Editor's note: This story was originally published by The Florida Trib.
Anamika Bennett was a child, home from boarding school, the night men came for her father.
It was around midnight, she remembers. They put a bag over Khem Raj Poudel's head before dragging him out of his house in Kathmandu, Nepal's capital city.
Hours later, around 2 or 3 a.m., neighbors brought him home. They had found her dad on the road, badly beaten with sticks and bleeding from his head.
"I knew that it was bad," she said. "But I didn't know the whole story."
The story, as it was documented years later in his asylum case files, was that Poudel, a longtime member of Nepal's Nepali Congress Party, had been targeted with violence by Maoist insurgents for his political work and fled for safety with his family to the United States, where his older daughter was in college. In 2019, an immigration judge in Baltimore granted him asylum, and he has since become a permanent resident.
Now 74, Poudel lives with his wife, daughter and her family in Marion County in North Central Florida. He has diabetes and high blood pressure as well as post-traumatic stress disorder, depression and anxiety. He takes 10 medications.
Since August, his daughters have been paying for those medications out of pocket, costing them hundreds of dollars per month, after the Florida Department of Children and Families denied him Medicaid coverage three times this year — assistance his lawyers say he is legally entitled to receive.
Two of the state's notices said he failed Medicaid's "citizenship requirement." Another cited income he doesn't have, other than Social Security insurance. DCF's eligibility manual says green-card holders who were granted asylum, as Poudel was, qualify.
Poudel, his attorneys say, is collateral damage as Florida officials attempt to enforce a new federal law — part of President Donald Trump's signature "One Big Beautiful Bill Act" — that, as of Oct. 1, ended Medicaid eligibility for many immigrants who are in the country legally.
The law layers a new set of criteria onto Medicaid eligibility. In Florida, those new, complicated requirements have been handed to a beleaguered and understaffed state agency that a federal judge found this year could not reliably get far simpler eligibility decisions and notices right.
Critics say people who still qualify, like Poudel, are getting pulled into a bureaucratic vortex along with those the law meant to remove, leaving already overburdened DCF frontline workers ill-equipped to handle complex cases the new immigration rules are creating.
The new complications build on a yearslong pattern of dysfunction within DCF, said Lynn Hearn, legal director of the Florida Health Justice Project, which represents Poudel and other families receiving Medicaid terminations, many of which are more straightforward examples of errors on the state's part: The legal advocacy group has been seeing "a high percentage of erroneous terminations" mostly of children, whose eligibility the new law did not change, Hearn said.
Of those termination notices the FHJP has seen, none of them say what immigration status the state has on file or what status would let someone keep coverage. Some families get no notice at all.
"There is certainly not enough information in this notice for a recipient to know whether the action is correct or not," Hearn said.
And unlike other groups of people who've lost coverage en masse due to policy changes, people Hearn's group are hearing from now are potentially just a fraction of those affected, she said, because many lawfully present immigrants "are reluctant to pursue the coverage they are entitled to due to fear of some form of retribution or negative impact to themselves or family members."
DCF didn't respond to The Trib's multiple requests for comment.
These most recent problems echo persistent issues DCF has been dinged for in recent years in lawsuits and audit findings.
In January, a federal judge ruled that the termination notices DCF sent to recipients of family-related Medicaid after the pandemic, based on income, violated due process. The court called the state's call center, where recipients are told to go for answers, an "abject failure."
Meanwhile, the agency's eligibility workforce has thinned. The DCF division that decides who qualifies for public assistance shed 211 positions over five budget years, and over 100 workers moved from local eligibility offices into the state's Hope Florida program, a Trib analysis found.
What the law changed
The strain shows up in food assistance, too. Florida's SNAP error rate could cost the state roughly $1 billion a year under the same federal law that changed immigrant eligibility.
Jared Nordlund, Florida policy director for UnidosUS, said the new rules recall the "very chaotic time" after pandemic-era protections ended, when Florida cut Medicaid for more than 1.8 million people and families received conflicting notices. There is probably still "a lack of trust within the community with DCF" about whether it can administer public assistance correctly, he said.
The One Big Beautiful Bill Act, the tax and spending law President Donald Trump signed in July 2025, limits federal Medicaid funding for noncitizens to three groups: lawful permanent residents, also known as green-card holders; Cuban and Haitian entrants; and migrants from three Pacific island nations under the Compacts of Free Association.
Refugees, people granted asylum who have not yet gotten green cards, and others admitted on humanitarian grounds lost eligibility Oct. 1. Children 18 and under, with lawful legal status, remain eligible for Medicaid.
Still, 177,000 people in Florida are expected to lose coverage, according to an analysis from KFF, a nonpartisan health policy organization.
