About 9,300 lawfully present immigrants in Illinois, including refugees, human trafficking survivors, and asylees without green cards, will lose their Medicaid coverage after Sept. 30 under federal law HR1, also known as the One Big Beautiful Bill Act. Signed into law by President Donald Trump in 2025, the legislation alters eligibility requirements for the federally and state-funded health insurance program. Teresita V. Morales learned of the policy change through an August letter delivered to her longtime partner, Euġen Cuťa, who requires round-the-clock nursing home care following a severe stroke more than 15 years ago.
Federal Medicaid Cuts Target Vulnerable Immigrants in Illinois
Morales said she panicked upon reading that Cuťa would lose benefits due to his “noncitizen status.” Cuťa, a Romanian immigrant and former plumber who got together with Morales about 25 years ago after he’d already been in the country for several years, is partially paralyzed and unable to speak. Morales, who is 66 and disabled, has been sorting through documents to address the cutoff. “At the end of the month, I don’t know what I’m going to do,” Morales said.
Who is Affected and Who Keeps Coverage Under HR1
The law establishes strict criteria for noncitizen eligibility. While refugees, asylees, and trafficking survivors with green cards may stay on Medicaid, those awaiting adjudication face termination. According to U.S. Citizenship and Immigration Services, refugees and asylees must wait a year before applying for green cards, and processing times can sometimes exceed a year and half. Edith Avila Hesser, health justice and policy director for the Illinois Coalition for Immigrant & Refugee Rights, described the situation as a complex case left to vulnerable individuals.
Certain groups remain exempt from the cuts, including lawfully present immigrants from Cuba, Haiti, Palau, the Marshall Islands, and Micronesia, alongside lawfully present children and pregnant individuals. In Illinois, over 40% of residents losing coverage reside in Cook County, and many speak Ukrainian, according to Cook County Health data.
Did you know? While refugees and asylees can apply for a green card after one year of residence, backlogs in the immigration adjudication system frequently extend the waiting period beyond a year and a half, leaving applicants without finalized status when policy changes take effect.
Healthcare Providers Warn of Disrupted Treatment
Medical professionals and legal advocates warn that terminating comprehensive insurance will cause severe health consequences for patients managing chronic illnesses. Andrea Kovach, a senior attorney at the Legal Council for Health Justice, noted that patients have depended on Medicaid for timely care, preventative screenings, and chronic condition management. Dr. Nimmi Rajagopal, associate chair of the Department of Family and Community Medicine at Cook County Health, reported widespread fear among patients who rely on Medicaid for essential prescriptions.
Advocates note that alternative options are limited. Patients can visit federally qualified health centers offering sliding-scale or free care, or utilize Refugee Medical Assistance, which lasts for eight months. Emergency Medicaid covers only acute medical crises rather than routine doctor visits or ongoing treatments. Dr. Rajagopal stated that Cook County Health will continue seeing patients without coverage, though available medications and treatments will be restricted.
Immigrant groups losing and keeping Medicaid coverage
Which immigrants are losing Medicaid coverage in Illinois?
Lawfully present refugees, asylees, and human trafficking survivors who do not yet hold green cards are slated to lose full Medicaid benefits after Sept. 30 under HR1.
Are any immigrant groups exempt from the Medicaid cuts?
Yes. Lawful permanent residents with green cards, Cuban and Haitian entrants, COFA migrants from Palau, the Marshall Islands, and Micronesia, as well as lawfully present children and pregnant individuals, retain their eligibility.
What healthcare options remain for individuals losing Medicaid?
Affected individuals may access care through federally qualified health centers, short-term Refugee Medical Assistance lasting eight months, or Emergency Medicaid restricted strictly to qualifying medical emergencies.
Why are refugees and asylees losing benefits if they have legal status?
While their status is legally recognized, federal law now requires green card possession for full Medicaid eligibility outside of specific exemptions, and processing delays often prevent applicants from securing green cards within the required timeline.
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