Thousands of refugees, asylees and other lawfully present immigrants in Ohio are set to lose their Medicaid coverage beginning Thursday, but nobody in state government can say exactly how many. The federal eligibility restriction is scheduled to take effect October 1, 2026, and Ohio's own numbers do not line up with what individual counties are reporting.
The Ohio Department of Medicaid told Signal Cleveland that 3,500 immigrants will lose coverage outright, with another 3,000 potentially subject to the restriction. But when Signal Statewide reached out to Ohio's ten most populous counties, only four provided data; estimates from those counties totaled between 14,500 and 18,000 residents who could lose coverage — figures the counties said were pieced together from cross-referenced datasets and educated guesswork rather than a uniform statewide count. Franklin County alone expects 8,000 to 12,000 residents could lose health insurance, while Cuyahoga County reported that 3,500 people already received notice they could be ineligible for Medicaid. Summit County estimated about 800 residents could lose coverage, and Lorain County put its number at fewer than 500.
A Federal Law Rewrites Who Qualifies
The cuts stem from the One Big Beautiful Bill Act, which strips Medicaid eligibility from several groups of lawfully present immigrants who have qualified for coverage since 1996, including refugees awaiting permanent legal status, asylees, parolees, and certain survivors of domestic violence and human trafficking. According to KFF, the law eliminates federally funded Medicaid and CHIP eligibility for many lawfully present immigrants, including refugees and asylees who do not hold a green card, effective October 1, 2026.
Not everyone loses out. KFF notes the law preserves eligibility for lawful permanent residents, Cuban and Haitian entrants, people residing in the U.S. under the Compact of Free Association, and certain lawfully residing children and pregnant immigrants in states that cover them under that option. Green-card holders generally remain eligible after a five-year waiting period, per cleveland.com. Emergency Medicaid and CHIP Health Services Initiative funding are also exempt, meaning people who need treatment for a qualifying emergency medical condition can still get it regardless of immigration status, according to the U.S. Committee for Refugees and Immigrants.
Why the Numbers Don't Match
Attorney Ben D'Avanzo said the process of determining who actually falls under the new restriction is inherently messy, and he noted that many affected people may obtain green cards within the next few years, at which point they would regain Medicaid eligibility. The Ohio Department of Medicaid says it is working with county offices to investigate why its statewide figures diverge so sharply from what counties are independently reporting.
Christopher Cabot said the loss is impactful to those losing eligibility, even as officials sort out the scale of the problem. Some affected refugees may qualify for temporary Refugee Medical Assistance, which the Office of Refugee Resettlement expanded from four months to eight months of coverage in July 2026 — though the refugee committee's explainer is clear that RMA serves as a stopgap and does not replace continued Medicaid eligibility. In the meantime, the group warns, affected immigrants face potentially untreated health conditions while they wait in immigration backlogs.
What Comes Next for Ohio's Medicaid Rolls
States are required to redetermine eligibility for all potentially affected existing Medicaid enrollees by the October 1 deadline, and KFF notes that anyone still verifying their immigration status is entitled to a 90-day reasonable-opportunity period during which coverage must continue. States must also give advance notice and the right to a Medicaid fair hearing before coverage is cut. The law does not ban states from using their own money to keep covering these groups — it only pulls federal funding, according to the refugees.org explainer.
This is just the first wave. Ohio's Medicaid enrollment is projected to fall by 305,000 people, or 10%, by 2028 once new work requirements take hold, according to Health Policy Ohio. Starting January 1, 2027, most adults ages 19 to 64 who are not disabled or pregnant will need to document at least 80 hours a month of work, education, training or volunteer service to keep their coverage. Nationally, the Congressional Budget Office estimates the immigrant eligibility restrictions alone will push 100,000 more people into uninsurance and cut federal spending by $6.2 billion by 2034, while separate CBO projections cited by KFF put the broader hit at 1.4 million lawfully present immigrants losing coverage, $131 billion in reduced federal spending and $4.8 billion in added federal revenue by 2034.
Other States Are Watching Similar Numbers
Ohio isn't alone in scrambling to quantify the fallout. New Jersey officials estimate as many as 25,000 noncitizens could lose Medicaid coverage on October 1, and separately predict that work requirements could force more than 300,000 people off the state's Medicaid rolls, producing an estimated $669 million a year in unpaid hospital bills, according to the New Jersey Monitor. New Jersey has responded by offering a special enrollment period this October, November and December for people losing Medicaid who may qualify for subsidized marketplace plans, and Gov. Mikie Sherrill included more than $10 million in the state budget to shore up enrollment systems ahead of the change. Those measures are part of New Jersey's response.
For now, Ohio's own accounting remains unsettled as coverage is set to lapse later this week. The Ohio Department of Medicaid says it is still working with county offices to reconcile the discrepancy between its statewide estimate and the far larger numbers counties are reporting on their own.
