A major change in federal health policy took effect on October 1, stripping Medicaid coverage from legally present immigrants across the United States and sending shockwaves through refugee communities, particularly those caring for family members with disabilities.
The change stems from H.R. 1, the wide-ranging budget legislation that Republicans in Congress passed with the backing of the Trump administration last summer. While the bill touched numerous areas of federal spending, its Medicaid provisions have triggered an immediate and tangible crisis for some of the country's most vulnerable newcomers.
Mustafa Rfat, a professor of social work at the University of Nebraska at Omaha, has found himself on the front lines of that crisis. In recent weeks, his phone has not stopped ringing with calls from panicked refugees, many of them desperate parents unsure how they will keep their disabled children alive without insurance.
"I spent these past two weeks just talking with so many of them, literally just terrorized by the reality that their children with disabilities are losing coverage," Rfat said. He described one particularly wrenching case: a father who himself lives with disabilities and is raising two children who also have disabilities. The man cannot understand how he will obtain the medications his family depends on now that their coverage has vanished.
Rfat's connection to this issue is not merely academic. His scholarly work centers on refugees living with disabilities, a subject he understands from direct personal experience. When he came to the United States as a refugee from Iraq in 2011, he was suffering severely from a chronic spinal condition that left him unable to walk and in constant agony. During that period, he went without his medications for an extended stretch and had no access to a doctor.
"It was a very, very difficult and vulnerable situation," Rfat recalled of those early months in his new country. He credits Medicaid with providing the lifeline that allowed him to stabilize his health, rebuild his life, and eventually pursue a career in higher education.
Now, he is watching that same lifeline being pulled away from others who are in circumstances similar to the ones he once endured. The irony is not lost on him: the program that helped him recover and contribute to society is now closed to a new generation of refugees facing identical medical needs.
The policy change is broad in scope. It affects refugees and other immigrants who are in the country legally, a group that had previously been eligible for Medicaid under longstanding federal rules. For decades, the program has served as a critical bridge for refugees during their first months and years in the United States, a period when many are still securing employment, learning English, and navigating an unfamiliar health care system.
Advocates for immigrant communities warn that the consequences will extend well beyond individual families. When people with chronic conditions lose access to regular medical care, they often end up in emergency rooms, where treatment is far more expensive and typically funded by taxpayers. For those with disabilities, interruptions in medication and therapy can lead to rapid deterioration, making it harder for them to ever achieve self-sufficiency.
The timing of the cuts is especially difficult, according to those who work with refugee populations. Many refugees arrive after fleeing war, persecution, or natural disaster, and a significant number carry both physical and psychological scars from their experiences. The resettlement process is already daunting, involving paperwork, cultural adjustment, and the challenge of finding work. Removing health coverage adds another layer of instability to an already fragile transition.
Rfat noted that the people calling him are not looking for special treatment. They are seeking the same chance he had: a period of stability that allows them to address urgent medical problems so they can eventually stand on their own.
The father he described, struggling to understand how he will medicate his children, represents just one of thousands of similar stories unfolding in communities across the country. Disability adds a particularly cruel dimension to the loss of coverage, because these families often cannot simply wait for a better job or a change in circumstances. Their medical needs are constant, and the cost of going without care can be irreversible.
It remains unclear what alternatives, if any, will be available to those who lose coverage. Some may qualify for other programs, but advocates say the eligibility gaps are significant and the application processes are complex. Many refugees also face language barriers that make navigating the system even harder.
Rfat said he will continue answering the phone and offering what guidance he can. But as a researcher who has documented the struggles of refugees with disabilities, he knows that individual efforts cannot replace the systemic support that has now been withdrawn.
For him, the moment carries a painful historical echo. He arrived in America broken in body but determined to build a future, and Medicaid was the foundation that made that future possible. Now, he fears, others who arrive under similar circumstances will find that foundation missing, and the nightmare he once lived through will become their permanent reality.
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