Washington state lawmakers set aside nearly $20 million this year to protect lawfully present immigrants from losing long-term care after federal Medicaid cuts, but that money will now stretch to cover just 173 people. State officials and advocates had expected the fund to serve nearly 1,200 noncitizens who rely on Medicaid for home care, nursing facilities, and other long-term services. Instead, higher-than-expected medical costs and a series of federal rulings have shrunk that number to a fraction of the original plan, leaving hundreds of Washingtonians facing the loss of caregiving support they depend on for daily life.
The state had assumed the $20 million would cover about 300 people for the current fiscal year, which runs through June 2027, according to KUOW. But state officials underestimated medical-service costs for the long-term care population, and federal officials ruled that Supplemental Security Income recipients would not automatically remain eligible for Medicaid — a decision Washington Rep. Nicole Macri called unprecedented, per the same report. Agencies also said they could not implement a reduced Medicaid benefit tier in time for the October 1 deadline, further narrowing who the fund can help.
The shortfall traces back to federal changes ordered under Public Law 119-21. The Centers for Medicare & Medicaid Services issued a directive in April, State Health Official letter SHO #26-001, telling states that federal Medicaid and CHIP matching funds for refugees, asylees, and humanitarian parolees will end on October 1, according to CMS. Federal officials also decided the affected population would lose coverage on that date rather than at their individual annual eligibility reviews, and CMS informed states of that timing decision in spring 2026, the KUOW report notes.
Nearly 1,500 People, Just 173 Covered
About 1,500 noncitizens currently receive long-term care services in Washington, and roughly 1,500 people total are affected by the coverage changes, including about 100 people in adult family homes and skilled nursing facilities, per KUOW's reporting. The state Department of Social and Health Services found that 1,500 people could potentially retain services if their immigration status has since changed, but the department is prioritizing people in long-term care facilities for continued coverage, leaving home-care recipients most exposed. Long-term care enrollees received initial notices of the coverage change in July, and termination notices are set to go out in late August.
Adam Glickman, secretary-treasurer of Service Employees International Union 775 — the union that pushed for the long-term care funding in the first place — said the funding shortfall was disappointing and frustrating. Glickman warned that people will get sicker as a result of losing care, and the union represents more than 60,000 long-term care workers across Washington, Montana, and Alaska, according to SEIU 775. The loss of Medicaid-funded home-care work could also force family caregivers to seek jobs outside the home, compounding the disruption for affected households.
Pressure Builds on Governor Ferguson
Earlier this month, SEIU 775 and the No Cuts to Health Care Coalition hosted a Seattle roundtable with U.S. Rep. Pramila Jayapal, state Sen. Manka Dhingra, and DSHS Secretary Angela Ramirez to press Governor Bob Ferguson to authorize emergency state spending before October 1, according to Rep. Jayapal's office. Ramirez, who leads the Washington State Department of Social and Health Services, said in Seattle that the Medicaid cut will be harmful, though she said the agency would continue looking for ways to help and suggested enrollees could adjust their immigration status or find other ways to maintain coverage.
Rep. Macri asked whether a reduced Medicaid benefit could stretch the state's funding further, but state agencies said that option could not be implemented by the October 1 deadline. Macri said the $20 million would not cover the initially expected number of people, even though lawmakers and advocates had expected the funding to reach nearly 1,200 lawfully present noncitizens when it was approved during the legislative session. The original goal of wider coverage would cost tens of millions more dollars each year — money the state does not currently have, as Washington faces broader fiscal troubles limiting new spending.
The Bigger Budget Picture
The math only gets harder from here. Washington would need closer to $100 million per year in the two-year budget beginning in July 2027 to sustain even the current, reduced level of coverage, per KUOW. That is on top of the roughly $150 million the state already budgets over two years for its separate Apple Health Expansion program, which covers low-income noncitizens ineligible for federal Medicaid but keeps enrollment capped due to fiscal limits, according to the Washington State Standard.
State officials project that nearly 14,000 Washington residents will lose Medicaid coverage altogether starting October 1, and the elimination of federal Affordable Care Act subsidies has already resulted in more than 36,000 exchange enrollees forgoing insurance, per KUOW's reporting. Congressional Republicans passed the law behind these changes, often referred to as the “big, beautiful bill,” in 2025. It cuts Medicaid coverage for refugees, asylees, and other lawfully present immigrants while maintaining eligibility for lawful permanent residents and select migrant categories, though it cuts Medicaid coverage for most noncitizens more broadly.
More Cuts Loom in January
The immigrant coverage crunch is just the first wave. Medicaid work requirements are set to take effect nationwide in January 2027, after CMS issued an Interim Final Rule in June requiring non-exempt Medicaid expansion adults aged 19 to 64 to complete 80 hours per month of work, education, or community service, according to CMS. State officials expect those requirements will likely remove tens of thousands more people from Medicaid in Washington, and will likely leave almost all people in home-care settings without Medicaid coverage. SEIU 775 leaders are urging state officials and lawmakers to find more money before that January deadline arrives.
The financial pressure extends well beyond Washington. A June 2026 RAND Corporation study projected that the federal law will reduce total state Medicaid funds nationwide by $665 billion and state general funds by $86 billion between 2025 and 2034. Washington itself applied for $1 billion from the federal Rural Health Transformation Program last November to offset an estimated $4 billion-plus drop in rural Medicaid funding over a decade, noting that more than 100,000 state residents rely on Medicaid for long-term care, according to HeraldNet.
Advocates warn the consequences will ripple beyond the people directly losing coverage. The loss of long-term care is expected to shift costs to emergency rooms, 911 calls, and other crisis situations as people go without the routine support that keeps them stable at home. Immigrants with disabilities will lose caretaking help with basic daily tasks, and home care aides — who must already complete 75 hours of state-approved training and pass a practical exam under a voter-passed 2011 initiative — face their own workforce bottlenecks amid administrative certification delays, according to the Tri-Cities Business News. For now, with October 1 approaching, Washington's fix for the immigrant long-term care gap remains far smaller than the problem it was designed to solve.
