Teresita V. Morales was in for a shock when she read a letter delivered to her longtime partner recently.

It was a letter from the state informing him that he would no longer qualify for Medicaid coverage after Sept. 30 because of a new federal law that changes which types of immigrants are eligible for the program.

Morales’ partner, Euǵen Cuťa, who is originally from Romania, suffered a devastating stroke more than 15 years ago that left him partially paralyzed and unable to speak, she said. He has lived in nursing homes ever since. The couple relies on Medicaid to pay for that round-the-clock care.

“I panicked,” Morales, 66, said of when she saw the letter. “I was like, ‘Oh my God, now what do I do?’”

Across Illinois, about 9,300 immigrants — including lawfully present refugees, human trafficking survivors and people who’ve been granted asylum but don’t have green cards — are slated to lose their Medicaid coverage after Sept. 30 under provisions of HR1, also called the One Big Beautiful Bill Act, which President Donald Trump signed into law in 2025.

The law makes a number of changes to who is eligible for Medicaid, a federally and state-funded health insurance program for people with low incomes and disabilities. One of the biggest changes will be the implementation of work requirements for many childless, able-bodied adults on Medicaid starting Jan. 1.

Cutting Medicaid coverage for refugees, asylees and survivors of human trafficking after Sept. 30 is among the first of the changes to take effect.

A spokesperson for the federal Centers for Medicaid & Medicare Services did not provide comment about the Trump administration’s rationale for cutting Medicaid for refugees and asylees. But the White House has said the overarching law “protects and strengthens Medicaid for those who rely on it — pregnant women, children, seniors, people with disabilities, and low-income families — while eliminating waste, fraud, and abuse.”

Those who advocate for immigrants’ rights, however, say the loss of Medicaid will be a blow to already-vulnerable individuals, their families and the medical providers that may have to eat the costs of treating people with no coverage.

“They’ve depended on having comprehensive health insurance to manage their chronic conditions, to get timely healthcare, to get preventative healthcare and screenings,” said Andrea Kovach, a senior attorney at the Legal Council for Health Justice. “When their coverage is terminated, that will be disrupted. It will lead to horrible health outcomes for them and their families.”

Refugee and asylum status is typically granted to people who have been persecuted or who fear they’ll be persecuted in their home countries because of their race, religion, nationality, social group and/or political opinions.

Morales, 66, said she isn’t sure exactly what her partner’s immigration status is, but the letter he received in August said he was slated to lose Medicaid after Sept. 30 because of HR1 and his “noncitizen status.” Morales and Cuťa got together about 25 years ago, after he’d already been in the country for several years, she said. He was a plumber by trade, she said.

She’s been digging through his papers and reaching out to anyone she can think of to try to address the situation, but so far she hasn’t had much luck.

“This individual is really left navigating a quite complex case,” said Edith Avila Hesser, health justice and policy director for the Illinois Coalition for Immigrant & Refugee Rights, who’s been trying to help Morales and Cuťa. “It’s actually a really sad situation.”

Morales wonders why the government can’t make an exception for her partner, and she thinks the overall change in Medicaid coverage for immigrants is wrong. Morales said she is also disabled.

“I think it’s totally unfair, especially to those who have been here and made a life here,” Morales said. “These people have paid their taxes.”

Under the new law, some types of immigrants will be exempt from Medicaid loss, including lawfully present immigrants from Cuba, Haiti, Palau, the Marshall Islands and Micronesia. Lawfully present children and pregnant people will also be allowed to keep their Medicaid.

Notably, refugees, asylees and trafficking survivors who are lawful permanent residents, meaning they have green cards, will also be allowed to stay on Medicaid. Green cards allow people to live and work permanently in the United States.

It can take time, however, for refugees and asylees to get green cards. Refugees can’t apply for green cards until they’ve been in the U.S. for a year, and asylees can’t apply for green cards until a year has passed since they were granted asylum, according to U.S. Citizenship and Immigration Services.

Once a person applies, it can then take more time to actually get a green card — sometimes more than a year and half, according to U.S. Citizenship and Immigration Services.

“They can apply for their green card after a year, but there’s a lot of sand in the gears of the immigration adjudication system right now as far as granting those green cards,” Kovach said.

That means that many legally present immigrants will be left in a bind, advocates say.

In addition to the case of Morales’ partner, Avila Hesser said she has seen a few people with diabetes in recent weeks who’ve also been informed they’re losing their Medicaid after this month. Now, they may have to manage their illness without insurance coverage.

“I think for this particular group of individuals, because they do have lawful status, there’s a sense of betrayal,” Avila Hesser said. “They have status that is recognized and they have had access to these services like Medicaid and are suddenly being removed from eligibility.”

Cook County Health family medicine physician Dr. Nimmi Rajagopal said she’s heard some of her patients, who are slated to lose coverage after Sept. 30, say they’re not sure how they’ll get their medication without Medicaid.

More than 40% of the Illinois residents losing Medicaid after this month live in Cook County, and many of them speak Ukrainian, according to Cook County Health.

“We hear a lot of fear,” said Rajagopal, who is associate chair of the Department of Family and Community Medicine at Cook County Health. “They’re not sure what the next steps will be and what will be happening.”

Immigrants who are losing Medicaid do have a few other options for healthcare — but none are as comprehensive as Medicaid, advocates say.

Immigrants who lose coverage may turn to federally qualified health centers and community clinics that can offer them free care or charge them on a sliding scale based on their incomes.

Also, they may still qualify for emergency Medicaid, but that only covers care during serious medical emergencies — not regular doctors’ visits, prescriptions or ongoing treatment, according to the Illinois Department of Healthcare and Family Services.

There is also a federally funded program called Refugee Medical Assistance that covers refugees who aren’t eligible for Medicaid, but that coverage lasts for only eight months.

“None of these options provide that sense of security that you have through having healthcare coverage, especially as someone with a disease or condition,” Avila Hesser said.

Cook County Health has been working to explain to its patients who are refugees and asylees that they should still seek care, even after they lose Medicaid, Rajagopal said. Cook County Health has a website with resources for patients without coverage.

“The things we can offer a patient without Medicaid are limited compared to when they have Medicaid or insurance,” Rajagopal said, referring to certain types of medications and treatments, “but we’ll make it work. We’ll do the best we can. We’re always going to be here for our patients.”

As for Morales, she’s still trying to figure out what options — if any — she has for her partner’s care. She’s not yet sure if his Northwest Side nursing home will let him stay once Medicaid stops paying the bills.

“At the end of the month, I don’t know what I’m going to do,” Morales said.