More than 10,000 refugees, asylum seekers and non-citizens living in Washington state could lose Medicaid coverage on Oct. 1, a consequence of President Donald Trump’s H.R. 1, or so-called “One Big Beautiful Bill.” With 40% of that population residing in King County, local organizations and agencies are hustling to find solutions.
Along with stripping refugees and asylees of their health coverage, H.R. 1 imposes new work reporting requirements on thousands of Apple Health enrollees starting Jan. 1, 2027. The two changes together create significant barriers to immigrants’ and non-citizens’ healthcare access.
H.R. 1 strips refugees and asylees of their healthcare
Signed July 4, 2025, H.R. 1 redefines who is eligible for Medicaid, called Apple Health in Washington state. Prior to H.R. 1, refugees and asylees were able to get Medicaid, but under the new law, they no longer qualify — only U.S. citizens, lawfully permanent residents and non-citizens who are Cuban Haitian Entrants or from Compact of Free Association nations qualify.
“In the past, if I came into the country and I was approved as an asylee or refugee, I automatically got Medicaid,” said Daphne Pie, regional health administrator overseeing the access and outreach program at Public Health – Seattle & King County (PHSKC). “But H.R. 1 came in and said, asylees and refugees, you’re going to lose your coverage.”
Pie said that, based on the number of letters sent by Washington state’s Health Care Authority and the Department of Social and Health Services (DSHS), an estimated 10,000-12,000 people currently on Medicaid could lose coverage, and about 40% of them live in King County. The highest volume of notification letters went out in the Ukrainian language, followed by Russian, Spanish, Dari, Arabic, Tigrinya, Pashto, Somali and Swahili.
Michael Itti, executive director of the Chinese Information and Service Center (CISC) — a nonprofit supporting a diverse group of immigrants who speak Cantonese, Mandarin, Russian, Vietnamese, Ukrainian, Spanish and more — expect about 70 of their clients who are living here under Ukrainian humanitarian parole will lose health coverage Oct. 1, several of whom are being treated for ALS, dementia, epilepsy or cancer.
“Access to affordable healthcare is essential,” Itti said. “And the client stories I’ve heard, people who are experiencing ALS or dementia or are trying to have cancer treatment and they need medication — those are all things that are irreplaceable.”
Pie said PHSKC is working case-by-case to explore their clients’ options. First, PHSKC will check if the client’s immigration status has changed, because if the status has changed since the client enrolled, “they may still be eligible for Apple Health assuming they meet other Apple Health requirements,” said Pie.
Second, if immigration status hasn’t changed, PHSKC will screen for any emergent medical conditions, which could make them eligible for the Alien Emergency Medical Program through the Washington Health Care Authority. They could also screen for disabilities, which could qualify them for Medical Care Services (MCS), a state-funded Apple Health program.
The third option is usually a marketplace health plan, which most Washingtonians can buy regardless of immigration status. Federal premium assistance that once made these plans more affordable for lawfully present immigrants was cut under H.R. 1, but Pie said most affected clients can still get a premium tax credit through the end of the year, and some state-funded programs can offset costs further.
If a client decides to go without insurance, PHSKC can help them find low-cost healthcare resources instead.
At International Community Health Services (ICHS), about 55% of the clinic’s total patient population — including children, adults and elders — currently has Apple Health coverage, according to Chief Health Officer Jeffrey Gibbs. He said that most ICHS patients are Asian American Native Hawaiian Pacific Islander (AANHPI), and that anyone relying on Apple Health “faces some risk of losing coverage” because of the new enrollment and eligibility requirements from H.R. 1.
“These re-enrollment and eligibility changes add extra steps for patients, making it easier to miss a deadline or a detail,” Gibbs said to the International Examiner in an email.
ICHS’s enrollment navigation team, which helps patients in more than 90 languages and dialects, is still figuring out how many of its patients could ultimately lose coverage, Gibbs said, but non-citizens will face the most challenges from H.R. 1.
“They will likely have to purchase healthcare insurance on the open market, which usually costs more, and sometimes quite a bit more,” Gibbs said. “As a result, they might end up without healthcare benefits which can have a domino effect if they become sick or injured.”
Strict work requirement reporting poses additional administrative barriers
Starting Jan. 1, Medicaid recipients ages 19-64 who qualify through the Affordable Care Act’s Medicaid expansion — or “Apple Health for Adults” in Washington — will have to start reporting at least 80 hours a month of “community engagement,” which could be working a job, job training, community service, being enrolled at least half time in school, or a combination of those activities.
Exemptions are made for folks who are pregnant or postpartum, former foster youth under age 26, a caretaker of a child under age 14, a caretaker of a person with a disability, a disabled veteran, or fall under any of the several other exempt categories.
Most Medicaid adults already meet the work requirements. KFF reported that in 2023, 64% of Medicaid adults were working full- or part-time, and 28% were not working but had a qualifying exemption. That means only 8% were neither working nor covered by an exemption category.
Shomya Tripathy, the Asian Counseling and Referral Service’s (ACRS) policy and civic engagement director, said the change isn’t really about whether folks on Medicaid aren’t willing to work — it’s about targeting a vulnerable population. Tripathy said extra steps could pose an administrative barrier, making it easy for people to miss a deadline or make a reporting mistake and lose their coverage.
“The concern is whether people will be able to…document [the work requirements] in a way the system requires when they’re already navigating an extremely complicated benefits system,” Tripathy said. “This is already a system that is extremely inaccessible to people that might have limited English proficiency, that might have limited digital access or regular work schedules.”
“It’s much harder to lose coverage due to an administrative barrier and then get back on it and re-enroll,” Tripathy said. “And I think we’re pretty clear that that’s what this change is intended to do and why it’s being challenged in the courts right now.”
Itti said CISC and ACRS joined SEIU 775, OneAmerica, Neighborhood House and other local organizations in a coalition called No Cuts to Healthcare. He said the coalition is asking the state to utilize funding to develop an emergency program or increase support for existing emergency programs to close immigrant healthcare gaps created by H.R. 1.
“For many of the people that we serve, Apple Health, our state’s Medicaid, is a lifeline for them — for primary care, for the behavioral health services that we have, and other essential supports,” Tripathy said. “We know that losing coverage for them can affect much more than just a doctor’s visit. It can affect their entire overall health, their stability and their livelihood, and many other factors that are attached to one’s healthcare.”
