MINNEAPOLIS — For Niraphanh Insomphou, the transition to life in the United States has been a journey spanning nearly four decades. Like thousands of other Minnesotans, her family arrived in the state during the 1970s, having fled the upheaval in Laos to seek a safer, more stable future. While her siblings integrated into the fabric of American society, eventually becoming U.S. citizens, Insomphou’s path was marked by different challenges. Living with intellectual and developmental disabilities that render her unable to speak, she has relied on the consistent, foundational support of Medicaid for nearly 40 years to maintain her residency in a group home and receive the specialized care necessary for her daily existence.
That stability evaporated on Oct. 1.
As of the first of the month, a significant shift in federal health policy — stemming from the "One Big Beautiful Bill Act" — has officially stripped Medicaid eligibility from thousands of refugees, asylees, and other noncitizens who are lawfully present in the United States. This legislative change marks the first major wave of eligibility adjustments under the new federal law, creating a sudden and profound gap in the safety net for some of the state’s most vulnerable residents.
According to the Minnesota Department of Human Services (DHS), approximately 5,550 people who previously relied on Medical Assistance, the state’s version of Medicaid, have been disqualified under the new federal mandates. While state officials are working to transition these individuals into MinnesotaCare — the state’s health care program designed for low-income residents — the shift is far from seamless and is not a complete solution for everyone impacted.
"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 a recent 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."
While the state is attempting to mitigate the damage, the situation remains precarious. Minnesota officials are currently bracing for further, more widespread impacts next year, when additional provisions of the massive federal tax break and spending package — including new work requirements and more rigorous eligibility verification processes — begin to take full effect.
For the thousands of noncitizens shifting to MinnesotaCare, the immediate reality is a shift in financial burden. Unlike the Medicaid coverage they lost, MinnesotaCare requires monthly premiums and copays, introducing a new, often prohibitive cost for families struggling with limited incomes. However, for a small but critical subset of these individuals, the change is far more than a financial inconvenience.
People like Insomphou, who rely on Medicaid-funded home and community-based service waivers, are facing a potential crisis. These waivers provide essential support ranging from transportation and employment assistance to the most basic needs, such as help with bathing, dressing, and eating. Crucially, these specific waiver services are not covered under the MinnesotaCare program.
State data indicates that between 200 and 250 Minnesotans who are losing their Medicaid coverage depend entirely on these life-sustaining waiver services. While DHS officials noted that individuals with certain life-threatening illnesses might qualify for Emergency Medical Assistance to provide a temporary bridge for some aid, there are virtually no alternative resources for those who fall into this newly created service gap.
For Insomphou’s brother, Soukkay Keomysy, the news has been both shocking and overwhelming. He contends that his sister, who has been a productive member of her community for decades, should never have been swept up in these eligibility cuts. In a race against time, Keomysy is scrambling to secure a temporary green card for his sister, hoping it might restore her eligibility, while simultaneously attempting to navigate a payment plan for the private care she now requires. The costs are staggering, estimated at approximately $340 per day.
The situation is particularly dire for those who lack a family advocate. A staff member at the disability services company providing care for Insomphou noted that other clients are in even more precarious positions. One client, a torture survivor from Nigeria, now finds herself stripped of her services without any family in the U.S. to help her navigate the bureaucracy or pay for her essential needs.
"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 ripple effects of this policy change are being felt throughout the state. In Coon Rapids, a 54-year-old refugee who suffers from chronic back and shoulder pain, along with post-traumatic stress disorder, is now in limbo. Her son, a 24-year-old who spoke on the condition of anonymity due to privacy concerns, explained that his mother had finally been approved for long-awaited personal care assistance just as the policy change took effect.
"Those are services that she needs and she was waiting for," he said. Now, the family is forced to step in, with members taking time off from work and school to provide the care that was previously managed through state programs, including preparing her meals and transporting her to medical appointments.
The legal community is also sounding the alarm. "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."
While the legislation specifically targets certain groups, it does include exceptions. Green card holders who have cleared the mandatory five-year waiting period remain eligible for coverage, as do those enrolled in the Cuban and Haitian entrant programs and residents from specific Pacific Islands. However, the cuts are broad, affecting many who have arrived under humanitarian parole, including immigrants from Ukraine and Afghanistan, as well as survivors of human trafficking and domestic violence.
When the "One Big Beautiful Bill" was debated in Congress, supporters framed the changes as a necessary correction to the federal budget. Senate Majority Leader John Thune, R-S.D., argued that the measures were essential to preserve the long-term viability of Medicaid for its core beneficiaries: vulnerable children, pregnant mothers, and the elderly. He characterized the removal of 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."
However, the loss of Medicaid is only one piece of a broader trend. Earlier this year, this same population lost their eligibility for the Supplemental Nutrition Assistance Program (SNAP), an adjustment that state officials estimate impacted approximately 9,000 refugees and noncitizens in Minnesota. In January, the situation will tighten further, as many in this group will lose their eligibility for Medicare coverage as well.
These compounding losses are fundamentally altering the experience of those seeking refuge in the United States, according to 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."
Beyond the individual toll, health care providers are warning of systemic consequences. The Minnesota Hospital Association has issued a stark warning that the changes will exacerbate an already strained health care system. When patients lose access to consistent, preventative care, they often delay seeking treatment until their conditions become acute and require emergency intervention.
"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 stated. "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."
