About 9,000 non-U.S. citizens in Rhode Island will lose their healthcare coverage Thursday, thanks to changes in federal law regarding who qualifies for Medicaid, the government program that covers people with low incomes.
Under legislation championed by the Trump administration passed in July 2025, many lawfully present immigrants will no longer be eligible for Medicaid. Undocumented immigrants were already ineligible for Medicaid, but the new rules cut access for many refugees, asylees without green cards and other immigrants with certain visa statuses.
While the impact of these changes is limited to refugees or people with asylum status, local healthcare professionals are expecting even more Rhode Islanders to lose Medicaid coverage next year because of new work requirements.
Ocean State Media morning host Luis Hernandez spoke with Erin Fuse Brown, a professor of health policy at the Brown University School of Public Health, about whether safety net providers in Rhode Island are prepared to meet the challenge posed by the addition of tens of thousands of uninsured people across the state.
Editor’s note: For more information about changes to Rhode Island’s Medicaid program, visit the website for Stay Covered RI.
Interview highlights
On who is losing Medicaid coverage in Rhode Island on Oct. 1
Erin Fuse Brown: The people who are going to be affected by this are non-citizens who were previously eligible for Medicaid, including many who were, for example, refugees or asylees or victims of domestic abuse or trafficking. Those are now categories who are now ineligible. Even if they are here legally, they're no longer eligible for Medicaid under the new law…
Lawful permanent residents – these are people who have green cards, particularly those who've already been in the country for five years – as well as Cuban and Haitian entrants, are still going to be eligible for Medicaid. As well, in Rhode Island, children and pregnant and postpartum people will still be eligible for Medicaid.
I think that this is going to create a lot of both health hardship (and) economic hardship. It's going to create a sense of crisis in some ways for people who have no other way of getting healthcare coverage in today's environment.
On the impact of thousands of Rhode Islanders losing Medicaid coverage
Fuse Brown: For the people who are going to lose their Medicaid coverage, technically they are still able to go to Health Source Rhode Island, which is the state's Affordable Care Act marketplace, and buy coverage. But they won't be eligible for any help or subsidies to help them pay for that, which, if you are low income enough to be on Medicaid, will make those Affordable Care Act policies out of reach for those people.
I think the assumption is most of the folks who lose coverage on Oct. 1 will become uninsured. And what happens to the healthcare system when all these people are uninsured is that they still need healthcare, and when they show up to the emergency department, they're not going to be able to pay those bills.
So the health system is going to have a larger burden of uncompensated care, bills that people cannot pay, and that's going to strain the existing safety net hospitals and providers that see a lot of low-income patients. But it also means, for those people who lose their coverage, that they're not just going to continue on with their care as they normally have. They're probably going to start scrimping and saving. They're going to make some choices, maybe delaying care that they don't think that they need urgently right now. That may mean that they don't get their preventative screenings, that they skip medications or they ration their care in some other way. That also could show up as more severe emergency department visits down the line.
On what Rhode Island lawmakers can do to help
Fuse Brown: There's very little that individual state legislatures can do to alter the rules that the federal government puts in place for Medicaid. So yes, it is a combined federal-state program. But generally speaking, when the federal government, as it did in this bill, in H.R.1, says, "this is a group that's categorically ineligible," the state doesn't have a lot of wiggle room to extend coverage to these folks.
The one thing that the state has done, and other states have done as well, is to extend coverage to undocumented and documented non-citizens who are children or pregnant… using state dollars. So the state basically has to come up with the entire share. Normally, the federal government funds the majority of those costs. But for these optional non-citizen policies that the state has extended for children and pregnant people, those are going to be covered entirely with state funds.
On the long-term consequences of the new federal Medicaid law
Fuse Brown: My sense is that we are facing a tidal wave change. I think that this is just the first hit of folks who are going to lose coverage on Oct. 1. It’s just the first wave of a larger shift in the Medicaid program. We also anticipate
in Rhode Island an additional 24,000 people (that) are going to lose coverage in January because of the implementation of new work requirements in the Medicaid program. So we're going to see a lot of people become uninsured. We're going to see a lot of strain, again, on the safety-net providers. I think that this is going to create a lot of both health hardship (and) economic hardship. It's going to create a sense of crisis in some ways for people who have no other way of getting healthcare coverage in today's environment.
