About 11,000 lawfully present adult immigrants in Washington state are projected to lose their Apple Health (Medicaid) coverage from 1 October, after H.R. 1, signed by President Donald Trump, narrowed eligibility for many non-citizens, state officials say.

H.R. 1 was signed on 4 July 2025, according to the Department of Social and Health Services. Coverage remains available to lawful permanent residents, Cuban and Haitian entrants and Compact of Free Association islanders.

Among those who no longer qualify are refugees and people granted asylum, the Washington State Health Care Authority says. Children and pregnant people can still qualify regardless of immigration status if they meet other eligibility requirements.

Who Is at Risk of Losing Cover Under Washington's Medicaid Changes

Governor Bob Ferguson's office says 14,000 lawfully present immigrants were originally due to lose Apple Health on 1 October.

Health navigators, the Office of Refugee and Immigrant Assistance and community partners helped 3,000 of them update their information and, in some cases, take steps to move to an immigration status that still qualifies, the office says, bringing the figure down to 11,000.

A preliminary order from US District Judge Thomas Zilly, which the federal government can appeal, also allows more than 800 non-citizens who receive Supplemental Security Income to keep their coverage for now. The state's update does not make clear whether they are counted in the 11,000.

'In the richest country in the world, Donald Trump is kicking the most vulnerable people off their health coverage,' Ferguson said when he signed an executive order on 3 September 2026.

The Trump administration has described the changes as a statutory requirement. In an April 2026 news release on guidance to states, the Centers for Medicare & Medicaid Services said its aim was to help states 'follow the law and safeguard taxpayer dollars', according to its administrator, Mehmet Oz.

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Fears of Busier Emergency Rooms

Ryan Moran, director of the Washington State Health Care Authority, told KUOW/Northwest News Network that the eligibility changes will affect more than the people losing cover.

'What happens when they no longer have coverage — when you have individuals who go to the emergency department as sort of their sole access point to health care?' he said. 'We worry about the strain and stress on the hospital system.'

The law also eliminates federal premium tax credits for many of these immigrants in 2027, although they can still buy Marketplace plans without the subsidy. The state expects most of those affected to become uninsured because full-price plans will likely be unaffordable for people who previously qualified for Medicaid.

State Scramble To Limit Fallout From Medicaid Changes

The bigger test arrives next year. More than 600,000 Washingtonians will be subject to new Apple Health work requirements from 1 January 2027.

To soften that, the state is building an automated verification hub that draws on existing records to confirm eligibility, sparing people fresh paperwork every six months. Officials expect it to help 400,000 people keep cover.

It will not be enough for everyone. At least 200,000 residents are still projected to lose Apple Health by the end of 2027 as a direct result of H.R. 1.

Ferguson's order also sets up the H.R. 1 Continuous Medicaid Response Committee, a public awareness campaign and a Department of Health system to track who is losing coverage and where the gaps lie.

Washington has already spent nearly $100 million (£75.6 million) implementing the law, per the governor's office, which estimates that replacing the funding H.R. 1 cuts would cost about $3.2 billion (£2.42 billion) per two-year budget cycle.

The governor's office says many people are still unaware of what is coming, given the long gap between the law passing and its provisions taking effect. Ferguson has urged everyone on Apple Health to check their details are current, watch for agency messages and help relatives do the same.

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