MINNEAPOLIS — For nearly four decades, Niraphanh Insomphou has called Minnesota home. Like many in the state’s vibrant immigrant community, her family arrived in the 1970s seeking refuge after fleeing conflict in Laos. While her siblings eventually navigated the complex path to U.S. citizenship, Insomphou—who lives with profound intellectual and developmental disabilities and is unable to speak—remained a permanent resident. For almost 40 years, she has relied on the stability of group home care, fully supported by the state’s Medicaid program.
That stability vanished on October 1.
Insomphou is among the roughly 5,550 Minnesotans who have abruptly lost their Medicaid coverage—known in the state as Medical Assistance—following the implementation of the first wave of eligibility changes mandated by the federal “One Big Beautiful Bill Act.” The sweeping federal legislation, which includes significant tax breaks and spending adjustments, has fundamentally altered the landscape of social safety nets for thousands of legally present noncitizens, including refugees, asylees, and humanitarian parolees.
The immediate impact has been a scramble for answers among families and service providers, as the state Department of Human Services (DHS) works to mitigate the fallout. While state officials note that many of those affected can transition to MinnesotaCare—the state’s subsidized health program for low-income residents—the shift is far from seamless.
“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,” said temporary DHS Commissioner John Connolly. “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.”
While Commissioner Connolly emphasizes the state’s proactive stance in providing an alternative, the transition is not a perfect one-to-one replacement. For many, the move to MinnesotaCare introduces new financial burdens in the form of monthly premiums and copays—costs that were previously covered under Medicaid. More significantly, the transition creates a dangerous gap for the most vulnerable.
For a subset of recipients, including individuals like Insomphou who rely on Medicaid-funded home and community-based service waivers, the change is not merely a financial inconvenience—it is a potential catastrophe. These waivers cover essential, non-medical daily needs that MinnesotaCare simply does not provide, ranging from transportation and employment support to the most basic activities of daily living, such as bathing, dressing, and feeding.
According to DHS estimates, between 200 and 250 Minnesotans who lost their Medicaid coverage rely specifically on these critical waiver services. While agency officials suggest that those with life-threatening illnesses might qualify for Emergency Medical Assistance to bridge the gap, there remains no clear safety net for those whose needs do not meet that specific, high-acuity threshold.
Insomphou’s brother, Soukkay Keomysy, is currently working against the clock to protect his sister. He is attempting to secure a temporary green card and negotiate a private payment plan to cover her care, which he estimates costs approximately $340 per day. It is an exhausting, high-stakes race for a family already burdened by the uncertainty of their loved one’s future.
“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.”
The situation is equally dire for those who lack the support of a family advocate. Staff at the disability services firm providing care for Insomphou highlighted the case of another client, a survivor of torture from Nigeria who arrived in the U.S. without family. Without Medicaid to cover her support services, her future in a stable living environment is increasingly precarious.
The ripple effects are being felt across the state, including in suburbs like Coon Rapids. A 54-year-old refugee living there, who suffers from chronic back and shoulder pain as well as post-traumatic stress disorder, was just days away from beginning a new, long-awaited care plan that included personal care assistance when the cuts took effect. Her 24-year-old son, who spoke on the condition of anonymity due to privacy concerns, explained that the family is now forced to bridge the gap themselves. He must now take time away from his own work and schooling to provide the basic support his mother requires, including preparing meals and coordinating medical transport.
The legal community has been quick to condemn the shift. “This is unprecedented and damaging,” said Eren Sutherland, Director of the Minnesota Disability Law Center. “Many people will lose personal care to get dressed, to eat, to get out of bed, and now won’t have anyone to help.”
The federal legislation creates clear winners and losers based on immigration status. While green card holders who have cleared the mandatory five-year waiting period remain eligible for Medicaid, as do participants in specific programs for Cuban and Haitian entrants, many others have been stripped of their coverage. This includes survivors of human trafficking and domestic violence, as well as immigrants from Ukraine and Afghanistan who arrived in the U.S. under humanitarian parole status.
When the legislation was moving through Congress, proponents framed the cuts as essential fiscal policy. U.S. Senate Majority Leader John Thune, R-S.D., defended the changes at the time, arguing that they were necessary to protect the long-term viability of the Medicaid program. He described the removal of noncitizens 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,” specifically citing vulnerable children, pregnant women, and the elderly.
However, the Medicaid cuts are part of a broader trend of declining support for immigrant populations. Earlier this year, this same group lost access to the Supplemental Nutrition Assistance Program (SNAP), a change that Minnesota officials estimated affected approximately 9,000 residents. Furthermore, many of these individuals face another impending cliff in January, when they will no longer be eligible for Medicare coverage.
Michelle Eberhard, who leads refugee services at the International Institute of Minnesota, believes these systemic changes are eroding the country’s reputation as a place of opportunity. “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, health care providers are warning that the policy will likely backfire, resulting in higher costs for the state and the broader medical system. The Minnesota Hospital Association issued a stark warning regarding the inevitable outcomes of stripping coverage from thousands of residents.
“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 association said in a statement. “The unpaid cost of that care shifts to every other patient, at a time when uncompensated care is already at historic levels. In the end, less coverage for anyone is paid for by everyone who accesses the health care system.”
As the state grapples with the current crisis, officials are also bracing for more widespread disruptions next year. The “One Big Beautiful Bill Act” is set to trigger additional mandates, including stringent work requirements and more frequent eligibility verifications, which experts fear will lead to even more people falling through the cracks of a shrinking safety net. For families like Insomphou’s, the policy shift is not a matter of abstract political debate or fiscal strategy; it is a profound alteration of their daily survival.
