Thousands expected to lose public benefits due to federal immigrant coverage changes
Federal changes will take effect in the coming months that will bar many legally present immigrants from accessing Medicaid, Medicare and Affordable Care Act subsidies.
Lawfully present immigrants have traditionally been eligible for some type of public health insurance coverage. The tax-and-spending law signed by President Donald Trump last summer changed that.
“We are now pivoting to a time that we haven’t really seen for quite some time where people are losing their eligibility for coverage, even when they are lawfully present immigrants,” said Caroline Gómez-Tom, enrollment network and accessibility manager for Covering Wisconsin, the state’s health insurance navigator agency.
Starting Oct. 1, Medicaid coverage will be available for U.S. citizens and nationals, green card holders, Cuban-Haitian entrants and people from the Federated States of Micronesia, Republic of Marshall Islands or Republic of Palau who live and work in the U.S. under the Compacts of Free Association. In January, Medicare and ACA subsidies will only be available for those populations as well.
Adults who hold other statuses, like refugees, asylees and parolees, will no longer be eligible.
The Department of Health Services estimates that around 7,200 people in Wisconsin will lose eligibility for either Medicaid, food assistance — which has similar eligibility changes — or both programs.
Medicaid may still be available for those in a life-threatening emergency who are undocumented or not in a qualifying immigration status.
Those who are under age 19, who are under age 21 and in an institution or who are pregnant will continue to be eligible for Medicaid, although Gómez-Tom noted that they too may still lose coverage.
“This is something that we’ve seen over time,” she said. “When eligibility changes for adult parents, then their children are likely to lose coverage as well.”
The impact will be statewide.
“We have traditionally been a refugee-friendly state,” she said. “There are pockets across the state where we’ve settled people with refugee and asylee statuses, or they came here because they have family members that have already settled here.”
Gómez-Tom spoke to Wisconsin Health News this week about the changes.
Edited excerpts are below.
WHN: What coverage options are available for folks losing eligibility?
Gómez-Tom: Outside of employer coverage, because employer coverage will be an option if they have access to that, it will be Healthcare.gov at full cost, which we know is extremely expensive if you are of a lower-income level, or private health insurance options that are off Healthcare.gov, which are also expensive and are confusing. In many cases, there are these competing short-term plans, or even scam plans, that people are going to fall into because of their unease of paying exorbitant amounts of money to maintain their quality health insurance.
What we’re going to be looking at as health insurance navigators is navigating the other options that people may need to look to, which will be the federally qualified health centers and their sliding fee scales if someone is not able to maintain their health insurance.
We’ll also be looking at the health systems in our area to make sure that people know how to qualify for the charity care programs if they do need to seek service and care outside of being insured. And then we’ll look at some of the direct healthcare models, if there are options where people can get preventive healthcare where they’re paying out of pocket but it at least is manageable in comparison to trying to maintain the full cost of very expensive health insurance.
WHN: What is Covering Wisconsin doing to help?
Gómez-Tom: We are playing the role of messenger because with all of the changes that happened around this tax law (also known as the One Big Beautiful Bill Act), not a whole lot of people have been talking about these immigrant eligibility changes. It’s been very focused on the work changes, which are important and are impacting a lot of people. But once people understand how to submit their verification, they will not be losing health insurance. Whereas with immigrant eligibility, people are losing their health insurance.
We want to make sure that our partners, our community-based organizations and community members who are impacted by this or need to be aware of this understand what is happening. And then our navigators, especially as this transition happens starting in October — even now because people are starting to receive those notices and letters telling them that they may be impacted by these changes— will make sure that people know what they need to do now so they can get the care that they need.
In some cases, it may be that someone has a status that is eligible for maintaining their health insurance coverage, and they just need to inform the Medicaid office, Medicare or what have you that they now have that updated immigrant status and making sure that they can maintain that coverage.
In other circumstances where they know they’re going to lose it because of their current status, it’s making sure that they know what other options are available to them and that they can start engaging with those programs or entities, whether it’s a community health center, et cetera, to build that medical-home relationship.
WHN: What impact could this have on the healthcare safety net?
Gómez-Tom: We’ve seen an ongoing increase in the uninsured rate based on the chilling effect of the policies that are going to be in place over the next year or so. Our safety-net programs and our community health centers, which are required by law to serve everyone, are already in a harder place because their number of uninsured patients continues to grow.
That means the reimbursements that they get that allow them to help cover other people are going to be challenged. That also puts our health systems in a precarious place where they’re going to be covering more care without reimbursement from insurance. What tends to happen in that circumstance is that those costs get passed down to other patients. What we’re looking at is a recipe for more increased healthcare costs down the line for all of us.
This article first appeared in the Wisconsin Health News daily email newsletter. Sign up for your free trial here.