“I feel like I’m just trying not to let patients die,” Dr. Sommer Aldulaimi says in an exasperated voice.
She’s been scrambling to prepare refugees set to lose their health care on Oct. 1. Aldulaimi is co-director of the University of Arizona Refugee Health Program.
Hundreds of thousands of refugees of war, asylees who fled persecution and other immigrants with legal status are set to lose full Medicaid coverage as a result of new eligibility restrictions under H.R. 1, also known as the One Big Beautiful Bill Act. Republicans passed the Trump administration’s budget measure last summer and the cuts take effect Oct. 1.
The Arizona Public Health Association said the Arizona Health Care Cost Containment System, or AHCCCS, the state’s Medicaid agency, has sent notices to 22,263 people likely affected by the changes.
In Tucson, Aldulaimi and local refugee resettlement agencies have spent months identifying patients at greatest risk, trying to find alternatives for people who could die without health care. “Panic and chaos,” is how she describes the moment for U.S. patients and their doctors.
Bobby Ghisolfo is the president & CEO of Lutheran Social Services of the Southwest, one of the three local refugee resettlement agencies in Tucson. His organization is working with between 750 and 1,000 people in Pima County and Southern Arizona to find sustainable employment, he said. Not all of those people will lose Medicaid coverage, but many will be affected by the changes.
The White House touted the cuts in June, saying the administration has kept its promise to stop “illegal immigrants” from “stealing taxpayer-funded health care benefits meant for American citizens.”
Medical providers and human rights organizations have stressed that many of the thousands of people losing critical health care are in the U.S. legally.
People eligible to maintain coverage include green card holders and certain Cuban and Haitian immigrants. But many refugees and asylees that don’t meet these criteria are still residing in the U.S. legally.
Physicians and human-rights groups also are concerned the Trump administration is stalling immigration processes that would provide some people permanent residency.
“The Trump administration has halted green card processing for most refugees, leaving them with no clear path to eligibility for life-sustaining benefits. For some, the consequences of being cut off from Medicaid could be deadly,” said a joint Sept. 30 statement by the Church World Service and Refugee Council USA.
Alduliami underscored this concern for local refugees. “The problem currently is that all of the applications that have been submitted during this administration are actually not being processed,” she says.
Aldulaimi’s team began preparing months ago, focusing first on refugees with complicated medical conditions and working with Tucson’s resettlement agencies to identify people who could lose coverage. But finding alternatives is particularly difficult for patients who need specialists such as oncologists, cardiologists or neurologists.
Aldulaimi and her team have been working to maintain care for cases that include people in Tucson being treated for cancer.
Federally qualified health centers can provide lower-cost primary care to uninsured patients, but they cannot replace all of the specialty care patients currently receive through Medicaid.
The change also is affecting pregnant refugees in the middle of prenatal care.
Aldulaimi says some patients have received letters telling them their coverage terminated Sept. 30. Her department can redirect some pregnant patients to its limited mobile health program. But she worries others will go without care or face financial bills they cannot afford.
For refugees who lose Medicaid, finding a job with health benefits could provide another path to coverage. But Ghisolfo said that is not a quick solution.
Even if someone finds a job Oct. 1, he said, an employer-sponsored health plan may not take effect for months, leaving vulnerable people with a gap in coverage. And refugees who are already working may be underemployed so they don’t earn enough to pay for health insurance or they are unable to afford the cost of adding spouses and children to an employer-sponsored plan.
For families who cannot find affordable coverage, Ghisolfo worries the loss of Medicaid will force them to choose between medical care and basic necessities.
“Are they going to pay for insurance, pay for medical, or are they going to keep the water, keep the lights on?” he says. “Are they going to pay for their rent? Are they going to pay for food?”
Some patients received little warning that their coverage was ending, Aldulaimi says. AHCCCS had previously sent notices to some people warning that they could be affected and instructing those with green cards to update their information with the state, she says. But other patients received no warnings before getting a termination notice shortly before the Oct. 1 change.
Federal laws require that states give at least a 10-day notice when ending Medicaid benefits.
Consequences of the federal cuts could extend beyond refugees themselves.
Ghisolfo says people who lose access to routine medical care may increasingly turn to emergency rooms when they become sick or need urgent treatment, adding pressure to an already strained health care system.
“This isn’t just a refugee or asylum seeker issue,” Ghisolfo says. “This is going to be a huge health community issue.”
Amelia Natoli is the grants and development manager at Iskashitaa Refugee Network in Tucson. She says the potential strain on the broader health care system also came up during a recent meeting with the Pima County Health Department and other community organizations.
A medical stakeholder at the meeting described refugees in Pima County as generally a younger, healthier population, Natoli says, and warned that removing their health coverage could ultimately harm the wider public as more people delay care or turn to emergency rooms.
“If they get kicked off healthcare, it just increases the cost to everyone else,” Natoli says, recounting the discussion.
The Pima County Health Department is aware of the impending changes and is communicating with AHCCCS about possible solutions, but its options are limited because the eligibility restrictions stem from federal law.
Iskashitaa’s Tucson team is similarly limited in what it can do.
“All we can do is just keep talking to the other stakeholders and trying to figure out where to direct people,” Natoli says. “But if somebody is going to lose coverage, and they need insulin or blood pressure medication, I mean, they may just have to go to the emergency room.”
Natoli says Iskashitaa will try to connect people with available resources but she expects the medical system could quickly become overwhelmed.
“Right now, we don’t have any answers,” she says.
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