Like many Minnesotans, Niraphanh Insomphou’s family arrived here in the 1970s after her parents fled Laos. Over the decades, her siblings became U.S. citizens, but Insomphou — who has intellectual and developmental disabilities and is unable to speak — did not.

For nearly 40 years, she has lived in group homes and Medicaid has covered her services.

That coverage is about to end.

Refugees, asylees and other noncitizens who are in the U.S. legally will lose Medicaid coverage Oct. 1 as one of the first Medicaid eligibility changes from the “One Big Beautiful Bill Act” takes effect.

Roughly 5,550 people who rely on Medicaid, called Medical Assistance in Minnesota, will lose that coverage this week, according to the state’s Department of Human Services (DHS). However, agency officials said most of those people can shift to MinnesotaCare, the state’s health care program for low-income Minnesotans.

“We are really fortunate that here in Minnesota we have an option for the majority of people affected by this first big federal cut to Medicaid,” temporary DHS Commissioner John Connolly said in a statement. “In most states, there is no health coverage option for this population of lawfully present immigrants which will be devastating to those impacted individuals and harmful to the greater health care system.”

Minnesota officials are bracing for more widespread health care impacts next year when work requirements, increased eligibility checks and other Medicaid mandates from the massive federal tax break and spending package start.

For the thousands of noncitizens shifting to MinnesotaCare, the change will primarily mean new monthly premiums and copays they didn’t need to cover with Medicaid.

But for a small subset of benefit recipients — those with disabilities and chronic illnesses, like Insomphou, who rely on Medicaid-funded home and community-based service waivers — family members and service providers said this change is devastating.

Waiver services can range from transportation to employment support to assistance with daily living, like helping someone bathe. The aid is not covered by MinnesotaCare.

Roughly 200 to 250 Minnesotans who are losing their Medicaid coverage rely on those services, according to the DHS. If people have certain life-threatening illnesses they might qualify for Emergency Medical Assistance to temporarily continue some aid, an agency official said, but there are no other options for those who fall through the new service gap.

Insomphou’s brother, Soukkay Keomysy, contends his sister should not be among those losing Medicaid and is scrambling to get her a temporary green card and figure out a payment plan to cover her services in the meantime, which he said amount to about $340 a day.

Not all individuals have such an advocate, said a staff member with the disability services company providing Insomphou’s care. Another client poised to lose services came to the U.S. from Nigeria, where she was a torture victim, and doesn’t have any family here.

“If they can’t stay where they’re at, some of the options are ... people in group homes being placed in homeless shelters, hospitals,” Keomysy said. “Which is devastating.”

For another woman in Coon Rapids who was supposed to start getting waiver services in October, the change has left her family with stress and uncertainty.

Back and shoulder pain and post-traumatic stress disorder make daily life difficult for the 54-year-old refugee, said her 24-year-old son, who asked not to be named due to safety and privacy concerns. His mother was about to receive long-awaited help, including personal care assistance.

“Those are services that she needs and she was waiting for,” he said.

Family members must take time off work or school to support her, he said, including making her meals and bringing her to medical appointments.

“This is unprecedented and damaging,” Minnesota Disability Law Center Director Eren Sutherland said in a statement. “Many people will lose personal care to get dressed, to eat, to get out of bed, and now won’t have anyone to help.”

This Medicaid change does not affect green card holders, who will generally continue to be eligible for the health coverage after they go through the previously-mandated five-year waiting period. People who are part of the Cuban and Haitian entrant program and those from a few Pacific Islands will also still qualify.

But immigrants from Ukraine and Afghanistan who are in the U.S. on humanitarian parole are among the groups that will lose Medicaid coverage, as are some human trafficking and domestic violence survivors.

When Republicans in Congress pushed for the various Medicaid changes last year, U.S. Senate Majority Leader John Thune, R-S.D., said they were trying to preserve and strengthen the program for those it was intended to serve, including vulnerable children, pregnant moms and the elderly.

He described removing noncitizens and others from the rolls as “commonsense reforms to Medicaid to eliminate waste, fraud and abuse and protect the program for the people who need it the most.”

Refugees, asylees and other legal non-citizens are not just losing Medicaid under the “Big Beautiful Bill.”

Earlier this year they lost their Supplemental Nutrition Assistance Program (SNAP) benefits. Minnesota officials estimated about 9,000 fewer refugees and other non-citizens could no longer get food stamps.

And in January, many in that group will no longer be eligible for Medicare coverage.

The changes are making the U.S. a less welcoming place for people seeking a better life, said Michelle Eberhard, who leads refugee services at the International Institute of Minnesota.

“The refugee program is a very small part of immigration in this entire country, but I think it represents a lot of hope to a lot of people, and a lot of opportunity,” Eberhard said. “Unfortunately, we just have to think about that differently going forward.”

Meanwhile, hospital officials warn the multitude of Big Beautiful Bill changes will exacerbate a growing health care crisis and have broad impacts.

“Minnesotans who lose coverage still receive care, but they often put it off until they are sicker and need more intensive, more expensive treatment. The unpaid cost of that care shifts to every other patient, at a time when uncompensated care is already at historic levels,” the Minnesota Hospital Association said in a statement. “In the end, less coverage for anyone is paid for by everyone who accesses the health care system.”

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