Thousands of immigrants living legally in the United States lost access to Medicaid, a public health program aimed mainly at the low-income population, after new rules from the Donald Trump administration came into force on October 1.
Those affected include refugees, asylum seekers and victims of human trafficking and domestic violence. Many work, pay taxes and depend on the program to pay for consultations, medicines and medical treatments.
It is estimated that more than 281,000 immigrants from nine American states and the District of Columbia will lose coverage, according to KFF, a health research organization. In Arizona alone, 29,000 people were excluded from the program earlier this month. In Florida, the forecast is for approximately 177,000 affected.
The measure is part of a broader reform approved in 2025, which foresees billion-dollar cuts in Medicaid and changes to the criteria for receiving the benefit.
According to the Congressional Budget Office (CBO), the set of changes could leave 7.5 million people without health insurance by 2034. This number includes American citizens affected by other restrictions, in addition to immigrants.
The government defends the changes as a way to reduce public spending and combat irregularities in the program. Immigrant advocacy organizations warn that loss of coverage could interrupt treatments and increase the demand for emergency care.
In Tucson, Arizona, María Chacon does not know how she will continue to pay for the treatment of her son, Jesus, who depends on a respirator to survive.
Almost five years ago, the young man was involved in a car accident, aged 17, which left him unable to breathe on his own. Since then, he has needed mechanical ventilation, tube feeding and daily medication. It also requires permanent care to avoid wounds caused by prolonged time in the same position.
The family, originally from Mexico, entered the United States legally in 2018, with a visa granted to victims of human trafficking.
Until the beginning of this month, Medicaid covered about US$25,000 a month in Jesus' medical expenses, including a small financial compensation for María and her husband, who were responsible for their son's care.
With the change in rules, the family lost coverage.
The medicines used by Jesus alone cost approximately US$7,000 per month. Available stock is expected to end in mid-October.
"Since that day, I haven't been able to sleep. We haven't been able to eat. We keep asking ourselves what we are going to do," María told the Associated Press.
She is trying to appeal the decision to state authorities and is in the process of obtaining a green card, a document that grants permanent residence in the United States.
María states that she is unable to return to Mexico because her son's health condition prevents the trip.
Medicaid is jointly funded by the federal government and US states. The program provides medical coverage primarily to low-income people, including children, pregnant women, the elderly and people with disabilities who meet eligibility criteria.
Before the changes, certain categories of immigrants with regular immigration status could receive the benefit, as long as they met the required requirements.
Since October 1st, federal legislation has started to restrict coverage to specific groups, including: immigrants with green cards, subject to other eligibility rules; certain immigrants from Cuba and Haiti; citizens of countries that maintain specific free association agreements with the United States; children and pregnant women legally living in the country, in states that offer coverage to these groups.
Refugees and people who have been granted asylum but do not yet have a green card are among the groups who are no longer eligible for federal coverage.
Having a green card, however, does not guarantee immediate access to Medicaid. In many cases, there is a five-year waiting period, although there are exceptions provided for in legislation.
According to Ben D'Avanzo, senior strategist at the National Immigration Law Center, an organization that works to defend the rights of immigrants, some beneficiaries may only discover that they have lost coverage when they seek medical care.
In response to the criticism, White House spokeswoman Lauren Bis stated that immigrants must be able to support themselves without depending on assistance programs financed by American taxpayers.
Steven Camarota, research director at the Center for Immigration Studies, an organization in favor of more restrictive immigration policies, also defended stricter criteria for immigrants to enter the country. According to him, the government should consider factors such as education and income potential to reduce dependence on public benefits.
Restrictions on immigrants are just one part of the changes planned for Medicaid. Legislation signed into law by Trump in July 2025 also establishes new requirements for certain beneficiaries, including work-related rules and more frequent eligibility checks.
Many of these changes are expected to take effect in 2027.
According to KFF, the reform is expected to reduce federal spending on Medicaid by approximately $911 billion over ten years.
The CBO estimates that by 2034, 7.5 million more people will be without health insurance as a result of changes to the program.
Health organizations warn that reducing coverage could have effects that go beyond the patients directly affected.
Unable to pay for consultations and medication, part of the population may postpone the diagnosis and treatment of illnesses, seeking assistance only when symptoms worsen.
For Carmen Feliciano, vice president of policy and defense at UnidosUS, a Latino civil rights organization, this could increase costs for the states themselves.
She explains that problems that could be treated early in primary care end up requiring more complex and expensive care in emergency rooms.
UnidosUS works with community organizations to expand access to medical assistance, but, according to Carmen, these institutions are already facing difficulties in meeting current demand.
"We won't have the capacity to serve all the people who need it," he said.
