On Oct. 1 a sweeping eligibility change will take effect in Ohio, stripping Medicaid coverage from thousands of people who are legally present in the United States but have not yet secured permanent residency. The groups affected include refugees awaiting green cards, asylees, parolees and survivors of domestic violence or human trafficking who have been covered since the program’s expansion in 1996. When the state re-evaluates eligibility, those deemed ineligible will be shifted to a limited emergency-only plan, leaving them without routine or preventive care.
State officials from the Ohio Department of Medicaid say the minimum impact will be 3,500 individuals losing full coverage, with an additional 3,000 possibly falling under the emergency-only tier. spokesperson Stephanie O’Grady confirmed these figures but declined to explain why local agencies report much higher numbers.
County officials estimate a far larger loss
Four of Ohio’s most populous counties provided their own calculations, suggesting the statewide impact could be between 14,500 and 18,000 people. In Franklin County, a Jobs and Family Services representative estimated that anywhere from 8,000 to 12,000 residents might lose Medicaid. Cuyahoga County reported that 3,500 individuals received notices of possible ineligibility, while Summit County put its figure at roughly 800. Lorain County’s count was under 500. County director Christopher Cabot noted the effect “is not as impactful in total in Lorain County as I thought it would be, but it is impactful to those that are losing eligibility.”
The discrepancy between state and county estimates highlights the difficulty of tracking immigration status. Data sources vary, and agencies often have to cross-reference multiple databases or rely on educated guesses. Immigration status can shift frequently, and coordination between local offices and federal immigration authorities is far from seamless.
Policy backdrop and financial stakes
The eligibility shift is one of the first concrete outcomes of the federal legislation known as the One Big Beautiful Bill Act—formally HR 1—signed during the second term of President Donald Trump. Ohio is projected to lose about $33 billion in federal Medicaid dollars over the next ten years, largely because of new work-requirement provisions that will not begin until next year. The Congressional Budget Office estimates that, nationwide, roughly 100,000 legal immigrants without permanent status could lose Medicaid by 2034 cutting federal spending by about $6.2 billion.
Beyond the immediate loss of coverage, experts warn of broader consequences. Ben D’Avanzo of the National Immigration Law Clinic called the move “incredibly cruel,” emphasizing that most of those affected work and pay taxes. He explained that access to healthcare is a foundational element for stable employment and family well-being, and that uninsured care often shifts costs onto other parts of the system.
For many refugees and asylum seekers, the timing is especially harsh. They are often caught in lengthy green-card backlogs and may regain eligibility in a few years, but in the interim they could face untreated medical conditions. As D’Avanzo put it, “they’re stuck in backlogs. So these are people who in a couple of years may have Medicaid again and are going to have health care or medical conditions that are untreated in the meantime.”
