Refugees and Asylees: Recent Changes in Access to Health Coverage and Other Assistance 

Introduction

Since 1980, the U.S. has had a formal system for admitting refugees and asylees—individuals and their families who are unable to return to their country of nationality due to a well-founded fear of persecution for certain protected reasons. The right to seek asylum is rooted in international law, and the system reflects the U.S.’s longstanding inclusion of humanitarian protection as a core principle of immigration law. Refugees and asylees are generally fleeing from unsafe conditions and arrive to the U.S. with few to no resources, with many facing traumatic experiences in their countries of origin and/or during their journey to the U.S. The U.S. historically provided refugees and asylees access to assistance with food, housing, and health care upon arrival to the country as well as other time-limited services to support their transition to the U.S.

Recently, President Trump has largely eliminated the entry of refugees and asylees into the U.S., and Congress passed legislation that will restrict refugees’ and asylees’ access to assistance programs. These changes could exacerbate the health and socioeconomic challenges refugees and asylees face and negatively impact the U.S. economy given that refugees and asylees have a long-term net positive impact on the U.S. economy, meaning that they contribute more through tax revenues than they cost the government.

This issue brief provides an overview of refugees and asylees in the U.S., trends in refugee and asylee admissions using data from the Department of Homeland Security (DHS), and recent changes in eligibility for assistance programs for refugees and asylees.

Overview of Refugees and Asylees

Following the passage of the Refugee Act of 1980, the U.S. established a standardized process for admitting refugees and asylees into the country through the U.S. Refugee Admissions Program. The right to seek asylum is rooted in international law, and this system reflects the longstanding inclusion of humanitarian protection as a core principle of U.S. immigration law.  Refugees and asylees are humanitarian immigrants who are unable or unwilling to return to their country of nationality due to persecution or fear of persecution based on one of five protected grounds that include race, religion, nationality, membership in a particular social group, and/or political opinion. For example, refugees living in the U.S. include young women who had to flee their lives and livelihoods in countries like Afghanistan following the departure of the U.S. military and subsequent takeover by Taliban, a fundamentalist group that is known for banning girls and women from going to school and working. Examples of asylum seekers in the U.S. include survivors of abuse, individuals from Central America who fear persecution due to identifying as Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ), and people fleeing death threats from drug cartels in Mexico. People seeking refugee status apply for their status from outside the U.S., and those seeking asylum apply for their status from within the U.S. or when seeking admission to the U.S. at a designated port of entry.

Refuges and asylees include significant shares who are children or female who mainly come from the Middle East, Central and South America, Asia, and Central Africa. In fiscal year (FY) 2023, the last year for which government data on the characteristics of refugees are available, the U.S. admitted 60,050 refugees. Nearly half (45%) were children ages 17 years and younger while 55% were adults ages 18 and older, who were primarily under age 35. They included equal shares of females and males (50%) (Figure 1). The top countries of nationality for refugees included Democratic Republic of the Congo (30%), Syria (18%), Afghanistan (11%), Burma (10%), Guatemala (3%), and Sudan (3%). In FY 2023, the last year for which government data are available, the U.S. granted asylum to 54,350 individuals. About a quarter (26%) of those receiving affirmative asylum were children ages 17 years and younger while the remaining nearly three in four were adults ages 18 and older, who were primarily under age 35. Over four in ten (44%) were female while 55% were male.¹ The leading countries of nationality for asylees included Afghanistan (27%), China (9%), Venezuela (7%), El Salvador (6%), India (5%), and Guatemala (5%). However, these data are incomplete because, as of October 2024, over 90% of asylum cases filed in FY 2023 were still pending with only 2% being granted approval due to immigration backlogs. 

Trends in Refugee and Asylee Admissions

President Trump placed an indefinite pause on the U.S. Refugee Admissions Program in January 2025. The pause led to halts in the processing of refugee applications, cancelation of refugee travel to the U.S., and the termination of the Welcome Corps program, which allowed for private sponsorship of refugees. While a court partially blocked the pause in March 2025 for refugees who were conditionally approved as of January 20, 2025, it still remains in effect for new refugees who may only be admitted on an excepted, case-by-case basis.

Reflecting the pause on admissions, the Trump administration reduced the refugee admissions ceiling to an all-time low of 7,500 for FY 2026 (Figure 2). The previous all-time low of 18,000 was in FY 2020 under the first Trump administration. Further, the Trump administration has stated that the FY 2026 refugee admissions will “primarily be allocated” to Afrikaners, who are White individuals from South Africa, representing a departure from admission patterns for previous years.

While there is no annual cap for asylum filings, President Trump took executive action in January 2025 to close the border to a vast majority of migrants, including asylum seekers. Building on limits to border entries established by President Biden in 2024, President Trump took executive action aimed at increasing border security that effectively closed the U.S. border for asylum seekers when he assumed office in January 2025. President Trump also rescinded a 2021 Biden administration Executive Order that was designed to aid in the “safe and orderly processing of asylum seekers.” While data on asylum grants under the second Trump administration are not yet available, there has been considerable variation in the number of individuals granted asylum over time reflecting shifting immigration policy priorities and reductions in border entry amid the COVID-19 pandemic (Figure 3). Going forward, it is likely that asylum grants will drop substantially due to the Trump administration’s border policies.