Hearn said that number "seems awfully high considering no children should be losing coverage under this change." California, which has more than twice as many immigrants as Florida, estimated about 148,000 people there would lose coverage.
These new restrictions land on a safety net that has already shrunk since the 2023 "unwinding," when federal pandemic-era subsidies to temporarily expand Medicaid ended. Florida cut Medicaid coverage for over 1.8 million people over the following year. A state audit found eligible children had been wrongly cut off of public assistance during the flurry of terminations.
At the same time, DCF depleted its ranks of frontline staffers who work on issues like benefits eligibility to instead staff up Hope Florida, a pet project of First Lady Casey DeSantis and a conservative reimagining of welfare designed to wean people off traditional programs like Medicaid and food assistance.
Nordlund said the people losing coverage now are often confused with undocumented immigrants, who were never eligible.
"They've gone through a process with the U.S. government, and the U.S. government has allowed them to be here," he said. Many are survivors of political or religious persecution, human trafficking or domestic violence, and many work and pay taxes.
In Florida, the law created "a two-tier system of people who are basically in the same situation," he said. Cubans and Haitians keep their coverage, but Venezuelans, Nicaraguans, Afghans and other asylum grantees don't. Nordlund said he suspects that distinction is confusing DCF caseworkers, who may be "coding people wrong."
The state is also likely working without a reliable source to determine the immigration status of Medicaid recipients. "There is no one database out there that has all this information done correctly," Nordlund said, which leaves immigrants to prove their own status.
In a letter from the Centers for Medicare and Medicaid Services to state Medicaid directors, federal guidance warns that the main database states use to check immigration status, known as SAVE, provides only a "point in time" answer and does not update past results when someone's status changes, such as when an asylum grantee becomes a permanent resident.
Nordlund said he suspected the Medicaid restrictions were a way to create cuts to the program intended to help pay for tax breaks in Trump's One Big Beautiful Bill Act. He argued the savings are partly an illusion.
People who lose Medicaid "don't stop getting sick," he said. They turn to free clinics, community health centers and emergency rooms, and the cost of their uncompensated care is passed on to insured families. He called it "a hidden tax."
'It depends on the country'
For years, Poudel's Medicaid coverage came automatically with Supplemental Security Income, a federal benefit for low-income older and disabled people. But federal law limits SSI for those granted asylum to seven years unless they become citizens. Poudel applied for his green card in 2020. It didn't arrive until 2024, and he can't apply for citizenship until 2028 or 2029, per the law. His SSI ended Aug. 1.
"We filed a request to SSI saying, hey, you know, this is not really our fault," Bennett said. "We applied for a green card in time. The immigration status took so long. There's nothing really we could do."
The lapse set Poudel's family down a labyrinthine path with DCF and federal workers that Bennett says has been frustrating to navigate even with the help of attorneys.
When his SSI ended, the Social Security Administration referred Poudel to DCF to see if he qualified for Medicaid another way. On Aug. 17, DCF denied him, saying he did not meet the citizenship requirement.
Poudel and his family expected the seven-year rule for asylum grantees, Bennett said. "What we didn't expect was DCF denying his Medicaid" application.
When Bennett called on behalf of her father, she was told the case couldn't be reopened and that her father should reapply. On Aug. 27, DCF denied him again, this time because of "income and/or a change in your household circumstances." But Poudel has no income, other than Social Security insurance. When Bennett called again, she said, she was told the system still showed him receiving SSI, and to apply a third time.
The day before the third decision, Bennett said, a DCF worker called to inform her he would be denied. When she pointed out that he had been granted asylum, the worker said eligibility "depends on the country."
In Poudel's case, it shouldn't.
DCF's policy manual says people who entered the country as asylees and later got green cards can qualify, and that asylees are exempt from the five-year waiting period most new green-card holders face, according to an inquiry the Florida Health Justice Project drafted for the family. A DCF policy memo issued after the new federal law says it didn't change who is exempt from the five-year bar.
The third notice, dated Sept. 28, gave both reasons: citizenship, and income or household circumstances. Like the others, it cited an outdated Florida administrative rule rather than the new federal law, and it did not say what immigration status DCF had on file for him.
The family has appealed and sent DCF a written inquiry. As of Oct. 14, they had not heard back.
"If it's happening to us, even with the help of the lawyer, with the documents, everything in hand, policy printed out, it's happening to families who can't," Bennett said. "I just want DCF to follow its own manual before rejecting it."
Lawful residents with no immigration status
Leticia's case shows a different gap: one where the state may have applied the law correctly but never told the family.
