Massachusetts to Cut Full Medicaid for 7,300 Legal Immigrants

About 15,000 documented immigrants across New England will lose full Medicaid coverage on Thursday, the latest in a series of cuts required by Congress’s “Big Beautiful Bill.” In Massachusetts, an estimated 7,300 people will lose MassHealth Standard. Another 8,000 or so will lose comprehensive coverage in Connecticut, Maine, New Hampshire, Rhode Island, and Vermont, officials in those states said.

The people losing coverage include refugees, asylum holders, some groups of parolees, and victims of human trafficking. They have legal status but do not yet hold green cards, though many are eligible for them. Many fled war zones.

The change leaves most of them with emergency-only coverage. Pregnant and postpartum women and anyone under 21 are exempt. In Massachusetts, most people 65 and older and people with disabilities will keep comprehensive coverage through MassHealth Family Assistance. Everyone else on the list gets a plan that covers emergency care but not primary care, most prescriptions, dental and vision care, or long-term services like home care.

The Centers for Medicare & Medicaid Services did not answer questions about the immigrant restrictions. The agency said only that the new standards protect taxpayers’ money and reduce the risk of abuse. Nationally, the new Medicaid restrictions are expected to cut nearly $1 trillion in federal spending through 2034. The immigrant-specific restrictions would add 100,000 people to the ranks of the uninsured and save the federal government $6.2 billion by 2034, according to an analysis from the health news site KFF.

Hospital leaders say the effects will reach beyond the people losing coverage. Daniel McHale, a senior vice president with the Massachusetts Health and Hospital Association, said hospitals that rely heavily on Medicaid face a real threat. “All hospitals, especially those that are heavily reliant on Medicaid, are going to be threatened,” he said.

Massachusetts is losing $3.5 billion a year in health care funding because of federal policy changes, MassHealth officials said. “The state is not able to make up for all of this lost federal funding,” said Stacey Nee, a MassHealth spokesperson. Andrew Cohen, a lead attorney at Health Law Advocates, said the state could have used its own money to keep this group covered. “Our state is not stepping up in the way that it really should to make sure these folks are really integrated into our communities,” he said.

One 55-year-old Ukrainian woman living in a Boston suburb described what the loss means for her. She fled Russia’s invasion with her daughter in 2022; her son serves in the Ukrainian military. She lives with depression and suffered two micro-strokes last year. Without Medicaid, she will pay for antidepressants and quarterly neurologist visits herself — or go without. “Here, every day I cannot sleep now, I cannot have normal life,” she said.

This week’s cut is the first of several. Work requirements and twice-a-year eligibility checks take effect in January. By 2034, the Medicaid and ACA changes are expected to leave Massachusetts with 200,000 to 300,000 fewer insured residents. Community health centers could gain 92,000 to 171,000 uninsured patients by 2034, according to the National Association of Community Health Centers. “I think this is just the tip of the iceberg for what’s coming in January,” said Shade Cronan, a spokesperson for the Massachusetts League of Community Health Centers. “Health centers will have to make decisions about curtailing services and potentially closing sites.”

There is still a backstop. The state’s health safety net reimburses medically necessary care at hospitals and community health centers for uninsured patients. But it is already running a shortfall of roughly $200 million, and MassHealth is already cutting other programs to cope.

Under a different set of circumstances, many losing coverage would have other options. Subsidized plans through the ACA marketplace have grown less accessible to immigrants and more expensive, and the processing of green cards and work authorizations has stalled, said Sarang Sekhavat, chief of staff at the Massachusetts Immigrant and Refugee Advocacy Coalition. One 37-year-old Ukrainian parolee in Boston put it plainly: “You’re kind of in limbo.”