Refugee and Asylee Eligibility for Health Coverage and Other Assistance

Refugees and asylees are generally fleeing from unsafe conditions and arrive to the U.S. with few to no resources, with many having faced traumatic experiences in their countries of origin and/or during their journey to the U.S. Many refugees and asylees may not be able to immediately obtain jobs due to linguistic, cultural, and other barriers and, therefore, are likely to face challenges to accessing health coverage, health care, and meeting their basic needs. Research shows that refugees have significantly higher rates of food insecurity than the general U.S. population, with some refugee groups having food insecurity rates that are six times higher than the general U.S. population. Further, research shows that refugees face challenges navigating private and public health insurance and have higher uninsured rates compared to the general U.S. population. Research also shows that culturally competent and language accessible health care services for refugees can improve communication and trust between refugees and health care providers. 

Historically, the U.S. provided refugees and asylees access to health coverage and other assistance upon arrival to the U.S., with research showing that health coverage, cash assistance, and employment are important tools for helping them gain self-sufficiency. When the Refugee Act of 1980 was passed, Congress stated that part of its purpose was to help provide “humanitarian assistance” and “transitional assistance” to those fleeing persecution in their countries of nationality. While most lawfully present immigrants (including Lawful Permanent Residents or “green card holders”) have to wait five years after obtaining a “qualified” immigration status to enroll in federal public benefits, including federally funded health coverage such as Medicaid and the Children’s Health Insurance Program (CHIP), refugees and asylees historically have not been subject to this waiting period if they met income and other state-specific eligibility requirements. Refugees and asylees also have been able to enroll in subsidized Affordable Care Act (ACA) coverage and Medicare without a waiting period if they are otherwise eligible. Further, refugees and asylees could access other income-based federal assistance programs such as the Supplemental Nutrition Assistance Program (SNAP) (i.e., food stamps), Temporary Assistance for Needy Families (TANF), and Supplemental Security Income (SSI) if they met income and other eligibility requirements.

The 2025 tax and budget law, H.R.1, eliminates eligibility for health coverage and food assistance for many lawfully present immigrants, including refugees, asylees, and other humanitarian immigrants. The law restricts eligibility for Medicaid, CHIP, subsidized ACA Marketplace coverage, Medicare, and SNAP to immigrants who are Lawful Permanent Residents (LPRs or “green card” holders), certain Cuban and Haitian entrants, and citizens of the Freely Associated (COFA) nations of the Marshall Islands, Micronesia, and Palau residing in U.S. states and territories. States that have taken up an option under Medicaid and/or CHIP to cover lawfully residing children and pregnant people, who include refugees and asylees, can also maintain this coverage. Under these changes, refugees and asylees will become ineligible for these programs, except for some in states that have taken up the Medicaid and CHIP option to expand coverage for lawfully residing children and pregnant people.

Implementation dates for the eligibility restrictions vary by program. Medicaid and CHIP restrictions will take effect October 1, 2026; limits for subsidized ACA coverage will go in place January 1, 2027; Medicare coverage limits took effect July 4, 2025 (the date the law was signed), with current beneficiaries losing coverage no later than 18 months from the enactment of the legislation (January 4, 2027); and SNAP restrictions for new applicants go into effect as early as November 1, 2025, with current beneficiaries losing access at the time of their next recertification.

The U.S. also provides refugees and asylees access to certain time-limited benefits and services through the Office of Refugee Resettlement (ORR) to facilitate their transition. These include:

• Refugee Medical Assistance (RMA): In cases where refugees and asylees are ineligible for Medicaid or CHIP, they may qualify for RMA, which had been available to refugees and asylees for up to 12 months prior to recent changes.
• Refugee Cash Assistance (RCA): RCA provides cash assistance to refugees and asylees for basic necessities such as housing, food, and transportation. RCA had been available to refugees and asylees for up to 12 months prior to recent changes.
• Refugee Support Services (RSS): Refugees and asylees also have access to a range of services to support employment and thereby, self-sufficiency, which include English language training, job training, childcare, and access to transportation. Access to RSS is available to refugees and asylees for up to five years.

The Trump administration has reduced access to time-limited support services that ORR provides to refugees and asylees. On March 21, 2025, the Administration for Children and Families issued a notice reducing the eligibility period for refugees and asylees to access RMA and RCA, citing budget constraints. This notice reduced access to RMA and RCA from 12 months to four months for refugees and asylees effective 45 days after the notice’s publication (i.e., May 5, 2025).

Together, these reductions are likely to exacerbate health and socioeconomic challenges faced by refugees and asylees and could also reduce their economic contributions to the U.S. Research by the Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation (ASPE) finds that between 2005 and 2019, refugees and asylees had a net positive impact of about $124 billion on the U.S. economy, meaning that they contributed more in revenue ($581 billion) than they cost in expenditures ($457 billion) to the federal, state, and local governments. Actions to limit the assistance refugees, asylees, and other humanitarian immigrants receive when they arrive in the U.S. could create barriers to successful transition to employment and self-sufficiency and foreclose opportunities for them to make economic and workforce contributions in the future.

1. Data on individuals granted asylum defensively in FY 2023 not available by age and sex. Affirmative asylum applies to those not in removal proceedings who apply directly to U.S. Citizenship and Immigration Services whereas defensive asylum applies to individuals already in removal proceedings. ↩︎