Trump’s ‘Big Beautiful’ law bars legal permanent residents, others from medical benefits

Jamaican permanent residents (green card holders) could find themselves shut out of medical services in the United States (US) unless they meet certain conditions.

If the green card holder is a low-income person and has had green card status for less than five years, that person could find himself/herself unable to access Medicaid.

Medicaid is health insurance for people at the lower end of the economic ladder.

The ‘Big Beautiful Bill’, passed recently by the US Congress and signed into law on July 4 by President Donald Trump, bars Medicaid services to most non-citizens.

The bill amends Medicaid law to prohibit federal Medicaid payments for anyone who is not either: (a) a US citizen or (b) a qualified alien in a very limited set of categories.

The bill will also bar certain non-citizens from receiving subsidies to assist with paying for health insurance under the Affordable Care Act (ACA).

The amendment also ensures that if an immigrant is ineligible for Medicaid due to status, they cannot get ACA insurance subsidies either.

All aliens – including those with other lawful statuses (temporary protected status, asylum, student/work visas) or undocumented status – will no longer be eligible for full Medicaid after October 1, 2026.

The law does preserve two narrow exceptions – emergency medical services for undocumented (the pre-existing limited Medicaid), and the option for states to cover lawfully present children or pregnant women under the Children’s Health Insurance Program Reauthorization Act. However, aside from those, federal funding is cut off for any non-citizen not in the allowed groups.

Previously, a Jamaican who has had their green card for less than five years and with low income could get a subsidised plan on the ACA exchange, but this provision would block that.

Dr Robert Clarke, head of Help Jamaica Medical Mission, and who has his own private practice in New Jersey, said the changes will have a disastrous effect on the Jamaican and Caribbean communities.

He said that many will be left without health insurance, and the cuts will have a domino effect on the country’s healthcare system.

“Many doctors in private practice, who serve in inner cities where patients depend on Medicaid and Medicare, will either be forced to sell their practices to hospitals and join groups in order to survive,” he told The Gleaner.

SERIOUS FALLOUT

Clarke said this could lead to a very serious fallout, with many more sick people unable to access healthcare.

“They will be forced to go to the hospital emergency rooms for treatment, and the hospitals, in turn, will bill them. But they will be unable to pay, so the hospitals will be forced to eat such costs, making them less solvent, which could result in more hospitals shutting down,” he said.

Clarke added that with some 12 million people also being forced off the ACA, the US could be facing a major health crisis.

Dr Michael Morgan told The Gleaner that he is very concerned for the patient population.

“I am very, very nervous about what the outcome will be,” he said.

According to Morgan, with the Medicaid cuts, the stage is being set for a very disastrous situation, as many safety net hospitals that take Medicaid could close, leaving patients without healthcare services.

“It could come down to patients having to decide between putting food on the table or seeking medical services,” he said.

Morgan said many doctors in private practice will not be able to see many patients who are without medical insurance such as Medicaid.

The bar on public healthcare is a major component of the Senate amendment as it overhauls eligibility for public benefits. It introduces strict immigration-status requirements for Medicaid, Supplemental Nutrition Assistance Program, Medicare, and ACA subsidies, effectively rolling back the inclusion of many non-citizens in these programmes.

These provisions will significantly affect Caribbean immigrants, particularly those who are not yet citizens.

DRAMATIC RESTRICTION

This is a dramatic restriction. Currently, many immigrants who are ‘qualified aliens’ can get Medicaid after a five-year waiting period. Some states also use state funds to cover certain immigrants.

Under the new rule, even after five years, a lawful temporary resident or refugee would not qualify unless they became a lawful permanent resident (LPR). Notably, it fails to list refugees, asylees, or victims of trafficking – groups traditionally considered ‘qualified’ for benefits.

The omission means that if such individuals haven’t yet obtained a green card, they would be ineligible for Medicaid. For example, a Jamaican granted asylum (a refugee) would, under current law, be Medicaid-eligible as a qualified alien within seven years of entry, but the new law doesn’t list asylees, only LPRs and Cuban/Haitian entrant status.

It is a tightening that even humanitarian statuses are not recognised for Medicaid until the person is an LPR. In the Caribbean context, Cuban and Haitian entrants are specifically allowed, so a parolee from Haiti might still be eligible as a ‘Haitian entrant’.

However, Jamaican immigrants have no such special status and would have to be LPRs or citizens.

The changes will affect states such as New York, Florida, New Jersey and Connecticut, which have large Caribbean populations and could see many residents lose Medicaid coverage.

New York has used state funds to offer Medicaid to certain immigrants, but the federal ban means that state could not get a federal match for many non-citizens. If New York wants to continue covering them, it would need to pay 100 per cent through state funds, or else thousands would be dropped from Medicaid rolls.

The new law also reduces federal cost-sharing for emergency services given to undocumented immigrants.

Under the previously existing law, emergency medical care for undocumented or otherwise ineligible aliens can be covered by Medicaid with the normal federal match. The amendment stipulates that, starting in 2026, the Federal Medical Assistance Percentage for emergency care for non-qualified aliens will be capped at the state’s standard rate, not the ACA expansion rate.

In other words, for expansion states that got 90 per cent federal funding for many Medicaid services, they can no longer claim that high match for emergency services for undocumented patients.

Currently, lawfully present immigrants who are barred from Medicaid can get ACA subsidies, even below poverty level. The new rule would close that access, leaving them with no affordable coverage.

editorial@gleanerjm.com