A sweeping federal budget measure has begun stripping Medicaid coverage from legally present immigrants across the United States, leaving refugees and their families scrambling to understand how they will access medical care. The change, which took effect October 1, stems from H.R. 1, the Republican-backed spending package signed into law last summer. The law ends Medicaid eligibility for many immigrants who previously qualified, including refugees, asylees, and others with lawful status.
Mustafa Rfat, an assistant professor of social work at the University of Nebraska at Omaha, has spent the past two weeks fielding distressed calls from refugee families. His research centers on refugees living with disabilities—a subject he understands on a personal level. Rfat described parents who are terrified that their children will lose access to essential treatments and medications.
He recounted one example of a father who is himself a refugee with disabilities and who has two children with disabilities. The man is overwhelmed by uncertainty, unable to determine how he will obtain the medications his family depends on. Rfat said the calls he has received convey a sense of sheer panic among some of the most vulnerable people resettled in the country.
Rfat's expertise is not merely academic. He arrived in the United States as a refugee from Iraq in 2011, and at that time a chronic spinal condition had left him in severe pain. He recalled being unable to walk, going without his medications for an extended period, and having no access to a doctor. He described that period as deeply difficult and vulnerable. Medicaid, he said, served as a lifeline that allowed him to stabilize his health and eventually build a life in his new country.
The expiration of coverage for refugees is tied directly to H.R. 1, the Trump administration's signature budget legislation that Republicans in Congress passed. The bill's provisions ended Medicaid eligibility for a broad category of immigrants who are in the country legally. Refugees, who typically arrive after fleeing war, persecution, or natural disaster, had previously been automatically eligible for the program upon arrival.
Advocates and researchers note that Medicaid is often the only bridge to health care for newly resettled refugees. Many arrive with untreated chronic illnesses, disabilities, or injuries sustained during conflict. The program covers doctor visits, prescription medications, hospital care, and long-term services that refugee families may not be able to afford otherwise.
The loss of coverage is likely to have ripple effects beyond individual patients. Community health centers that serve refugee populations may see a surge in uncompensated care. State and local health systems could absorb rising costs as families turn to emergency rooms for routine treatment. And public health experts warn that untreated conditions can worsen and become far more expensive to manage later.
For families with disabilities, the stakes are especially high. Children with conditions such as cerebral palsy, epilepsy, or developmental disabilities often require continuous therapies, specialized equipment, and regular monitoring. Interruptions in care can lead to preventable hospitalizations, developmental setbacks, and long-term declines in health and functioning.
Rfat's research has focused on the intersection of disability and forced migration, examining how resettled families navigate complex health and social service systems. He explained that refugees with disabilities face layered barriers that include language differences, unfamiliarity with American institutions, transportation challenges, and limited financial resources. Removing Medicaid, he suggested, intensifies those obstacles and pushes families toward crisis.
The father Rfat described in his phone calls is a case study in that dynamic. A person with disabilities himself, the man must now try to secure medications for two children with disabilities without the coverage that previously made treatment possible. Rfat said the family is confused about what options remain and where to turn for help.
The change coincides with an ongoing national debate over immigration policy and the scope of public benefits. Supporters of the budget law argue that it restores fiscal discipline and prioritizes resources for citizens. Critics contend that ending coverage for legally present immigrants, particularly refugees, contradicts the country's humanitarian commitments and creates preventable public health risks.
For Rfat, the policy carries a particular sting. He credits Medicaid with helping him recover from the severe spinal condition that afflicted him when he first arrived. That support, he said, allowed him to pursue an education and ultimately a career dedicated to helping others in similar circumstances. Now he finds himself supporting families who are losing the same assistance that once made his own recovery possible.
He noted that the families calling him are not asking for special treatment. They are seeking basic medical care for themselves and their children. He said the uncertainty alone—not knowing whether a prescription can be filled or a therapy session attended—is causing significant psychological strain on parents already coping with the trauma of displacement.
The effects are expected to unfold over the coming months as coverage terminations are processed and families attempt to find alternatives. Some may qualify for other programs, while others could remain uninsured. Legal aid organizations and refugee resettlement agencies are reportedly working to inform affected communities about their rights and options, though many questions remain unanswered.
Rfat described the situation in blunt terms, calling it a nightmare for the people he studies and serves. He said the families he speaks with feel abandoned and afraid, and that their children's health hangs in the balance. Without intervention or a change in policy, he warned, many will go without the medical care they need.
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