For nearly 20 years, Maria would call her sister \u2014 a nurse in Mexico \u2014 for advice on how to manage her asthma and control her husband\u2019s diabetes instead of going to the doctor in California.<\/p>\n
She didn\u2019t have legal status, so she couldn\u2019t get health insurance and skipped routine exams, relying instead on home remedies and, at times, getting inhalers from Mexico. She insisted on using only her first name for fear of deportation.<\/p>\n
Things changed for Maria and many others in recent years\u00a0when a handful of Democrat-led states opened up their health insurance programs to low-income immigrants regardless of their legal status<\/a>. Maria and her husband signed up the day the program began last year.<\/p>\n \u201cIt changed immensely, like from Earth to the heavens,\u201d Maria said in Spanish of Medi-Cal, California\u2019s Medicaid program<\/a>. \u201cHaving the peace of mind of getting insurance leads me to getting sick less.\u201d<\/p>\n At least seven states and the District of Columbia have offered coverage for immigrants since mostly 2020. But three of them have done an about-face, ending or limiting coverage for hundreds of thousands of immigrants who aren\u2019t in the U.S. legally in California, Illinois and Minnesota.<\/p>\n The programs cost way more than officials had projected at a time when the states are facing multibillion-dollar deficits now and in the future. In Illinois, adult immigrants ages 42-64 without legal status have\u00a0lost their health care<\/a>\u00a0to save an estimated $404 million. All adult immigrants in Minnesota\u00a0no longer have access<\/a>\u00a0to the state program, saving nearly $57 million. In California, no one will automatically lose coverage, but\u00a0new enrollments for adults will stop<\/a>\u00a0in 2026 to save more than $3 billion over several years.<\/p>\n Cuts in all three states were backed by Democratic governors who once championed expanding health coverage to immigrants.<\/p>\n The Trump administration this week shared the home addresses, ethnicities and personal data of all Medicaid recipients<\/a>\u00a0with U.S. Immigration and Customs Enforcement officials. Twenty states, including\u00a0California, Illinois and Minnesota<\/a>, have sued.<\/p>\n Health care providers told The Associated Press that everything, especially the fear of being\u00a0arrested or deported<\/a>, is having a chilling effect on people seeking care. And states may have to spend more money down the road because immigrants will avoid preventive health care and end up needing to go to safety-net hospitals.<\/p>\n \u201cI feel like they continue to squeeze you more and more to the point where you\u2019ll burst,\u201d Maria said, referencing all the uncertainties for people who are in the U.S. without legal permission.<\/p>\n \u2018People are going to die\u2019<\/p>\n People who run free and community health clinics in California and Minnesota said patients who got on state Medicaid programs received knee replacements and heart procedures, and were diagnosed for serious conditions like late-stage cancer.<\/p>\n CommunityHealth is one of the nation\u2019s largest free clinics, serving many uninsured and underinsured immigrants in the Chicago area who have no other options for treatment. That includes the people who lost coverage\u00a0July 1<\/a>\u00a0when Illinois ended its Health Benefits for Immigrants Adults Program, which served about\u00a031,500 people<\/a>\u00a0ages 42-64.<\/p>\n One of CommunityHealth\u2019s community outreach workers and care coordinator said Eastern European patients she works with started coming in with questions about what the change meant for them. She said many of the patients also don\u2019t speak English and don\u2019t have transportation to get to clinics that can treat them. The worker spoke to the AP on condition of anonymity to protect patients\u2019 privacy.<\/p>\n HealthFinders Collaborative in Minnesota\u2019s rural Rice and Steele counties south of Minneapolis serves low-income and underinsured patients, including large populations of Latino immigrants and Somali refugees. Executive director Charlie Mandile said they\u2019re seeing patients rushing to squeeze in appointments and procedures before 19,000 people age 18 and older are kicked off of insurance at the end of the year.<\/p>\n Free and community health clinics in all three states say they will keep serving patients regardless of insurance coverage \u2014 but that might get harder after the U.S. Department of Health and Human Services decided this month\u00a0to restrict federally qualified health centers from treating people without legal status<\/a>.<\/p>\n CommunityHealth CEO Stephanie Willding said she always worried about the stability of the program because it was fully state funded, \u201cbut truthfully, we thought that day was much, much further away.\u201d<\/p>\n \u201cPeople are going to die. Some people are going to go untreated,\u201d Alicia Hardy, chief executive officer of CommuniCARE+OLE clinics in California, said of the state\u2019s Medicaid changes. \u201cIt\u2019s hard to see the humanity in the decision-making that\u2019s happening right now.\u201d<\/p>\n A spokesperson for the Minnesota Department of Human Services said ending the state\u2019s program will decrease MinnesotaCare spending in the short term, but she acknowledged health care costs would rise elsewhere, including uncompensated care at hospitals.<\/p>\n Minnesota House Speaker Lisa Demuth, a Republican, said the state\u2019s program was not sustainable.<\/p>\n \u201cIt wasn\u2019t about trying to be non-compassionate or not caring about people,\u201d she said. \u201cWhen we looked at the state budget, the dollars were not there to support what was passed and what was being spent.\u201d<\/p>\n Demuth also noted that children will still have coverage, and adults lacking permanent legal status can buy private health insurance.<\/p>\n Health care providers also are worried that preventable conditions will go unmanaged, and people will avoid care until they end up in emergency rooms \u2013 where care will be available under federal law.<\/p>\n One of those safety-net public hospitals, Cook County Health in Chicago, treated about 8,000 patients from Illinois\u2019 program last year. Dr. Erik Mikaitis, the health system\u2019s CEO, said doing so brought in $111 million in revenue.<\/p>\n But he anticipated other providers who billed through the program could close, he said, adding: \u201cThings can become unstable very quickly.\u201d<\/p>\n Monthly fees, federal policies create barriers<\/p>\n State lawmakers said California\u2019s Medi-Cal changes stem from budget issues \u2014\u00a0a $12 billion deficit<\/a>\u00a0this year, with larger ones projected ahead. Democratic state leaders last month agreed to stop new enrollment starting in 2026 for all low-income adults without legal status. Those under 60 remaining on the program will have to pay a $30 monthly fee in 2027.<\/p>\n