Refugees disqualified from Medicaid, Medicare in Big Beautiful Bill

As the One Big Beautiful Bill ricocheted from proposal to signed law by President Donald Trump, Minnesota immigration advocates kept a close eye on how the giant measure would expand detention and deportation programs.

In the end, the bill did indeed siphon billions of dollars toward immigration law enforcement. But the One Big Beautiful Bill also enacts something else on immigration, a measure that has caught advocates and also Minnesota health care officials off guard.

The bill stipulates that refugees and those granted asylum status can no longer access Medicaid. These immigrants also can no longer get Medicare. And they cannot get a tax credit for joining a private health care plan, or qualify for the Children’s Health Insurance Program (CHIP). These measures go into effect in October 2026.

“The legislation eliminates eligibility for many categories of lawful immigrants, reducing their access to affordable health care,” John Connolly, Minnesota’s state Medicaid director at the Department of Human Services, said on a call with reporters this week.

Connolly said that he is not sure how many Minnesotans will be impacted. Nor do immigration and health care policy experts interviewed, who pointed out that the affected population is already in a legally precarious spot, not allowed to travel outside the country or vote among other limitations.

“We are trying to figure out what this means and then how to communicate this information,” said Julia Decker, policy director at the Immigrant Law Center of Minnesota.

Minnesota has been a hub for refugees from Cambodia, Somalia, Ethiopia, Sudan, Myanmar, and other countries. In the 2020s, a few thousand refugees arrived in the state from war ravaged Ukraine and Afghanistan.

“The whole point of refugee and asylum status is that when people are displaced by war and conflict there is a mechanism for them to live somewhere else,” Decker said.

If it works out, refugees and asylees can find a safe place to live and apply for a green card. But if it doesn’t work, Decker said, such immigrants are subject to laws unfavorable to them that they may not understand.

Here is what we know now about changes in health care assistance for asylees, refugees and other specific categories of immigrants.

What was the law on health assistance for refugees pre-Big Beautiful Bill?

Back in 1996, President Bill Clinton fulfilled his campaign promise to “end welfare as we know it,” by signing into law the Personal Responsibility and Work Opportunity Act, which reset the rules around federally funded public assistance.

Among its array of provisions, the welfare reform law clarified who can apply for Medicaid and Medicare.

Eligibility included U.S. citizens as well as legalized permanent residents, in other words, people with a green card.

Also eligible are individuals granted asylum by a federal immigration judge, as well as immigrants granted refugee status by the United Nations High Commissioner for Refugees.

The 1996 law also notes other legal subcategories of immigrants – many of which are victims of specific traumas – who can access Medicare and Medicaid.

Inclusive here are women who secured citizenship through marriage but then fled an abusive relationship. Also eligible are victims of human trafficking who have been given a temporary visa.

Subsequent laws, including the 1997 Children’s Health Insurance Program and the 2010 Affordable Care Act, copied and pasted the welfare reform measure’s language on eligibility.

To be clear, all this legislation does not automatically give immigrants money toward health coverage. It just lets them apply like everyone else.

“Under current law, everyone must apply for Medicaid and CHIP and meet all eligibility requirements including income,” explained Shelby Gonzales, vice president of immigration policy at the Center on Budget and Policy Priorities. “And people must have their citizenship or immigration status verified.”

What is the law now?

The Big Beautiful Bill keeps Medicaid, Medicare, CHIP and health care tax credit eligibility for all U.S. Citizens and green card holders.

It also retains eligibility for immigrants from Cuba and Haiti. People from the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau also can still apply (These are self-governing states that are sites for U.S. military bases.)

Each of the other immigration categories you just read about – asylees, refugees, people who escaped domestic violence, those fleeing trafficking – can no longer get federally funded health care assistance beginning next October.

You keep saying federally funded. Where does the Minnesota government fit in?

The costs to enroll most Minnesotans in Medicaid are basically split 50/50 between the state and federal government.

Connolly, the state Medicaid director, said that in total the Big Beautiful Bill will cost the state $1.1 billion in federal dollars and means the eventual loss of health care coverage for 140,000 people.

“The Medicaid reductions in federal funding and new eligibility requirements will be a dramatic change for Minnesota,” Connolly said. “It will impact health care providers and the people who count on them to stay healthy.”

Do we know how many of those 140,000 people are the refugees and asylees we’re discussing?

Not really, no.

Connolly would only say that the majority of the 140,000 people losing Medicaid will be childless adults of working age who fail to comply with new work requirements (A population not necessarily exclusive of the immigrants we are discussing.)

And no one at the Department of Human Services could readily track the immigration status of its Medicaid recipients.

“It is a tough number to get a handle on,” Decker said. There are plenty of figures about how many refugees or asylum grantees enter the state, but not on how many stay here, she said.

National estimates are also hard to come by.

The Congressional Budget Office, which publishes independent analyses on legislation, estimated that these new restrictions will save $6.2 billion in health care costs. But CBO did not spell out who might lose their health coverage specifically due to immigration status.

Groups like the National Immigrant Law Center and Global Refuge say they have no data on this particular issue. Nor does KFF, a nonprofit that can typically supply whatever health care numbers one desires.

Drishti Pillai, associate director of the Racial Equity and Health Policy Program at KFF, said that she has been repeatedly stymied in efforts to secure this information from the federal Centers of Medicare and Medicaid Services (CMS), which runs Medicare and Medicaid.

Questions MinnPost sent CMS were not answered by the end of day Wednesday.

Before you go, wasn’t health coverage for immigrants a huge deal in the Minnesota Legislature? Does that have anything at all to do with this?

The debate back in the spring that divided DFLers and sent lawmakers careening into a special session was about whether undocumented immigrants can use MinnesotaCare, an entirely state funded health care subsidy program.

The outcome was that adult undocumented immigrants can no longer apply for MinnesotaCare, but children can.

Long before the political rise of Trump and the Big Beautiful Bill, undocumented immigrants were (and remain) ineligible for federal health care assistance.

That all said, the new restrictions will, down the line, pose a major decision for the Minnesota Legislature and Department of Human Services about (again) expanding MinnesotaCare. Should the state make up for erased federal money and help fund health care for refugees and similarly classified immigrants?

A Department of Human Services spokesperson said that, “Work is underway to understand how many people may be eligible for MinnesotaCare, or insurance affordability programs, such as premium tax credits through MNsure,” the state’s health care marketplace.

Refugees disqualified from Medicaid, Medicare in Big Beautiful Bill

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