Refugee and Asylee Green Card Decisions Have Fallen by Close to 90 Percent, and Medicaid Now Waits on Them

USCIS has nearly stopped deciding green card applications from refugees and asylees, and since Oct. 1 that slowdown has carried a health coverage cost. In the first nine months of fiscal 2026, the agency completed 3,805 refugee applications for adjustment of status, down from 37,908 in the same months a year earlier, according to an analysis of USCIS data released Oct. 15 by KFF, a nonpartisan health policy research organization. Under the 2025 budget reconciliation law, refugees and asylees without a green card have generally lost Medicaid eligibility as of Oct. 1, so the pace at which USCIS works through Form I-485 now decides when many of them can be covered again.

That changes what a backlog means. Refugees and asylees already have lawful status and work authorization, so a slow green card used to cost them mostly time. Until this month, refugee or asylee status itself opened Medicaid and CHIP, with no five-year wait like the one most new green card holders face. The 2025 law removed that link. Refugees and asylees still skip the five-year wait once they get a green card, but they now need the green card first. Marketplace premium subsidies and Medicare follow the same rule in January 2027, KFF noted. The green card is now the gate.

Form I-485 measure	Oct. 2024 to June 2025	Oct. 2025 to June 2026
Refugee applications completed	37,908	3,805
Asylee applications completed	57,369	8,660
Refugee applications pending, June 30	67,502	149,470
Asylee applications pending, June 30	83,446	126,267
Average processing time, refugees	7.8 months	13.3 months
Average processing time, asylees	10.7 months	19.9 months

Source: KFF analysis of USCIS “All USCIS Application and Petition Form Types” quarterly data, first three quarters of fiscal 2025 and fiscal 2026. Completed means approved or denied.

Together, the two groups had 275,737 applications pending at the end of June, and KFF expects the number to keep rising. Processing time is still climbing within the year: for refugees it went from 7.6 months in the first quarter to 17.6 months in the third, and for asylees from 12.1 to 25.6 months.

Two memos, two different holds

The refugee collapse has a documented cause. On Nov. 21, 2025, USCIS Director Joseph Edlow ordered a review, and possible reinterview, of every refugee admitted between Jan. 20, 2021, and Feb. 20, 2025, and put their pending green card applications on hold, according to the memo as reported by the Associated Press and CBS News. According to CBS, Edlow wrote that the prior administration “prioritized expediency, quantity, and admissions over quality interviews and detailed screening and vetting.”

Asylees face a narrower freeze. A Dec. 2, 2025, USCIS memo paused pending green card, citizenship and asylum applications from nationals of the 19 countries covered by the June 2025 travel ban, NPR reported. That reaches some asylees but not all, and the published data do not show how much of the asylee decline traces to it.

The few refugee decisions being made are also harsher. From January through August 2026, USCIS acted on only 441 refugee green card applications and denied 27 percent of them, compared with an average denial rate of 5.6 percent over the previous five calendar years, according to a separate analysis of USCIS data that the Urban Institute, a Washington-based nonprofit research organization, also published Oct. 15.

Those numbers cut both ways. The administration points to its own findings: an interim final rule DHS published Oct. 14, cutting the time refugees have to answer a termination notice from 30 days to 10, cites a USCIS review of about 14,500 cases from five Central and South American countries that flagged about 1,500 with possible public safety indicators. Refugee advocates counter that refugees are already the most heavily vetted immigrants, as the International Refugee Assistance Project told the AP when the review was announced. A 27 percent denial rate fits the view that earlier screening missed problems, but it comes from a tiny set of cases, and USCIS has not said how it chose which ones to decide first.

Why the wait costs more in health care than in citizenship

Immigration law cushions one part of the delay. When a refugee’s green card is approved, permanent residence is recorded as of the date of arrival, and an asylee’s is rolled back one year from approval, under section 209 of the Immigration and Nationality Act and its implementing regulations. The five-year clock for naturalization therefore runs from those earlier dates, so a long wait for the card does not push back eligibility for citizenship one for one.

Health coverage has no such cushion. Refugee Medical Assistance covers up to 12 months after arrival, Urban noted, but refugees in the held group arrived between 2021 and early 2025 and are well past it. What remains is state choice: 38 states cover lawfully present children and 32 cover pregnant people without a waiting period, according to KFF data cited by Urban, and California will keep covering affected noncitizens through June 2027, Urban reported. Other adults, including older and disabled refugees, depend on fully state-funded programs that only a few states offer.

The practical effect is that the end of the refugee review, not any change in health law, is now the main thing that would restore coverage for this group. The memo promised a priority list of people to reinterview within 90 days, the AP reported, but USCIS has given no public end date for the hold. The next test is USCIS’s fourth-quarter fiscal 2026 data, covering July through September, which will show whether completions have started to recover before Marketplace subsidies end for the same people on Jan. 1, 2027.

This article is for general information and is not legal advice.

Sources

Vasanth Vaidyanathan, Esq.

Administrator

Vasanth Vaidyanathan is an immigration attorney with over 20 years of experience focused exclusively on U.S. immigration and nationality law. He holds a LL.M. from California Western School of Law, San Deigo and advises individuals and businesses on employment and family-based immigration matters, including H-1B, PERM, EB categories, and adjustment of status. He has also been a featured speaker at immigration seminars across the U.S. To reach Vasanth visit: https://www.vnathan.com/

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