About 11,000 refugees, asylum-seekers and other lawful immigrants in Washington lost their Apple Health coverage Thursday, Oct. 1, as federal Medicaid eligibility changes under H.R. 1 took effect, the Seattle Times reported.
In King County alone, an estimated 4,000 residents lost coverage, according to a King County Board of Health briefing on Sept. 18. Harborview Medical Center, the region's safety-net hospital, projects $120 million in enrollment-related losses in the first full year of the law, according to the same briefing.
The cuts hit patients at HealthPoint, a community health organization with clinics across King County. About 1,600 HealthPoint patients were set to lose coverage Oct. 1. Staff spent months trying to contact all of them and reached over half.
Of those reached, about 75% scheduled medical or dental appointments before the deadline. That's more than 660 people, said Dr. Liza Perpuse, regional director of clinical care at HealthPoint. Providers gave last-minute care including 90-day medication refills and told patients they could apply for a sliding-scale pay structure.
"Regardless of your ability to pay, I am still your primary care doctor. I am still here for you," Perpuse told the Seattle Times.
Not everyone was reached. Dr. Shoshana Aleinikoff, HealthPoint's specialty director of immigrant and refugee health, warned that some patients will show up at the front desk, hand over their insurance card and learn they no longer have coverage. Perpuse said she worries patients will skip care if forced to choose between seeing a doctor and paying for food.
Who loses coverage
H.R. 1, the federal spending law Congress passed last year, restricts Apple Health eligibility to U.S. citizens, nationals, lawful permanent residents in the country longer than five years, Compacts of Free Association islanders and certain Cuban-Haitian immigrants. Those now excluded include asylum-seekers, refugees and trafficking survivors.
Children, pregnant people and those within 12 months postpartum remain eligible regardless of immigration status.
Ryan Moran, director of the Washington State Health Care Authority, said the initial estimate of 14,000 people losing coverage dropped to 11,000 after providers and state teams helped members update their information over the past year.
Harborview braces for losses
Before H.R. 1, the Affordable Care Act had reduced Harborview's uninsured patient population to 4%. The hospital now projects that share will climb back to 13%.
Harborview CEO Sommer Kleweno-Walley warned at the Sept. 18 Board of Health hearing that program closures driven by funding losses would affect all patients, not just those on Medicaid. Moran said healthcare systems statewide face potential layoffs and service closures as hospitals continue treating patients without reimbursement.
What comes next
The Health Care Authority is building an online verification hub to identify exemptions that could help about 400,000 of the 600,000 Apple Health members at risk retain coverage. Even so, more than 200,000 Washingtonians are estimated to lose coverage by the end of 2027.
In January 2027, a second H.R. 1 change will subject more than 600,000 Washington residents to new work requirements and require them to reapply for coverage twice as frequently.
Gov. Bob Ferguson signed an executive order on Sept. 3 creating the H.R. 1 Continuous Medicaid Response Committee to coordinate the state's response. Washington has already spent nearly $100 million implementing the law, according to the governor's office. Replacing all the cuts would cost an estimated $3.2 billion per two-year budget cycle, KOMO News reported.
King County residents who need help navigating coverage changes can call the free Community Health Access Program at 1-800-756-5437 or visit kingcounty.gov/coverage/HR1.
