Federal Medicaid Cuts Leave Thousands of Washington Illegals Without Coverage

Thousands of immigrants in Washington State are losing Medicaid coverage as a result of federal spending cuts approved by Congress last year.

A provision that took effect Thursday under President Donald Trump’s tax and spending law removes Medicaid eligibility for refugees, asylees, Ukrainian war evacuees, trafficking survivors, and other lawfully present immigrants. State officials estimate roughly 10,000 people in Washington are affected.

Healthcare advocates warn the loss of coverage will leave many without access to doctors, medications, and preventive care, forcing more people to rely on emergency rooms and potentially worsening health outcomes.

A federal judge in Seattle provided temporary relief for some immigrants on Wednesday, ruling that recipients of Supplemental Security Income (SSI) remain eligible for Medicaid despite new federal guidance. The decision protects an estimated 800 people, although the federal government could appeal.

State officials also helped preserve coverage for roughly 3,000 additional immigrants by updating immigration records and eligibility information. Earlier estimates suggested as many as 14,000 noncitizens could lose coverage.

The federal law does not affect lawful permanent residents with green cards and certain other protected immigration categories.

The Medicaid changes are only the beginning. Starting in January, new work requirements are expected to remove tens of thousands more Washington residents from Apple Health, the state’s Medicaid program. State officials project that more than 200,000 Washingtonians could lose coverage by the end of 2027 because of the law.

Critics argue that many people who qualify under the new rules could still lose benefits due to paperwork and administrative hurdles. Washington is investing millions in new technology systems to verify compliance with the upcoming requirements.

Local leaders also warn the cuts could create financial strain for hospitals and clinics, leading to longer wait times, reduced services, and higher costs for insured patients. Nearly two out of every five immigrants losing coverage live in King County.

In response, Gov. Bob Ferguson recently signed an executive order directing state agencies to develop strategies to help residents maintain health insurance coverage and to track the impact of the federal cuts.

Advocates are urging state lawmakers to provide additional funding to restore coverage for affected immigrants. Some local officials have suggested new tax measures similar to those adopted elsewhere to offset the loss of federal support.

Washington already operates a state-funded health coverage program for some immigrants who do not qualify for federal Medicaid, but enrollment capacity is limited. Lawmakers have also set aside nearly $20 million to help certain immigrants retain long-term care coverage, though officials say the funding may not be sufficient to meet demand.