Coverage losses begin: Thousands of Mass. immigrants to be kicked off health insurance

New federal policies borne out of President Trump’s “Big Beautiful Bill” have begun to kick certain populations off public health insurance.

In Massachusetts, state officials have estimated that about 250,000 people will ultimately lose coverage as a result of the federal budget reconciliation bill signed into law by Trump on July 4. It’s a devastating blow in a state that has spent the better part of two decades working to achieve near-universal health insurance coverage for its citizens.

Many of those who will be impacted first are immigrants, as announced by the Massachusetts Health Connector — the state’s health insurance marketplace — this month.

As of Aug. 25, Deferred Action for Childhood Arrivals (DACA) recipients are no longer considered lawfully present by the federal government for the purpose of enrolling in marketplace coverage. DACA recipients currently enrolled in plans through the Health Connector will see their coverage end on Aug. 31.

There are approximately 5,000 DACA recipients residing in Massachusetts.

Starting Jan. 1, 2026, more than 34,000 legal immigrants in the state will lose coverage with the elimination of the ConnectorCare Plan Type 1. ConnectorCare plans have $0 or low monthly premiums, low out-of-pocket costs and no deductibles.

The ConnectorCare Plan Type 1 currently covers immigrants who are not yet eligible for MassHealth Standard because of their status (must be in the country legally for five years) and have incomes that are below 100% of the federal poverty level.

In order to maintain coverage, they would have to see their income rise, qualifying them for higher income plan types. Changes to their immigration status and household size could also factor into their continuing to receive coverage.

Nearly all of the 34,000 people losing coverage under ConnectorCare Plan Type 1 will remain eligible for emergency care only under MassHealth Limited and care provided by hospitals and community health centers through the state’s Health Safety Net.

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But the Health Safety Net — the state’s health care charity fund, essentially — is currently operating in the red.

In the 2023 budget year, the program reported a $152 million shortfall, and the Massachusetts Health and Hospital Association has estimated the losses could reach $290 million at the close of the federal government’s 2025 budget year on Sept. 30.

“These coverage losses will push the fragile Health Safety Net program into a precarious state that will lead to undesirable consequences to patient access and providers who care for low-income uninsured,” Dale McHale, senior vice president for healthcare finance and policy at the Massachusetts Health and Hospital Association, said in a statement. “Hospitals remain committed to working with state leaders to identify solutions to ensure the commonwealth’s safety net remains viable as we enter this period of significant health care coverage losses due to federal cuts.”

In light of the federal policy changes, the state has also ended the special enrollment period for low-income people, which allowed individuals making less than $22,590 annually to enroll in health insurance throughout the year — not just during open enrollment.

Audrey Morse Gasteier, the Health Connector’s executive director, told WBUR-FM this week the federal government will save about $250 million a year by ending subsidies for the lowest-income legal immigrants in Massachusetts.

“Massachusetts has spent the better part of two decades working to bring all lawfully present residents into the ranks of the insured,” Gasteier told the station. “Rolling back those promises and principles that have animated the work that Massachusetts has been doing is really heartbreaking.”

During a webinar this week, Jonathan Burks, executive vice president of economic and health policy at the Bipartisan Policy Center, said they expect 8 million fewer Medicaid enrollees nationwide by 2034 and approximately 2 million fewer participants on health insurance exchanges.

Of the $1.5 trillion in spending reductions, two-thirds is coming out of Medicaid.

“Across Medicaid, Medicare and the health insurance exchanges, participation by non-citizens is pretty strictly restricted,” Burks said. “That’s a significant change from current law.”

The Massachusetts Health Connector is updating coverage losses at this webpage.