Minnesota family stuck without care after thousands of immigrants lose Medicaid coverage

In a sunny room at a Twin Cities-area assisted living home, a young woman leans down to squeeze her mother’s hand, as she sits in a wheelchair.

The care facility has been the mother’s home for four years. Here, she gets care for a brain injury sustained in a bombing at the Kabul airport. She can’t walk or take care of herself — but she can answer basic questions and laugh at her daughter’s jokes in her weekly visits.

Both women are asylees from Afghanistan, and asked to remain anonymous out of fear of retaliation from the federal government based on their immigration status. Speaking in Farsi with an interpreter, the daughter said the care home covers what her mother needs for day-to-day life.

“They provided us all the medication which is required,” she said. “My mother requires 24-hours-a-day care, and that is the kind of place she will need.”

But in the coming days, she may have to move her mother out — and the family doesn’t know where she’ll go. Her Medicaid benefits, which covered her stay in this care home, ended on Oct. 1, due to federal rule changes enacted in the “one big beautiful bill.”

“We are in a stressful situation,” her daughter said. “We are thinking all day long, day and night, to find out the solution.”

So far, she doesn’t have one. Advocates for the family — and for immigrants in similar situations — say it’s creating a massive strain for them, and for the agencies and counties that are now scrambling to cover their care.

What rules changed?

According to Minnesota’s Department of Human Services, more than 5,000 immigrants in the state lost Medicaid coverage due to the federal rule change this week.

Under the old rules, immigrants in the United States legally — including refugees and asylees — were eligible for Medicaid before they got their green card. The new rule eliminates eligibility for anyone over the age of 21 and not pregnant who doesn’t yet have a green card.

The impacted group also includes Afghan and Ukrainian humanitarian parolees, trafficking victims, noncitizens protected under the Violence Against Women Act, and qualified noncitizen veterans living in Minnesota.

“The Trump Administration has a public mandate, a statutory obligation, and a moral duty to safeguard our federal healthcare programs,” said Centers for Medicare & Medicaid Services Administrator Dr. Mehmet Oz in a statement announcing guidance on Medicaid changes.

A spokesperson at DHS said that most of the individuals impacted — about 75 percent — will qualify for the state’s insurance program, Minnesota Care.

But Minnesota Care doesn’t cover some of the services that Medicaid waivers do. Those allow people to get care and support in their homes and communities — like the care home service that the Afghan woman receives.

DHS has identified more than 200 people receiving waiver services who are losing their coverage.

A family ‘trapped’

The daughter found out about the rule change via a letter in the mail from DHS, notifying her that her mother would no longer be eligible for Medicaid under the new rules. She saw it less than two weeks ago. The family appealed the end of care, but has not heard an answer.

They believe the mother will also lose access to her wheelchair, which was paid for through Medicaid.

The daughter says she can’t take her mother in; she lives in an apartment with no elevator, and has to leave home to go to work.

She asked for help from Michael Van Keulen. He’s the executive director of Open Path Resources, a Twin Cities organization helping immigrant communities navigate life in Minnesota.

Van Keulen said the family has only found two possibilities for the mother, should she have to leave the care home: a homeless shelter, or a stay at Hennepin County Medical Center.

A homeless shelter, he said, is off the table. They’re not equipped to accommodate the mother’s need for around-the-clock care.

And the county hospital isn’t an ideal option, either.

“They'll have to take up a bed with no solution in sight, no change in sight, and dramatically more expensive model of care,” Van Keulen said.

For now, the woman is still in the care home. The home’s director told MPR News she worked out a plan to keep her there for a few extra days, with the home taking on the cost of her care. But after that, the small, seven-bed home can’t afford to cover the bill for her care.

The daughter said the problem would also be solved if they were able to get their green cards, which she says her family applied for two years ago. But their applications are still pending.

According to the Department of Homeland Security, current processing times for green card applications are about three years. Immigration experts in the Twin Cities say that, a few years ago, it took just nine months.

Van Keulen said that leaves the family squeezed from two sides, with no word on their green cards and no word on how to access the healthcare they need without them.

“These are people intentionally trapped into a status that's being attacked,” Van Keulen said.

Looking for solutions

Immigrant assistance organizations are helping eligible clients transfer over to Minnesota Care. But the process can be tricky to navigate.

Michelle Eberhard, director of refugee services at the International Institute of Minnesota, said every individual is in a different situation. Some people received letters informing them that they’d been automatically switched to Minnesota Care; others received another letter from DHS with forms and instructions to apply for Minnesota Care.

“It's not totally clear to me kind of how someone ends up in one process versus the other,” Eberhard said.

The result is a logistical maze.

“The concern I have is that there are people who may not really understand what's happened, and if there was an action that was needed prior to Oct. 1, that could be problematic because they would go into the month potentially not covered,” Eberhard said.

Van Keulen said the family he works with has not found a way to get the woman’s current needs covered under Minnesota Care. He’s gone to officials in Hennepin County and state legislators to ask for help.

Hennepin County Commissioner Heather Edelson said the county is scrambling, too. She’s been on the phone with constituents and case managers, trying to figure out what is and isn’t covered in different people’s unique cases.

“We want to figure out how to get people the care they need, but the county also can't take on costs that can't be covered for every single person that is not able to get Minnesota Care,” Edelson said.

She said it’s part of a broader concern she has about the federal government cutting benefits and leaving counties to fill the gaps. In this instance, she said, the county is now on the hook for finding care for people, or paying their hospital bills if they can’t stay in their current care situations.

“We're trying to figure out with all of the changing rules how we can actually be helpful, and there's a lack of resources with an abundance of people to help,” Edelson said.

The family at the center of this situation is hoping they find an answer before they need to move the mother out of her home — and likely into Hennepin County Medical Center.

The daughter said she’s grateful for all the help she’s getting, and for the benefits the government has provided her mother before. But after surviving a bombing and going through the process to get asylum and apply for green cards, she said, she feels like the government is breaking a promise to her and her family.

“You leaving us here in this situation is injustice,” she said. “We were not expecting this situation. We came here as legal immigrants … we followed rules and policy.”

The Minnesota DHS Refugee and Immigrant Helpline remains available for free at 1-800-814-4806, and individuals can call to connect with resources for healthcare and insurance.

MPR News health reporter Erica Zurek contributed to this story

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