A refugee who uses Medicaid for herself and her newborn.

An immigrant trying to schedule surgery in the next three months.

A sick relative in a multigenerational household who relies on Medicaid for affordable medication.

Because of their immigration status, these Mainers and more than 620 others may soon lose full Medicaid coverage when sweeping eligibility changes take effect in October, said Dina Malual, policy advocate at the Maine Equal Justice nonprofit.

“There’s a lot of fear and anxiety,” said Malual, who spoke with dozens of immigrants at risk of losing MaineCare — the state’s name for Medicaid — at a recent training in Augusta. “I think the biggest concern is for people who have upcoming surgeries or who have health conditions that require more appointments. We’re really going to see this group slipping through the cracks.”

The change, part of the Trump administration’s budget law that initiated extensive cuts to the Medicaid program last year, makes some legal immigrants, including refugees and asylees, ineligible for nonemergency coverage beginning Oct. 1. Those who have obtained green cards are still eligible for Medicaid.

The Maine Department of Health and Human Services sent a letter to 627 immigrants on July 1 informing them that they will likely lose full MaineCare coverage. Those who lose full coverage will transition to Emergency Services MaineCare, the letter said. Receiving an “early awareness” letter does not mean a formal decision has been made.

Without coverage, though, experts say more immigrants will avoid healthcare settings and forgo care. One person at the training in Augusta said if they can’t schedule a critical surgery by Oct. 1, they won’t be able to afford it and will have to cancel, Malual said.

Panagioti Tsolkas, communications manager for the Maine Immigrants’ Rights Coalition, said losing access to healthcare would be “devastating” to families. There will still be some healthcare available, such as emergency care and primary care at free health clinics, but “there’s a limit to how much care they can provide.”

Kate Ende, policy director at Consumers for Affordable Health Care in Augusta, said the care that will remain for immigrants losing coverage is a patchwork and not a substitute for comprehensive care.

“These programs aren’t going to cover ongoing medications,” Ende said. “They’re not going to be covering ambulance rides. Oftentimes, lab work is done by a third party — so it’s not a replacement for comprehensive coverage by any means.”

In addition to these changes, Medicaid work requirements go into effect in 2027. The state has estimated about 31,000 people will lose coverage next year as a result of the work requirements, which mandate that some Medicaid recipients work 80 hours per month, attend school or volunteer. 

James Myall, senior economic policy analyst for the Maine Center for Economic Policy, a left-leaning think tank, said when people delay care, it costs the health system more because their conditions worsen.

“Anytime people lose their health coverage, those costs are getting pushed to the rest of us,” Myall said. “It will have an upward pressure on insurance premiums.”

Immigrants losing Medicaid can apply for Affordable Care Act marketplace plans. However, the new law prohibits immigrants who are no longer eligible for Medicaid from qualifying for ACA subsidies, said Lindsay Hammes, a spokesperson for Maine DHHS, making the plans cost-prohibitive.

Malual said another path is changing immigration status. She has encouraged people who are waiting for a green card — a process that can take a year or longer — to reach out to Maine’s Office for Family Independence as soon as they have it in hand.

“You’re now eligible again for MaineCare,” Malual said, once a green card is secured.

Regardless of immigration status, anyone under age 21 in Maine will retain full coverage. People who become pregnant will be eligible for full MaineCare coverage until one year postpartum.

Malual said the new mother she met in Augusta told her she goes to her doctor to discuss pain, breastfeeding and other postpartum issues. After the first year, she said she will lose access to her doctor even as her baby remains covered.

Members of the family caring for their sick relative told Malual that once cut off from MaineCare, they will have to pool their money to pay for prescriptions. Some members of the family have obtained a green card and will remain on MaineCare, while Malual said others won’t because of their immigration status or pending case.

Nonprofits like Maine Equal Justice, Maine Immigrants’ Rights Coalition and the Maine Immigrant Business Coalition said they are working with individuals and families to help them figure out next steps. Leaders also speak with dozens of providers on a monthly call to answer questions about coming eligibility changes and work requirements.

Ende, of Consumers for Affordable Health Care, said the healthcare system works best when everybody can access care in a timely manner.

“When that doesn’t happen, it really erodes the ability of the system to work for everybody,” she said.