About 11,000 refugees, asylum-seekers and other lawful immigrants in Washington will lose health insurance starting Thursday, as a significant federal change to Medicaid eligibility takes effect.
Beginning in October, President Donald Trump’s House Resolution 1, the so-called One Big Beautiful Bill that Congress passed last year, will push hundreds of thousands of people nationwide with certain immigration statuses off Medicaid, or Apple Health in Washington. The result, local providers and health leaders say, will likely be sicker patients, higher out-of-pocket costs and an enormous weight on an already overburdened healthcare system.
“Individuals who are hearing this are understandably scared and fearful about what comes next for their overall long-term health,” said Ryan Moran, director of the state Health Care Authority. The agency administers Apple Health and has been running an “all hands on deck” operation, particularly in the last few months, to warn Washington patients of the coming moves.
“The very harsh reality is that the federal government and President Trump and Congress passed this law that will remove individuals overnight from Medicaid with no other option,” Moran said. “Those are often heartbreaking conversations.”
Apple Health eligibility will now be limited to U.S. citizens and nationals, lawful permanent residents who have been here longer than five years, Compacts of Free Association islanders, and certain Cuban-Haitian immigrants. Those who are no longer eligible include asylum-seekers, refugees and victims of trafficking, among others.
Children, pregnant people and those within 12 months postpartum continue to be eligible for Apple Health regardless of immigration status, if they meet other requirements.
Initially about 14,000 lawfully present residents in Washington were set to lose coverage with Apple Health, Moran said, but the figure dropped over the last year as providers and state teams have helped members update their information to keep coverage.
In January, another HR 1 change will impact more than 600,000 Washington residents who will be subject to new work requirements at the start of 2027, and required to reapply for coverage twice as frequently.
Nearly 2 million lower-income Washington residents are enrolled in Apple Health, funded by both the state and the federal government.
Ripple effects of this mass loss of health insurance will likely hit everyone in the state over the next year, Moran said. Because people will continue to become sick and injured regardless of their insurance status, hospitals and clinics will continue to treat patients; they just won’t be reimbursed for the care they provide. Instead, some hospitals, like Harborview Medical Center, plan to spend more in state charity care funds, which help cover care for low-income patients.
That means healthcare systems will be at risk of layoffs and service closures in order to keep their doors open, Moran said.
“Medicaid is not just a lifeline of care and services, which it is, but it's an economic lifeline for our state,” he said. “As that continues to be squeezed, there definitely will be consequences across the overall larger healthcare system from this.”
At HealthPoint, a community health organization with clinics across King County, about 1,600 patients are set to lose Apple Health coverage Thursday — all of whom clinic staff have worked to contact over the last few months. They were able to reach over half.
Of those, about 75% of patients, or more than 660 people, quickly scheduled medical or dental appointments before the October deadline, said Dr. Liza Perpuse, a regional director of clinical care at HealthPoint.
On one day, Perpuse blocked off her schedule to mainly see people set to lose insurance. For these patients, she and other HealthPoint providers did as much as they could with the time they had, like refilling medications with a 90-day prescription, or whatever was clinically appropriate, to give people what they needed while they were still insured, Perpuse said. Clinic staffers also informed patients they’d still be able to apply for a sliding pay scale for care, as was already the case with its status as a federally qualified health center.
And Perpuse wanted to be sure to impart an important message: “Regardless of your ability to pay, I am still your primary care doctor. I am still here for you.”
Still, she worries some trust has already been lost.
“If they are a refugee or immigrant coming from another country, they just started building their new life and started learning a new language. And now they lose their insurance,” said Omranna Sahak, a refugee and immigrant coordinator at HealthPoint. “It’s really hard.”
In addition, clinic staff know there will be patients who just won’t seek care anymore, or delay until they need to go to the emergency department.
“I really don’t know that they’re going to come in with the added cost, if they have to choose between seeing their physician and paying for food,” Perpuse said.
And while HealthPoint and other healthcare organizations in the state have spent months working to reach out to everyone slated to lose Apple Health coverage, they didn’t reach everyone, said Dr. Shoshana Aleinikoff, HealthPoint’s specialty director of immigrant and refugee health.
“I think there will continue to be people who show up to check in at the front desk, hand them their insurance card, and be told in that moment they no longer have insurance,” Aleinikoff said. “And I worry that’s going to add to the chilling effect.”
The state Health Care Authority will continue to track patient and healthcare trends after the Thursday deadline to see how the eligibility change affects who seeks medical services, Moran said. The HCA is also working on developing an online “verification hub” to help identify which exemptions people who apply for Apple Health could qualify for, like being pregnant, and could therefore allow them to keep coverage.
The online hub, which will not be public-facing, should allow about 400,000 of the 600,000 Apple Health members at risk of losing insurance to keep their coverage, Moran said. That still leaves more than 200,000 Washingtonians who are estimated to lose their Apple Health coverage by the end of 2027.
“These are seismic shifts in Medicaid policy and eligibility in the historical inflection of the program,” Moran said. “But we are really rallied around a goal at HCA to support people as much as we can.”
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