Luciana, a physical therapist from São Paulo, Brazil, moved to Boca Raton in 2019 with her husband, a mechanic, and their only child, Leticia. (The Trib has withheld the family's last name at their request to protect their identities.)
Leticia was born with severe cerebral palsy, epilepsy and hydrocephalus, which requires a shunt in her brain that has had to be surgically replaced. She uses a wheelchair and struggles to speak. If her mother hands her a piece of bread, she can feed herself, but she can't manage a full meal.
In Brazil, Luciana said, specialized care was scarce and costly. A special-needs school, four hours a day with no therapy included, cost about $2,000 a month.
In January 2020, Luciana applied for green cards for the family through a visa for professionals whose work serves the national interest. While they waited, they were allowed to live and work here legally. Leticia qualified for Medicaid through Children's Medical Services, the state's program for children with special health needs. It covered her medications, hip and spinal surgeries at Nicklaus Children's Hospital in Miami, and a medical day care where nurses and therapists see her every weekday, allowing both parents to work.
Immigration authorities denied the petition after more than three and a half years. Luciana refiled using the same documents showing her professional experience, standing and degrees, and their green cards were approved in September 2024. The family is still waiting for fingerprints, medical exams and background checks to clear, but the timeline for that process is unclear and, according to Luciana, could take anywhere from weeks to years.
That wait is what cost Leticia her coverage. Florida covers children who are in the country lawfully through age 18. After that, Medicaid requires a qualifying status, such as a green card, and a pending application doesn't count.
The family is in what's called an "adjustment status," Luciana said DCF staff told her. "That means we have no status. We are here lawfully but with no status at all."
Leticia turned 19 on Sept. 29. Her coverage ended the next day. But the family received no notice, Luciana said, not by mail and not in the state's online portal, which simply read "terminated." Staff at Leticia's medical day care caught it.
At a DCF office in Riviera Beach on Oct. 2, a worker first suggested the family hadn't uploaded its documents, which records show they had. A supervisor then pulled up the file and said Leticia had no immigration status. Luciana left with one sheet of paper about the federal law and a referral to the Health Care District of Palm Beach County.
"They terminate her CMS without telling me," she said.
While Luciana waits, the medical bills keep arriving.
A neurologist visit later this month will cost $100. Luciana canceled a rheumatology appointment after the office said it could run anywhere from $150 to $450. One of Leticia's seizure medications, Epidiolex, costs more than $1,000 a month. The day care is keeping her for now, even though the family cannot afford to pay, and when that ends, Luciana will stay at home with her. She and her husband buy their own marketplace insurance, but no plan she has found covers what Leticia needs.
Luciana requested an appeal by email. She hasn't heard back.
For Luciana and her husband, the coverage isn't simply about securing Leticia's medical care, she said, but also their ability to provide "a decent life," one where she can enjoy small things such as trips to the ocean in a special chair that floats, rollercoasters, and days spent among other children at day care.
"It's about being able to buy food and to have a house," Luciana said, "sometimes having a fun day going to the beach or going to Orlando."
"When they turn 19, nothing changes," she said, referring to Leticia's health problems. "They are the same."
A backlog of appeals
Appeals over immigration status go through the same fair hearing process as any Medicaid termination, and Hearn said that office is far behind. It is just now acknowledging requests filed in mid-August, she said, and hearings are typically set about six weeks after that.
State and federal law require DCF to keep coverage in place while some appeals are pending. Hearn said the agency "is routinely failing" to do so.
In the January ruling — which did not include allegations about mishandling immigration-related Medicaid notices — the federal judge held that a termination notice must give people "sufficient information to evaluate the accuracy of the State's decision and make an informed decision whether to challenge it." And while those notices, indicating termination of family-based Medicaid based on income, have improved, Hearn said the notices going to immigrants now give "zero information" about the status the state has on file, which immigrants still qualify, or where to go for help.
The people most likely to push back, she said, are those with the greatest medical needs, "because it is often literally a life or death situation."
In December, Poudel's wife, who was granted asylum with him, will reach the same seven-year limit on SSI. She takes two kinds of insulin for type 2 diabetes. Bennett plans to start her mother's DCF paperwork in the first week of December, but if she's denied, Bennett and her sister will be paying out of pocket for their mother's medications as well.
"Just because you're denied doesn't mean it's correct," Bennett said. "Someone needs to say it out loud."
The Tributary is a nonprofit newsroom producing high-impact government accountability and investigative journalism in the public interest. Based in Jacksonville, the Florida Trib's mission is to shine a light on systemic problems and solutions, hold those in power accountable, and focus on under covered topics through collaboration with other news organizations and the community.
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