Thousands of refugees and other lawful permanent residents awoke on October 10 to discover that their Medicaid benefits had been terminated overnight. The Associated Press reports that the Trump administration’s latest cost-saving measure eliminates federal reimbursement for most non-emergency Medicaid services provided to foreign nationals who have lived in the United States for fewer than five years. The rule quietly took effect on October 1, but state agencies began sending termination notices late last week, producing a wave of confusion at doctors’ offices and pharmacies over the long holiday weekend. Although the move is framed as a budgetary adjustment, immigration attorneys warn that it represents another front in the administration’s strategy of making the United States less hospitable to immigrants. Foreign workers sponsored on employment-based visas—particularly H-1B, E-2, and O-1 professionals—frequently rely on Medicaid while they wait for employer-provided insurance to kick in. Employers that fail to ensure alternative coverage could face back-wage liability under Department of Labor rules that require H-1B sponsors to pay “actual wage” equivalents, including medical benefits. Hospitals are already bracing for higher uncompensated-care costs. New York’s Mount Sinai Health System told AP it had identified more than 600 insured immigrant patients who lost coverage in the first 48 hours. “We will not turn anyone away,” said Dr. Luis Ramos, the system’s chief medical officer, “but in many cases the hospital—not the government—will absorb the bill.” State Medicaid directors say they were given only two weeks’ formal notice of the change, leaving little time to update eligibility systems or to warn vulnerable communities. Corporate mobility managers should expect ripple effects in relocation programs. Employers that reimbursed foreign hires for Affordable Care Act marketplace plans may now see premiums soar because recent arrivals—who previously defaulted to Medicaid—must buy commercial insurance. Immigration counsel also note that the terminations could become a negative factor in future “public-charge” determinations if an affected worker later applies for a green card. Practical tips: • Audit current foreign national employees for continuous health-insurance coverage and consider temporary premium subsidies. • For upcoming transfers, budget at least US $6,000 per year for individual ACA plans in high-cost states. • Update internal I-9 and public-charge checklists to document private coverage at the time of filing adjustment-of-status applications. • Communicate proactively with impacted employees; many are unaware that their coverage has lapsed until a medical claim is denied.
Source: Associated Press
