New federal restrictions have stripped Medicaid coverage from certain legal immigrants—including refugees and victims of human trafficking—as part of sweeping changes to the health insurance program that are projected to force millions of people off their coverage.

The change, which took effect Oct. 1, removed an estimated hundreds of thousands of people who legally immigrated to the United States from the program's rolls; many of those affected work and pay taxes. It is the latest Trump administration policy targeting foreigners and forms part of extensive Medicaid overhauls under President Donald Trump's 2025 tax cut and policy law, many of which are set to take effect early next year—meaning the full impact of the overhaul is still unfolding.

The Congressional Budget Office projected in 2025 that the Medicaid changes would leave 7.5 million fewer people with health insurance by 2034, as more states implement the new coverage restrictions.

Advocates say that without Medicaid, people will be unable to afford private insurance and will either delay care or end up in emergency rooms, adding pressure to an already strained health system. For immigrants, the cuts could be felt more acutely, compounding other administration efforts to restrict access to public assistance under a broader immigration crackdown.

“This is about telling every immigrant in the United States that they are not welcome here and that they should leave,” said Ben D'Avanzo, a senior strategist at the National Immigration Law Center, which has pursued litigation against the Republican administration over its immigration agenda.

Refugees, asylum seekers and victims of human trafficking and domestic violence are among those who have lost coverage. Green-card holders were not affected.

Lauren Bis, a White House spokesperson, said in a statement that “immigrants must be able to support themselves without taking from overburdened benefits programs paid for by hard-working American taxpayers.”

D'Avanzo said many people who have lost coverage will likely realize it only when they need medical care. For some families, however, the impact has been immediate.

A family's care hangs in the balance

In Tucson, Arizona, María Chacon has been caring for her son Jesus for nearly five years, since a car accident at 17 left him unable to breathe on his own. He relies on a ventilator and a feeding tube, takes daily medication and must be turned once every two hours to prevent sores from forming. Chacon said he sometimes opens his eyes.

The family is originally from Mexico and entered the United States in 2018 on a T visa, which is offered to victims of human trafficking.

Chacon said Medicaid has helped cover nearly $25,000 per month of care for her son, including a small stipend for her and her husband as compensation for serving as his long-term caregivers. Doctors, she said, have explained that even if both of them worked 24 hours a day, they would not be able to cover the cost of his care.

“Since that day I haven't been able to sleep. We haven't been able eat or anything. We're wondering what we're going to do?” Chacon said.

Jesus takes medication that Chacon estimates costs $7,000 a month. His current supply runs out in mid-October. Without coverage, she does not know how her son is going to survive.

Chacon learned only days before the cuts took effect that she was losing coverage, and called the state's Medicaid offices to appeal. Although she is in the process of obtaining a green card, Medicaid coverage would begin only five years after her approval—a waiting period federal rules generally impose on lawful permanent residents before they can qualify for the program.

She believes the Medicaid cuts are part of the administration's clampdown on immigrants, but said her son is in no condition to travel.

“I know that's what he's doing, but, as my son is, I couldn't go to Mexico,” Chacon said.

Competing views on the cuts

Steven Camarota, research director for the Center for Immigration Studies, a right-leaning think tank that seeks reduced immigration, said the administration “is trying to nibble around the edges” with the Oct. 1 cuts, finding piecemeal ways to curb immigration into the United States. He believes the government should screen legal immigrants for income potential and education, reducing the number who might rely on public benefits.

“You need immigrants who are unlikely to need welfare,” he said, or those with high educational attainment.

The administration recently revived a federal rule, commonly known as the “public charge” rule, that could deny green cards to immigrants who use public benefits, which could include food stamps, Medicaid, housing vouchers and other assistance.

A widening political fight

Medicaid, jointly funded by states and the federal government, has become a political focal point during Trump's second term. The president has pushed to root out what he describes as fraud in the program. In July, the administration deferred more than $1 billion in Medicaid payments to California and Minnesota, citing suspected fraud; critics argued the move targeted Democratic-led states.

As more people are removed from Medicaid, federal spending on the program is projected to fall by $911 billion, according to KFF, a health care research nonprofit.

State-level figures illustrate the scale of the Oct. 1 change. Officials in Arizona said 29,000 legal immigrants were cut from the state's Medicaid rolls that day, while estimates in Florida are closer to 177,000. Overall, more than 281,000 immigrants across nine states and the District of Columbia are expected to lose Medicaid coverage, according to KFF.

Pressure on the health system

Without coverage, people are expected to turn to emergency rooms for care. When patients delay seeing a doctor, conditions can worsen and become more expensive to treat.

“At the end of the day, it does raise the cost for the states because once you get these people in for something that could have been prevented, they could not go to the doctor because they were uninsured; they most likely will end up at a hospital in an emergency room,” said Carmen Feliciano, vice president of policy and advocacy at UnidosUS, a Latino civil rights organization.

UnidosUS partners with community organizations to help provide medical care, but Feliciano said those groups are already overwhelmed and will not be able to support the number of people set to lose coverage in the coming months.

“We are not going to have the capacity to serve all the people who need it,” Feliciano said.

This story was originally featured on Fortune.com.