When the missiles began streaking through the sky, Nataliia Otbliesk pretended that the bombs falling over her home country of Ukraine were merely “a thunderstorm.”
In her early 80s at the time, she refused to acknowledge the gravity of the war breaking out around her. Her son Dmitry called her daily, urging her to come join him in the United States. She stood her ground: Ukraine was her home, and that’s where she’d stay.
When houses in Kyiv began to smolder and his mother’s health began deteriorating, Dmitry finally convinced her.
Nataliia moved to New Hampshire in 2023 under the Uniting for Ukraine program, which granted temporary protected status to Ukrainians displaced by the war. In the time since she uprooted her life halfway around the world, she applied for Medicaid as a non-citizen adult and, with her physical and mental health declining, was able to move into Pleasant View Center last year.
Medicaid paid not only for her medical needs but for her nursing costs as well.
With upcoming changes from H.R.1, called the One Big Beautiful Bill Act, slated to go into effect on Oct. 1, Nataliia’s family expects she will lose her coverage.
“She’s physically unable to leave. She cannot get out of bed, do the toilet on her own, eat on her own,” said Dmitry. “This is why we were expecting some provisions for people already in nursing homes.”
As of the start of October, “adults who are not pregnant must be a U.S. citizen, U.S. national, Legal Permanent Resident, Cuban-Haitian Entrant or Compact of Free Association Migrant to remain eligible for full-benefit Medicaid,” according to information on the state Department of Health and Human Services website.
The state agency has identified 296 people “who may lose coverage,” DHHS spokesperson Kathleen Remillard shared in a statement to the Monitor.
Eligibility for people under nineteen and pregnant and one-year postpartum women will not change, and “emergency Medicaid may still be available in certain circumstances. People who need health care coverage can sign up for a plan through the Federal Marketplace,” she said.
The Ukrainian Humanitarian Parole program under which Nataliia came to the U.S. does not count. The program began in 2022 “to provide a pathway for Ukrainian citizens and their immediate family members to come to the United States with the financial support of a U.S. sponsor,” according to Ukraine Immigration Task Force.
The program admitted around 25,000 people before it was canceled in 2025.
Once in the U.S., Nataliia qualified for Medicaid under Ukrainian Humanitarian Parole.
“Not many people [are] eligible for this, so we needed to collect all bank statements from Ukraine,” Dmitry said. “It was difficult because she doesn’t have direct access to her bank account, so we needed to ask some friends. So they actually selected the documents, and also it’s been processed for many months. So finally, we arranged it, and now it’s been canceled.”
A new report by the advocacy organization Protect Our Care estimates that 15,506 New Hampshire residents have lost their Medicaid or CHIP coverage as a result of Republican-led federal legislation. The report also flags that rising premiums will prevent more people from being able to afford health care.
As of next year, new work requirements will go into effect for people on Granite Advantage, the state’s expanded Medicaid plan: People between the ages of 19 and 64 “may need to participate” in 80 hours each month of “work or community engagement activities” to retain coverage, per DHHS. The program will also require twice-yearly redeterminations and limit retroactive coverage — going back one month for those on Granite Advantage and two months for those on other types of Medicaid.
Jessica Williams, a senior policy analyst at the New Hampshire Fiscal Policy Institute, explained some of the changes going into effect.
“Refugees, asylees, victims of human trafficking and domestic violence, certain parolees that were lawfully admitted for certain humanitarian reasons, as well as special immigrant visa holders from Iraq and Afghanistan, will lose Medicaid eligibility altogether, and lose Medicaid coverage altogether,” she said. “Eligibility will still continue for certain green card holders as long as they’ve had at least five years as residents.”
This set of changes is happening nationwide, she said. Other new requirements are altering who qualifies for the Supplemental Nutrition Assistance Program, or SNAP.
Dmitry said his family never received official word that Nataliia would be dropped from her coverage under the new rules. Only after he saw the updated language on DHHS’s website and called the offices of U.S. Reps. Maggie Goodlander and Chris Pappas was he able to get confirmation, he said.
“At first, it was so actually horrible, so we thought it was some kind of rumor or gossip. So we could not believe it. The same way as she would believe that bombs [were] falling into Ukraine,” he said.
Dmitry asserts that, even now, his mother still hasn’t received written notice from DHHS. However, Remillard, the spokesperson, said DHHS notified the 296 individuals who may lose their Medicaid coverage.
“The Department has reached out to all of those individuals to make them aware of the change and to give them an opportunity to provide verifications of or updates to their legal status,” she said.
One difficulty for Nataliia, Dmitry said, is that he cannot get her onto a marketplace insurance plan until she’s received the official denial notice from Medicaid. In the meantime, not only is she losing her insurance, but she’s also losing the source of income that keeps her in a nursing home.
With the deterioration of her condition, which now includes cognitive impairment, the level of care Nataliia requires is so acute that Dmitry worries that a potential move out of Pleasant View could lead to her “premature death.”
“We would need an ambulance,” he said. She cannot sit up in a wheelchair on her own anymore and requires a special sort of chair even to help her move from the bed to the bathroom.
Beyond that, his mother can’t return to Ukraine, as much as she may want to: “There are no airplanes flying to Ukraine. Flights to Ukraine do not even exist.”
Pleasant View costs around $12,000 per month for Nataliia, Dmitry said.
His mother receives around $200 from a Ukrainian pension. This is her only income, he added.
Richard Rogers, executive director of Pleasant View Center, said that in the event a patient cannot pay and cannot be discharged safely, the nursing home “will eat the cost.”
“And that’s general across the board,” he said. “There are laws and regulations in play that don’t allow us to do an unsafe discharge.”
Rogers said he cannot speak about any specific patient, but that on the whole, this policy remains true.
“We can issue a 30-day discharge notice for failure to pay, but if they don’t have a safe discharge plan, we can’t kick them out onto the street.”
Nataliia, who speaks predominantly in Ukrainian and Russian, is rarely awake enough to hold conversations anymore. She often gets confused.
But she wasn’t always like this. She was once an accomplished engineer, an active swimmer, a nurturing mother and the kind of person who “always tried to help other people,” her son said.
When he visits, she’s sometimes asleep, sometimes conscious. She doesn’t always recognize him, but she always knows he’s someone she cares about.
Dmitry tries to bring her something sweet or parts of her favorite Ukrainian meal: “Every piece of cake, she always gives half to me.”
This, he said, is emblematic of who she is — far more than an elderly woman in decline, thousands of miles from the country she still calls home.
He’s been lying awake at night, restless, contemplating what will happen come October 1. He said he wonders if someone would sponsor her in some manner. Even if the nursing home doesn’t discharge her, she still won’t have health insurance.
“It’s a problem for everyone losing Medicaid, but it’s catastrophic for her,” he said.
