By Carolyn Bick
NORTHWEST ASIAN WEEKLY
Agencies, organizations, and individuals across Washington are scrambling to find ways to provide health coverage for at least 12,000 non-citizen immigrants who will lose state health coverage come Oct. 1, due to provisions in the so-called One Big Beautiful Bill, or H.R. 1. More than 1,300 additional elders and people with disabilities will also lose coverage.
The bill, which President Donald Trump signed into law on July 4, 2025, tightens restrictions on who is eligible for state health coverage, which in Washington is known as Apple Health. The bill also restricts who is eligible for Medicaid, the joint state and federal health coverage program. While undocumented immigrants have never been eligible for state coverage, other non-citizen immigrants have historically been eligible for it.
“So now our refugees and asylees are going to have to have a green card in order for them to get Apple Health, to get Medicaid,” Daphne Pie, Public Health – Seattle & King County (PHSKC)’s regional health services administrator for the health agency’s Access and Outreach Program, told KUOW in July. “There will be some exceptions. For example, individuals who are from the COFA (Compact of Free Association) Islanders, Marshallese—they will be exempt. Haitian and Cuban individuals will be exempt. But our non-citizens, refugees, asylees, and other categories like [Afghanis]—they have special permission to be here—they will also need to have that green card to get Apple Health.”
Local preparations, concerns
Local organizations, including the Chinese Information and Service Center, have been working around the clock to try to help those who will lose coverage. Michael Itti, the center’s executive director, said that up to 70 clients will lose health coverage and long-term care benefits. Several of them are Ukrainian, and at least one person belongs to the Asian American community.
“We are working with state and local partners to see if they can access other programs for the most urgent medical needs,” he said. “We’re still working on the pathways, which are limited. Hopefully the most urgent cases can utilize the state Medical Care Services program, however, it’s expected to get more applicants due to H.R. 1.”
He said that a group of organizations, including CISC, formed the No Cuts to Healthcare Coalition. Rep. Pramila Jayapal held a roundtable with the group in early August.
The provisions in H.R. 1 have overlapping negative effects for non-citizen survivors of crime, as well as their families, Mary Le Nguyen told the Northwest Asian Weekly in an email. Le Nguyen serves as the executive director for API Chaya, a grassroots organization that works to help survivors of domestic violence who come from marginalized communities. The organization is survivor-led.
While federal laws recognize that non-citizen survivors of crimes deserve legal rights and protections through avenues like the Victims of Trafficking and Violence Protection Act and asylum, long immigration processing times often mean survivors wait for years without legal documentation. This prevents them from rebuilding and moving forward with their lives, she said.
“During this period, they rely on organizations like ours to meet basic needs, including access to healthcare,” she said. “For survivors of domestic violence, sexual assault, and human trafficking, healthcare is not a luxury—it is essential to their safety, recovery, and long-term wellbeing. Taking away that access would place some of our most vulnerable community members at even greater risk and undermine their ability to heal and move forward.”
Ever-tighter restrictions mean ever-decreasing coverage
One of the biggest obstacles, Pie told KUOW, is figuring out who is a citizen and who is not. In most cases, she said, if a refugee or asylee has moved to green card status, agencies can get them back on Apple Health, if they meet income requirements (currently set at up to less than 138% of the federal poverty level). Others may have to meet a five-year residency requirement.
People on Apple Health will also have to meet new work requirements starting on Jan. 1, 2027. Starting at least six months before applying or reapplying for Apple Health, individuals will have had to have made at least $580 per month, or average that amount in the six months leading up to applying for coverage. Other ways to meet this work requirement are if a person is enrolled in an educational program at least half-time, participates in a work program or completes community service for at least 80 hours per month, or has a combination of any of these that total up to 80 hours per month. Any of these options must be ongoing for six months before applying.
Pie also highlighted that agencies are working to figure out whether people are receiving ongoing emergency treatment, such as treatment for cancer or kidney dialysis, or if they are pregnant or have been pregnant within the last year. She said that people could be eligible for a program in Washington, if they meet either of those conditions.
“If the individual doesn’t meet any of those categories, the next thing we’re going to ask them is if they have a physical or mental condition that prevents them from working, because if they do, what we have to do next is we want to do an application to Department of Social and Health Services and see if the client is going to be eligible for housing and essential needs program,” she said.
If a person is eligible for none of that, she said, they may purchase health coverage under a qualified health plan. These plans range in price, and a person will have monthly premiums and copays.
For immigrants who rely on Apple Health, any extra hurdles or interruptions in coverage could be fatal.
“Some of our community members who are losing coverage are managing serious health conditions while receiving the essential medical care that allows them to remain in our communities with dignity,” the Washington Immigrant Solidarity Network (WAISN) said in a statement. “Without social safety nets at the state level and now having our medical coverage defunded by the people in power who claim to support immigrants, many individuals will be barred from accessing the list for organ donations, many will also experience worsening health conditions, unnecessary hospitalization, institutionalization, and may even be left to die.”
These immigrants are already facing the federal government’s mass detention and deportation agenda, WAISN said, and excluding them “from vital access to healthcare because of their immigration status in a state like Washington that has pledged to support us is incongruent with state values, and point blank inhumane and increasingly destabilizing to Washington communities.”
Uncertain future
In order to try to prepare people, Pie said that PHSKC sent out letters on July 1 urging people to update their citizenship status, if they haven’t yet, but are eligible. Still, she said, there is only so much the state and local agencies can do, as people slowly lose benefits and assistance.
“Back in October [2025], it started with DACA, Deferred Action for Childhood Arrival. They lost their premium assistance. Then in January, it was residents who are here legally on a green card, income is under 100% of the federal poverty level,” she said.
“They lost their premium tax credit. So this is a gradual hit that we continue to take because as we get to January, we’ll be subject to Apple Health work requirements, and then people on Medicare who are non-citizen losing [coverage].”
Pie told KUOW that her biggest fear is that, on Oct. 1, people will suddenly find that they are without access to life-saving medications and important behavioral health service coverage.
“That really hurts. … I know all the work we do, all the work our partners do, because our partners are just embedded in this. We’re still going to miss clients,” she said. “There’s still going to be those clients that are going to walk in and they’ve lost their coverage. And that’s my biggest fear.”
“These cuts to Apple Health are cuts to our immigrant neighbors, coworkers, and everyday people standing next to us in line at the grocery store,” Le Nguyen emphasized. “The recent pandemic showed us that healthcare is a public health issue. When anyone is left out of our health care system, we are ALL more at risk.”