This story was reported and written by VPM News.
Effective Oct. 1, many noncitizens without green cards will lose eligibility for Medicaid as a result of HR 1 — the federal spending plan widely known as President Donald Trump’s “One Big Beautiful Bill Act,” which passed in 2025.
The change limits eligibility for the government-funded health insurance to lawful permanent residents, Cuban and Haitian entrants or migrants from the Republic of the Marshall Islands, Federated States of Micronesia and Republic of Palau.
Many legally residing immigrants with humanitarian statuses — including refugees, people granted asylum, victims of trafficking, and others — who were previously eligible for Medicaid will now be unable to access publicly-funded coverage.
The cuts don’t extend to pregnant people, and there are special rules for pediatric patients up to age 19.
People worried about losing their coverage have been contacting service providers and nonprofit organizations repeatedly.
“We’re certainly hearing from parents that are refugees or asylees who are really concerned about losing their status because they need to maintain access to medication,” said Eleanor Sullivan, a senior policy analyst at the Virginia Poverty Law Center.
Sullivan told VPM News that some disabled and older adult refugees and Ukrainian parolees in long-term care, like nursing homes or in-home, have reached out.
“A lot of folks just don’t know what they’re going to do,” she said.
Staff at International Neighbors, a Charlottesville-based nonprofit, said they’ve been hearing about more families losing healthcare coverage — impacted by processing delays and freezes in their immigration cases.
“When we first heard about this, it sounded like it was just a few families within our wide, broad network,” said communications director Molly Crouch. “But over the last few months, we’ve heard of more and more people who have fallen into this gray area of they’ve been here for years, they have not received their green card.”
Crouch added that the organization has been hearing from people with chronic health conditions who struggle to access treatment without insurance.
“It is, in some cases, pretty dire,” she said. “We know people who are receiving treatment for things like multiple sclerosis.”
Sullivan said VPLC has been telling people to seek care at free clinics.
Except there’s a challenge with that, too.
“Most of our clinics are at capacity already, ahead of all these changes with Medicaid that are going to result from HR1,” said Rufus Phillips, CEO of the Virginia Association of Free and Charitable Clinics, “and going to result in a lot more uninsured individuals throughout Virginia.”
He said the clinics’ ability to take on more patients is constrained and most are spending more on care than they receive in funding. That’s on top of difficulties finding paid and volunteer providers to staff them.
Health Brigade is a nonprofit free clinic in Richmond that offers primary care, mental healthcare, sexual healthcare, chronic disease management and other services.
“The door is open. It’s full, but it’s open,” said executive director Karen Legato. “And if we can’t help them, we usually can find somebody who can.”
Health Brigade staff said they’ve been hearing regular concerns from people worried about losing their insurance.
“For many of our clients, things like language barrier, transportation, limit income, and not fully understanding the healthcare system can make it even harder to get care they need,” said community health worker Sultana Salehzada.
The state Department of Medical Assistance Services said it reached out to around 5,800 legally present immigrants affected by the upcoming federal changes. In August, DMAS sent notices asking them to provide updated citizenship information in case their statuses had changed.
In May, Leon Henry, the head of Charlottesville’s Department of Social Services told VPM News the office was already preparing for the Oct. 1 changes.
“We’re trying to make sure that we get information to share out to the community, so that they’re aware of the changes,” Henry said at the time, “and also just having team members available and up to speed and up to date with what it is that the information that they need to best support community members.”
Kedra Keith, a public relations manager with DMAS, said that members who provided updated information and remained eligible had their records updated to remain enrolled in full coverage. Keith said those who “attested to an eligible status that could not immediately be verified were given a federally required 90-day reasonable opportunity period to provide documentation and remain enrolled.”
But language barriers may make it difficult for many to understand the English-language notices, which have also been translated into Spanish, Arabic, Amharic, Farsi, Urdu and Vietnamese.
“There is no translation towards any of that, and that feels pretty deliberate because what you don’t understand, you get less resistance about it,” Legato told VPM News, “or you can get people to comply because they don’t know what the difference is in signing it.”
Crouch added that the confusion sparked by the change in federal policy feels “willful and purposeful.”
“It’s just one more barrier for a newcomer to have to try to climb over on their way to access basic care, which, by the way, they were promised when they came to the United States as a refugee or [Special Immigrant Visa],” she said.
International Neighbors and Health Brigade both said they’ve been trying to help people understand mailed notices.
“I would encourage people to not ignore the letter of the notice from Virginia Medicaid,” said Salehzada. “If they don’t understand something, it’s OK. They can ask for help.”
Crouch also said International Neighbors has helped clients read letters from the UVA Health system regarding financial assistance.
“They’re getting things like these letters from UVA, where, although it is good news in some ways, it’s just one more thing to have to try to decipher, one more thing to have to try to understand fully,” said Crouch.
Eric Swensen, UVA Health’s public information officer, told VPM News in an email that the hospital system has multiple “established procedures in place to help eligible patients receive financial assistance, beginning before they receive care and continuing through the patient billing process, which includes a three-year look back period to retroactively adjust balances for patients that qualify for financial assistance.”
Legato said without coverage through Medicaid for regular preventive care, patients will certainly get sicker.
“What ends up happening is you’re going to get more people in using the wrong kind of care, which is emergency care, which really costs the system,” Legato said.
As a result, she said, insurance raises costs and everyone ends up paying more.
“In addition, there’s no consistency in the care for those who are going to the emergency rooms,” she said, “particularly if they have chronic illnesses, which is what a lot of these marginalized populations have.”
Legato said conditions like diabetes, heart disease, high blood pressure and other chronic illnesses are treated best — and most cheaply — by primary care providers: “When you put up all of these obstacles, and you don’t have enough resources in the places that are equipped to kind of serve these folks, then we as a society pay for it as a whole.”
She added that illnesses go unchecked — and people in the community get sicker.
Over the past six weeks Sullivan, of the Virginia Poverty Law Center, has led a series of trainings and webinars to answer service providers’ questions on the policy.
Phillips, CEO of the free clinic association, attended one of these training sessions and said it was “very helpful” as they try to understand the technical details.
There are more restrictions coming Jan. 1, 2027, as a result of HR 1, including six-month eligibility redeterminations and work requirements. Service providers say they’re trying to prepare for those changes, too.
This isn’t the first time Health Brigade has seen “healthcare fires” since 1970, said Legato.
“This is not our first rodeo,” she said. “At the same time, it’s a real challenge in the political environment that we’re in, because the individuals that we see are the most marginalized individuals in our community, and they’re under assault in various ways — not just around their healthcare.”