Beginning October 1, the first of the healthcare (Medicaid) cuts from H.R. 1 kick in – throwing thousands of legally present refugees and asylees off of Medicaid coverage.
Refugees, people granted asylum and several other humanitarian groups who’ve long been eligible will no longer qualify because federal Medicaid funding is being taken from these legally present immigrants.
The federal rules also knock off people in several other humanitarian immigration categories that previously counted as qualified noncitizens.
Folks that will still qualify are certain Cuban and Haitian entrants, people from Compact of Free Association countries (e.g. Marshall Islands) and lawful permanent residents (called LPRs or green-card holders).
The people who will get kicked off AHCCCS aren’t undocumented immigrants sneaking into Medicaid. They’re people the federal government (under federal law) legally admitted and allowed to remain in the US because they fled persecution, violence, trafficking or other dangerous things.
Here’s What That Means in Real Life
Imagine a woman named Samira.
She’s 42. In South Sudan she was a nurse. She fled after she and her family were threatened, leaving behind her profession, her home and almost everything familiar to her. She eventually made her way to the US, where the federal government reviewed her case and granted her asylum because she had a legitimate fear of persecution if she returned home.
Today, she lives in Arizona.
Her nursing credentials didn’t transfer easily, so she works as a nursing assistant, caring for seniors who need help bathing, dressing, eating and getting through their day. She works. She pays taxes. She’s building a life here. And she is here legally, with the permission and protection of the US government and under federal law.
Refugee Services | Valleywise Health
Samira also has Type 1 diabetes. AHCCCS pays for the insulin, testing supplies and regular medical care that allow her to manage her disease and keep showing up for work. With treatment, diabetes is something she lives with. Without treatment, it can become life-threatening very quickly.
On September 30, Samira is eligible for AHCCCS coverage.
On October 1, she’s not. She’s still the same person with the same income. She still has the same job. She is still caring for Arizona patients. She still has diabetes. She’s still legally living in the US under asylum granted by our own government.
But she’ll no longer qualify for full Medicaid coverage solely because she is an asylee, because of H.R. 1 (it’s not AHCCCS’ fault).
Unless Samira has since become a green-card holder or falls into one of the narrow immigration categories Congress preserved, she’s left with only Federal Emergency Services.
Federal Emergency Services can help pay when Samira is sick enough to have a true medical emergency. It doesn’t replace the insulin, routine doctor visits, laboratory testing and ongoing care designed to prevent that emergency from happening in the first place.
The AHCCCS Letters Are Going Out
AHCCCS has already sent advance notices to about 22,263 people who are likely affected by the H.R. 1 cuts. Another 12,000 people receiving SSI cash benefits will need to go through a separate review.
Members are beginning to receive Requests for Information asking them to provide documents so AHCCCS can figure out whether they still qualify.
There are going to be two ways people lose AHCCCS coverage because of H.R. 1. The first is a real loss of eligibility.
Samira could turn in every document AHCCCS asks for and still lose her full coverage because she simply doesn’t fit the new rules Congress wrote.
The second is paperwork.
Suppose Samira had already gotten her green card. In that case she might still qualify. But AHCCCS needs to know that.
What happens if the letter goes to an old address? What if she doesn’t understand what AHCCCS is asking for? What if she can’t find the immigration document quickly enough? What if she sends something in but it isn’t exactly what the AHCCCS eligibility worker needs?
She could lose coverage even though she’s actually still eligible. Many will.
Get Used to Those Two Problems
These same two ways of losing Medicaid are going to become a much bigger issue next year.
Beginning in 2027, H.R. 1 puts new work and community-engagement requirements on many Arizona adults covered through Medicaid expansion. It also requires many of them to prove their eligibility twice a year instead of once.
AHCCCS now estimates about 380,000 Arizonans will be subject to the new work requirements after exemptions are considered.
Again, people will lose coverage in two different ways. Some won’t meet the new rules and will lose eligibility.
Others actually will meet the rules but could lose their AHCCCS because they didn’t or couldn’t successfully complete the paperwork needed to prove it.
UPDATED: Where Does Arizona’s Medicaid Work Requirement Planning Stand? A Summary – AZ Public Health Association
That second group matters.
Hospitals, community health centers and other providers will end up absorbing more uncompensated care, but not for routine kinds of care that people need and deserve. Just emergency care.
Remember who we’re talking about.
Refugees are people who fled persecution. People granted asylum went through a legal process and convinced a judge using US law rules that they needed our protection.
Trafficking victims have survived exploitation. Humanitarian parole is granted because the federal government found an urgent humanitarian reason to let somebody enter the country.
These are some of the most vulnerable people living among us.
They’re legally presnet. They qualified for Medicaid legally. They enrolled in AHCCCS legally. Many have doctors, medications and ongoing treatment just like everybody else.
Now Congress has decided to take that health coverage away from them. Arizona didn’t make that choice. AHCCCS didn’t make that choice.
Congress did.
Samira came to this country because we told her she could be safe here. She built a life, found a job caring for others and did everything we asked of her.
Beginning October 1, we’ll still benefit from the care she gives to others while taking away the health coverage that helps keep her well enough to provide it.
Who have we become?
