About 3,500 Cuyahoga County residents who came to the United States legally could lose Medicaid coverage Oct. 1 because they are not U.S. citizens.
That’s how many people received a notice that their insurance could be cut when new federal rules go into effect Oct. 1, said Kevin Gowan, the county’s director of Job and Family Services. The rules, passed by the Trump administration last year, limit which non-U.S. citizens can enroll in Medicaid.
The rules stop refugees and other non-citizens without lawful permanent residence from receiving Medicaid. Refugees are people who are granted permission to be in the United States because of persecution or well-founded fear of persecution in their home country.
Most people who received the letter in Cuyahoga County are refugees or Ukrainians on humanitarian parole, said Patrick Kearns, the director of Re:Source Cleveland, a nonprofit that supports international newcomers to Greater Cleveland. The Ukrainians in that status came to the United States after Russia invaded Ukraine in 2022.
Kearns is working alongside the county to build an “immigration hub” to help families continue to access healthcare. But there’s no local solution to the loss of federal programs, he said.
“October is only the first date,” Kearns said, adding that Medicaid work requirements and restrictions on Medicare access for non-citizens will both come online in January. “Every hospital and every clinic in our community is going to bear the cost of all three of these.”
Kearns told the story of one refugee family — a mom and two adult children — who expect to lose coverage. The family arrived in Cleveland in 2024 from the Democratic Republic of Congo. The children work and support their 60-year-old mom, who is chronically ill. Medicaid currently covers her medication and doctors’ appointments, Kearns said.
He worries she will start skipping appointments. But eventually, she’ll likely need a doctor — or the emergency room, he said.
“At that point, one of two things will happen. Either the family receives a bill that they cannot pay on entry-level wages, or a local provider absorbs the cost,” Kearns said.
One group of refugees who will be able to keep Medicaid coverage are children under age 21 and women who are pregnant or postpartum, Gowan said. Cuban-Haitian entrants and citizens of the Marshall Islands, Micronesia or Palau will still be eligible as well. Green-card holders — or lawful permanent residents — can still get Medicaid after a five-year waiting period.
The members of the family Kearns spoke about have applied for green cards, which would restore their Medicaid. But the federal government paused green card processing for refugees, he said.
Cleveland healthcare providers brace for insurance cuts
The shrinking safety net is a challenge for both patients and providers.
Neighborhood Family Practice is the primary health care provider for the three refugee resettlement agencies in Greater Cleveland. Domonic Hopson, the president and chief executive officer of Neighborhood Family Practice, is predicting that 1,000 of its refugee patients will lose coverage due to the change in October.
The nonprofit health center plans to continue serving them. As a federally qualified health center, it has to treat residents regardless of insurance status or ability to pay. The organization is directing patients who lose their insurance to sign up to pay a sliding-scale fee out of pocketinstead. How much patients pay is based on their income and family size and goes down to $10 per primary care or behavioral health appointment.
That’s not a cure-all, though, Hopson said. Even if they’re able to pay the fee for primary care at Neighborhood Family Practice, they might not be able to afford the cost of specialty care at hospitals, which is typically more expensive.
“For some of our specialty providers, that could be hundreds of dollars that they are required to pay — and sometimes up front — before they can be seen,” Hopson said. “It’s just not sustainable for most people.”
The sliding fee scale is also less likely to cover the full cost of providing medical services. Hopson said Neighborhood Family Practice is “doing everything we can to help offset that loss” by fundraising.
A spokesperson for MetroHealth wrote in a statement that the increase in uninsured patients will mean a rise in uncompensated care — i.e., care the hospital provides but does not get paid for. Last year, the hospital said uncompensated care was growing to the point of becoming unsustainable, costing $1 million a day.
Medicaid enrollment shrinking generally
The federal law passed last summer cut Medicaid spending by an expected $911 billion over the next 10 years. In addition to restrictions on which non-citizens can get Medicaid, it will add work requirements next January for people between the age of 19 and 64 who are not pregnant or do not meet another exemption, such as having a disability.
But Medicaid rolls are already shrinking, even before these changes go into effect.
U.S. Rep Shontel Brown, a Democrat, pointed that out at a press conference Sept. 14. The number of people enrolled in Medicaid in Cuyahoga County shrank by about 28,000 between July 2025 — when Congress passed the bill cutting Medicaid — and September 2026.
“Those numbers should alarm all of us,” she said.
It’s not entirely clear why Medicaid enrollment is dropping, Gowan said.
He pointed out that enrollment in Medicaid fluctuated significantly over the past five to six years. During and following the pandemic, enrollment ticked up as the federal government relaxed the rules around Medicaid re-enrollment to ensure more people had insurance. That ended in 2023, and enrollment in Medicaid began shrinking.
In Cuyahoga County, it hasn’t stopped shrinking.
It’s a trend that’s holding up in Ohio. Statewide, Medicaid enrollment dropped about 6.5% between June of 2025 and June of 2026.
Re:Source Cleveland and Cuyahoga County team up for “immigration hub”
One of the trickiest parts of the new limitations on which non-citizens can get Medicaid is answering this exact question: Who is still eligible? And who isn’t?
“It is radically complicated,” Kearns said. Large families might have different citizenship statuses within them. Or, family members might have the same citizenship status but the rules apply differently to each of them — for example, kids can still get Medicaid while their parents can’t.
Kearns said ReSource Cleveland is working to build an “evaluation tool” for organizations that work with newcomers like refugees. This tool will help staff determine who can continue to get Medicaid and who needs to look at other options to get healthcare.
He hopes that the tool can also include information for people who are not eligible, such as a list of the self-pay options at different healthcare providers in town.
The goal is to roll the tool out in the next several weeks, he said.
