate over immigration and public benefits. Supporters of the budget bill have argued that restricting Medicaid eligibility for certain immigrants is a matter of fiscal responsibility and that the program should prioritize those with longstanding ties to the country. Critics, including health advocates and social work professionals, contend that the change punishes vulnerable people who entered the country through legal channels and who often have no other path to care.
For Rfat, the situation is a painful echo of his own early experience. He knows what it means to go without medication and to live with untreated pain. He also knows how much difference consistent care can make. That is why he has spent recent weeks on the phone, listening to refugees describe their fears and trying to help them understand what comes next.
The coming months will determine how many people are affected and how they respond. Community organizations, health centers, and social service agencies are likely to see increased demand for assistance as refugees seek alternatives to Medicaid. Whether those alternatives exist in sufficient supply remains an open question.
What is clear is that the change has created uncertainty and anxiety for some of the country's most vulnerable residents, including children with disabilities whose care now hangs in the balance. For families already navigating the challenges of resettlement, the loss of health coverage adds another layer of instability.
Rfat continues to take calls and to advocate for the people he studies and once stood among. "It's a nightmare," he said, describing the current moment for refugees with disabilities. For him and for the families he speaks with, the policy is not an abstraction. It is a daily reality that affects whether a child receives medication, whether a parent can manage a chronic condition, and whether a family can find stability in a new country.
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