3 Democrat-led states have rolled back Medicaid access for people
lacking permanent legal status
[July 21, 2025]
By TRÂN NGUYỄN and DEVI SHASTRI
SACRAMENTO, Calif. (AP) — For nearly 20 years, Maria would call her
sister — a nurse in Mexico — for advice on how to manage her asthma and
control her husband’s diabetes instead of going to the doctor in
California.
She didn’t have legal status, so she couldn’t get health insurance and
skipped routine exams, relying instead on home remedies and, at times,
getting inhalers from Mexico. She insisted on using only her first name
for fear of deportation.
Things changed for Maria and many others in recent years when a handful
of Democrat-led states opened up their health insurance programs to
low-income immigrants regardless of their legal status. Maria and her
husband signed up the day the program began last year.
“It changed immensely, like from Earth to the heavens,” Maria said in
Spanish of Medi-Cal, California’s Medicaid program. “Having the peace of
mind of getting insurance leads me to getting sick less.”
At least seven states and the District of Columbia have offered coverage
for immigrants since mostly 2020. But three of them have done an
about-face, ending or limiting coverage for hundreds of thousands of
immigrants who aren’t in the U.S. legally in California, Illinois and
Minnesota.
The programs cost way more than officials had projected at a time when
the states are facing multibillion-dollar deficits now and in the
future. In Illinois, adult immigrants ages 42-64 without legal status
have lost their health care to save an estimated $404 million. All adult
immigrants in Minnesota no longer have access to the state program,
saving nearly $57 million. In California, no one will automatically lose
coverage, but new enrollments for adults will stop in 2026 to save more
than $3 billion over several years.
Cuts in all three states were backed by Democratic governors who once
championed expanding health coverage to immigrants.
The Trump administration this week shared the home addresses,
ethnicities and personal data of all Medicaid recipients with U.S.
Immigration and Customs Enforcement officials. Twenty states, including
California, Illinois and Minnesota, have sued.
Health care providers told The Associated Press that everything,
especially the fear of being arrested or deported, is having a chilling
effect on people seeking care. And states may have to spend more money
down the road because immigrants will avoid preventive health care and
end up needing to go to safety-net hospitals.
“I feel like they continue to squeeze you more and more to the point
where you’ll burst,” Maria said, referencing all the uncertainties for
people who are in the U.S. without legal permission.
‘People are going to die’
People who run free and community health clinics in California and
Minnesota said patients who got on state Medicaid programs received knee
replacements and heart procedures, and were diagnosed for serious
conditions like late-stage cancer.
CommunityHealth is one of the nation’s largest free clinics, serving
many uninsured and underinsured immigrants in the Chicago area who have
no other options for treatment. That includes the people who lost
coverage July 1 when Illinois ended its Health Benefits for Immigrants
Adults Program, which served about 31,500 people ages 42-64.
One of CommunityHealth’s community outreach workers and care coordinator
said Eastern European patients she works with started coming in with
questions about what the change meant for them. She said many of the
patients also don’t speak English and don’t have transportation to get
to clinics that can treat them. The worker spoke to the AP on condition
of anonymity to protect patients’ privacy.
Health Finders Collective in Minnesota's rural Rice and Steele counties
south of Minneapolis serves low-income and underinsured patients,
including large populations of Latino immigrants and Somali refugees.
Executive director Charlie Mandile said they’re seeing patients rushing
to squeeze in appointments and procedures before 19,000 people age 18
and older are kicked off of insurance at the end of the year.
Free and community health clinics in all three states say they will keep
serving patients regardless of insurance coverage — but that might get
harder after the U.S. Department of Health and Human Services decided
this month to restrict federally qualified health centers from treating
people without legal status.
CommunityHealth CEO Stephanie Willding said she always worried about the
stability of the program because it was fully state funded, “but
truthfully, we thought that day was much, much further away.”
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Maria, who requested to use only her first name out of fear of
deportation, is photographed Thursday, June 26, 2025, in Sacramento.
(AP Photo/Godofredo A. Vásquez)
 “People are going to die. Some
people are going to go untreated,” Alicia Hardy, chief executive
officer of CommuniCARE+OLE clinics in California, said of the
state's Medicaid changes. “It’s hard to see the humanity in the
decision-making that’s happening right now.”
A spokesperson for the Minnesota Department of
Health said ending the state’s program will decrease MinnesotaCare
spending in the short term, but she acknowledged health care costs
would rise elsewhere, including uncompensated care at hospitals.
Minnesota House Speaker Lisa Demuth, a Republican, said the state's
program was not sustainable.
“It wasn’t about trying to be non-compassionate or not caring about
people," she said. "When we looked at the state budget, the dollars
were not there to support what was passed and what was being spent.”
Demuth also noted that children will still have coverage, and adults
lacking permanent legal status can buy private health insurance.
Health care providers also are worried that preventable conditions
will go unmanaged, and people will avoid care until they end up in
emergency rooms – where care will be available under federal law.
One of those safety-net public hospitals, Cook County Health in
Chicago, treated about 8,000 patients from Illinois’ program last
year. Dr. Erik Mikaitis, the health system’s CEO, said doing so
brought in $111 million in revenue.
But he anticipated other providers who billed through the program
could close, he said, adding: “Things can become unstable very
quickly.”
Monthly fees, federal policies create barriers
State lawmakers said California’s Medi-Cal changes stem from budget
issues — a $12 billion deficit this year, with larger ones projected
ahead. Democratic state leaders last month agreed to stop new
enrollment starting in 2026 for all low-income adults without legal
status. Those under 60 remaining on the program will have to pay a
$30 monthly fee in 2027.
States are also bracing for impact from federal policies. Cuts to
Medicaid and other programs in the recently signed massive tax and
spending bill include a 10% cut to the federal share of Medicaid
expansion costs to states that offer health benefits to immigrants
starting October 2027.
California health officials estimate roughly 200,000 people will
lose coverage after the first full year of restricted enrollment,
though Gov. Gavin Newsom maintains that even with the rollbacks,
California provides the most expansive health care coverage for poor
adults.
Every new bill requires a shift in Maria's monthly calculations to
make ends meet. She believes many people won’t be able to afford the
$30-a-month premiums and will instead go back to self-medication or
skip treatment altogether.
“It was a total triumph,” she said of Medi-Cal expansion. “But now
that all of this is coming our way, we’re going backwards to a worse
place.”
Fear and tension about immigration raids are changing patient
behavior, too. Providers told the AP that, as immigration raids
ramped up, their patients were requesting more virtual appointments,
not showing up to routine doctor’s visits and not picking up
prescriptions for their chronic conditions.
Maria has the option to keep her coverage. But she is weighing the
health of her family against risking what they’ve built in the U.S.
“It’s going to be very difficult,” Maria said of her decision to
remain on the program. “If it comes to the point where my husband
gets sick and his life is at risk, well then, obviously, we have to
choose his life.”
___
Associated Press journalist Godofredo Vasquez in San Francisco
contributed to this report. Shastri reported from Milwaukee.
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