More than 5,000 immigrants in Minnesota will lose access to federally funded Medicaid health coverage starting Thursday under changes enacted through a sweeping tax and spending law. President Donald Trump signed the measure into law in July.

The law eliminates Medicaid eligibility for many immigrants who have legal status but do not yet hold green cards. Refugees and asylum seekers are among the hundreds of thousands of immigrants affected across the country.

In Minnesota, federal Medicaid coverage is known as Medical Assistance. Michelle Eberhard, director of refugee services at the International Institute of Minnesota in the Twin Cities, said hundreds of refugees assisted by her office had qualified based on their legal status.

“This is a dramatic shift, especially for those individuals who maybe have some medical needs that require more attention,” Eberhard said. “To have kind of built their lives around the understanding of those types of supports, and then now, suddenly, things are changing.”

The Minnesota Department of Human Services said the changes will affect more than 5,000 noncitizen adults who are at least 21 and are not pregnant. Green card holders can retain their Medical Assistance coverage.

Others losing eligibility include Afghan and Ukrainian humanitarian parolees, trafficking victims, qualified noncitizen veterans living in Minnesota, and noncitizens protected under the Violence Against Women Act. These groups had previously qualified for federal coverage.

“The Trump Administration has a public mandate, a statutory obligation, and a moral duty to safeguard our federal healthcare programs,” Centers for Medicare & Medicaid Services Administrator Dr. Mehmet Oz said in a statement announcing guidance on the Medicaid changes.

The Minnesota Department of Human Services began mailing notices in late August and early September to people who will no longer qualify. Some residents losing Medical Assistance may be able to obtain private insurance through MNsure, Minnesota’s health insurance marketplace.

A spokesperson for the department said 75% of those losing Medical Assistance are eligible for MinnesotaCare, a health care program for Minnesota residents with low incomes. That option could limit the number of people left without insurance.

“We in Minnesota are fortunate to have the option to offer people in this category MinnesotaCare,” temporary DHS Commissioner John Connolly said in a statement. “Other states have many more people impacted and do not have a similar program that can help.”

Eberhard called MinnesotaCare a good option but warned that switching plans could still be difficult. Her office is helping people make the transition, while worrying that missed enrollment deadlines could leave some without coverage in the coming months.

Immigrants are already less likely than U.S. citizens to carry health insurance. Advocates and health policy experts say the eligibility changes could deepen existing coverage disparities within noncitizen communities.

Eberhard also worries that confusion surrounding coverage could cause people to skip medical care. “When something becomes more complicated to navigate, there are some people who are just going to say, ‘Actually, I don’t need to go to the doctor because I can’t figure out how to get there,’” she said.

Medical Assistance and MinnesotaCare provide different benefits and carry different costs. MinnesotaCare requires a monthly premium and includes some copays, while Medical Assistance covers certain services that MinnesotaCare does not, including home and community based care and long term care services.

Immigration service providers say longer waits for green cards make the eligibility loss especially difficult. Eberhard said refugees previously received green cards about nine months after applying, but the process now takes nearly three years, leaving them ineligible for federal medical benefits for longer.

Ruth LePage, director of refugee services at Arrive Ministries, expressed frustration about the people affected. “We work with people who are legally present in the United States, have been invited into the country, have jobs and social security numbers, and pay their taxes, and have applied for the next step in the immigration process, and all of that seems to be worth nothing right now,” she said.

Service providers are helping people seek alternatives before their Medicaid coverage ends on Oct. 1. LePage said the process involves extensive paperwork, telephone calls, long waits and efforts to secure interpreters.

“It's a lot of paperwork and a lot of calling and being on hold and trying to get interpreters,” LePage said. “I would say it is yet another attack on lawful status holders in this country.”

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