On Oct. 1, thousands of refugees and members of similarly vulnerable immigrant subgroups living in Ohio – all of whom are considered lawfully present in the U.S. – will be deemed ineligible for health insurance through Medicaid.
Exactly how many people will lose care is unclear. The few county agencies contacted by Signal Statewide that were able to provide data offered a much higher estimate than the Ohio Department of Medicaid, which refused to explain the discrepancy.
The state said at least 3,500 immigrants will lose coverage, with another 3,000 possible. However, four of Ohio’s larger counties reached by Signal Statewide collectively pegged the number closer to 14,500 to 18,000, suggesting a higher statewide count.
What’s far clearer is that thousands of residents, granted legal status in the U.S. because they fear persecution in their home countries, could be without health insurance as soon as Wednesday.
The change in eligibility for these residents is one of the first tangible effects of the Medicaid cuts embedded in what is commonly known as the One Big Beautiful Bill Act, the signature legislation of President Donald Trump’s second term. Ohio is estimated to lose $33 billion in federal Medicaid funds over the coming decade under the bill, mostly through new work requirements to enroll, which don’t take effect until next year.
But starting Oct. 1, several groups of immigrants that haven’t yet obtained permanent legal status lose their eligibility for Medicaid, the publicly funded health insurer for the poor. That includes refugees waiting on permanent legal status, asylees, parolees, and certain survivors of domestic violence and human trafficking. Most of these groups have been eligible for coverage since 1996. Once people are deemed ineligible, federal law directs states to make new eligibility determinations where they’re expected to formally drop the coverage.
Franklin County expects at least 8,000 to lose coverage; Cuyahoga expects 3,500
There’s no definitive, state-by-state count of how many legal immigrants without permanent legal status in total are expected to lose coverage The Congressional Budget Office, nonpartisan researchers for federal lawmakers, estimates about 100,000 people nationally will lose coverage by 2034, reducing spending by $6.2 billion.
The Ohio Department of Medicaid has “confirmed” that 3,500 state residents will lose full coverage and shift to a state program that covers only acute emergency care, according to department spokeswoman Stephanie O’Grady. Another 3,000 “may be subject to this restriction,” she said.
However, with the policy a few days from taking effect, counties suggested far more residents could be affected. In Franklin County, somewhere between 8,000 to 12,000 could lose their health insurance, according to a county Jobs and Family Services spokesman, though he emphasized this was a rough and low confidence estimate, based on available citizenship data and inferences from staff.
In Cuyahoga County, officials say 3,500 people received notice they could be ineligible for Medicaid Oct. 1 – county officials said they couldn’t explain the discrepancy but stood behind their count. Summit County estimated about 800. Lorain County estimated less than 500.
“It is not as impactful in total in Lorain County as I thought it would be, But it is impactful to those that are losing eligibility,” said county Jobs and Family Services Director Christopher Cabot in an email.
Few counties had answers
Signal Statewide reached out to agencies in Ohio’s 10 most populous counties to see how many people might lose care. Only those four provided data. Several said they don’t have it and referred reporters to the state. The counties that did offer data said they did so with a mix of cross-referenced data sets and educated guesswork.
The Ohio Department of Medicaid, via O’Grady, is “working with county offices to see where the inconsistency might be.” She declined to comment further or put a department official forward for an interview.
Determining people’s immigration statuses isn’t easy. They change over time, and sometimes there are different classifications of immigrants in the same house. And different government bodies like county administrative agencies and federal immigration authorities don’t always share information efficiently or accurately.
“In general, it is also an inherently messy process, because these laws are so convoluted,” said Ben D’Avanzo, of the National Immigration Law Clinic.
He said it’s “incredibly cruel” to kick these people, most of whom work and pay taxes, from health insurance. Proper care is a base requirement for stability, work and healthy families, he said, and the costs of uninsured care tend to ripple outward in economies to other payers. It’s even worse when you consider the circumstances of refugees and their reasonably feasible paths to citizenship.
“For these folks in particular, especially the refugees and asylum recipients and the domestic violence survivors, these are folks who actually in the next few years may have a green card themselves,” he said.
“They’re stuck in backlogs. So these are people who in a couple of years may have Medicaid again and are going to have health care or medical conditions that are going untreated in the meantime.”
