A sweeping federal budget measure has begun stripping Medicaid coverage from legally present refugees across the United States, leaving thousands of medically vulnerable people scrambling to understand how they will obtain care. As of October 1, the change took effect nationwide under H.R. 1, the major budget legislation Republicans passed last summer at the urging of the Trump administration.
The policy shift has triggered a wave of panic among refugee families, particularly those caring for children and adults with disabilities. Mustafa Rfat, a professor of social work at the University of Nebraska at Omaha, said his phone has been ringing constantly with desperate calls from people who suddenly face the loss of medical coverage for serious health conditions.
Rfat described two harrowing weeks spent speaking with refugees who are, in his words, terrorized by the reality that their disabled children will no longer have health insurance. He recounted the case of a father who himself lives with disabilities and is raising two children who also have disabilities. The man, Rfat said, is confused and frightened about something as basic as how he will secure medication for his family.
Rfat brings a rare combination of scholarly expertise and personal experience to the issue. His academic research focuses specifically on refugees living with disabilities, and he understands the stakes because he has lived through similar hardship himself. He arrived in the United States as a refugee from Iraq in 2011, at a time when the chronic spinal condition he suffers from had become severe.
Recalling that period, Rfat said he was in a very bad situation. He could not walk, he was in enormous pain, and he went without his medications for an extended stretch. He did not see a doctor during that time, a circumstance he described as a deeply difficult and vulnerable experience. Medicaid, he explained, served as a lifeline that allowed him to stabilize and eventually build a career helping others.
Now Rfat is trying to assist refugees with disabilities who must confront the challenges of daily life in America without that same support. He noted that many of the people calling him are not simply worried about routine checkups but about survival — access to prescriptions, ongoing treatment, and specialized care that keeps chronic conditions from becoming life-threatening.
The October 1 change stems from H.R. 1, the Republican budget bill that Congress approved last summer and President Trump signed into law. Although supporters framed the legislation primarily as a spending and tax measure, it included provisions that narrow Medicaid eligibility for certain lawfully present immigrants, including refugees who had previously qualified for coverage.
Under longstanding practice, refugees admitted to the United States have generally been eligible for Medicaid soon after arrival, recognizing that many flee persecution with few resources and significant untreated health needs. The new law alters that compact, effectively ending automatic coverage for a population that resettlement agencies describe as among the most medically fragile.
Advocates warn that the consequences will ripple well beyond individual households. When refugees lose insurance, they often delay care until conditions worsen, driving them toward emergency rooms — the most expensive point of entry into the health care system. Hospitals, community clinics, and local public health departments may absorb costs that were formerly covered by federal Medicaid dollars.
The impact is expected to be especially acute for people with disabilities, who frequently require continuous medication, durable medical equipment, physical therapy, and coordination among multiple specialists. A gap in coverage can quickly undo years of progress, leading to preventable hospitalizations and long-term deterioration in health.
Refugee-serving organizations say they are fielding a surge of questions from clients who do not know where to turn. Many families have limited English proficiency, little familiarity with state insurance marketplaces, and incomes too low to afford private plans. Navigating appeals or seeking charitable care can be overwhelming, particularly for parents already stretched thin caring for children with complex needs.
Rfat's research underscores that refugees with disabilities face layered barriers even in the best of circumstances — language access, cultural differences in understanding disability services, and transportation obstacles. Removing a stable source of health coverage, he argues, compounds those difficulties and places an unreasonable burden on families still rebuilding their lives.
The professor's own trajectory illustrates what is at stake. After arriving from Iraq in pain and without consistent medical care, he eventually received the treatment he needed and went on to earn a doctorate and a faculty position. He now trains social workers and studies how systems can better serve refugees with disabilities. Without Medicaid at that critical juncture, he said, his path would have been far different.
It remains unclear how many refugees will be affected nationwide, or what alternative coverage options states might create. Some may qualify for Medicaid under other eligibility categories, and a patchwork of nonprofit clinics and charity programs may try to fill gaps. But advocates caution that these are stopgaps, not substitutes for comprehensive insurance.
For families like the one Rfat described — a disabled father raising two disabled children — the coming months will bring hard choices about medication, appointments, and care. Health policy analysts note that such decisions are not abstract; they translate directly into health outcomes, financial strain, and, in the worst cases, lost lives.
As the new rules settle into practice, Rfat said he will continue answering the phone, offering what guidance he can, and documenting the effects for his research. The calls, he added, keep coming, each one a reminder that a budget provision crafted in Washington is now playing out in living rooms and clinics across the country.
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