Many children may lose public health insurance and nutrition assistance benefits under proposed changes to U.S. immigration policy.

Under current policy, any foreign national may be designated a “public charge” if more than half of his or her household’s income is from certain government sources, such as Supplemental Security Income or cash assistance from the Temporary Assistance for Needy Families program. Historically, health benefits such as Medicaid, the Children’s Health Insurance Program (CHIP), and health subsidies under the Affordable Care Act were specifically excluded from public charge evaluations, as were nutrition assistance programs such as the Supplemental Nutrition Assistance Program (SNAP). Any immigrant who has been designated a public charge may be prevented from changing status (such as converting from a nonimmigrant student visa to legal permanent resident status), denied citizenship, or, in rare cases, deported.1

How the Proposed Policy Change Could Affect Children

A recent policy proposal seeks to broaden the list of programs that would be considered in public charge evaluations to include public health insurance such as Medicaid and CHIP, and public nutrition assistance such as SNAP.2

If the proposed rule goes into effect, a noncitizen child’s participation in public health and nutrition assistance programs could negatively affect the child’s public charge determination. A dependent citizen child’s participation in such programs would be excluded from consideration in their noncitizen parent’s or guardian’s public charge determination, but the child’s participation could affect the calculation of household income. The proposed policy suggests that dependents’ sources of income would be counted as part of household income, which could then affect the parent’s or guardian’s public charge determination.

This proposed new rule sends a seemingly contradictory message about the effect of citizen child participation in public health insurance and nutrition assistance programs. Confusion over the new policy may lead to a chilling effect that would cause noncitizen parents to opt their citizen children out of these programs. The implications of these changes are clear. To avoid a potential public charge designation, millions of families that include noncitizen parents and children may forgo participation in public health insurance, nutrition assistance, and other programs that provide a critical safety net for lower-income children.

The Kaiser Family Foundation (KFF) estimated that in 2016, 10.4 million U.S. citizens under age 19 were living with at least one noncitizen parent.3 Of those children, 5.8 million had Medicaid or CHIP health insurance coverage, and 2.6 million received nutrition assistance through SNAP.

Working with the Lucile Packard Foundation for Children’s Health and the Children’s Partnership, PRB expanded the KFF analysis to estimate the number of noncitizen children who would be at risk under the proposed new policy. PRB also produced estimates for California counties using data from the American Community Survey (ACS), an annual survey of more than 3.5 million addresses nationwide.

To avoid a potential public charge designation, millions of families that include noncitizen parents and children may forgo participation in public health insurance, nutrition assistance, and other programs that provide a critical safety net for lower-income children.

Using ACS data for 2014 to 2016, we estimate that nearly 180,000 noncitizen children in California would be at risk of losing their health insurance coverage—mostly Medicaid or CHIP—under the new rule. An additional 1.6 million citizen children of noncitizen parents in California could also be at risk. (See Method for Measuring Children at Risk, below.) While Los Angeles County accounts for the largest number of at-risk children (more than 50,000 noncitizen children and 530,000 citizen children of noncitizen parents), concentrations are highest in Central California. In Monterey and San Benito counties, more than one-third of all children are at risk (3 percent of children are noncitizens who participate in Medicaid, CHIP, or other means-tested public health insurance, and 31 percent are citizen children of noncitizen parents who participate in public health insurance programs).

Medicaid and CHIP are not the only programs being considered for inclusion in public charge determinations. In California, the parents or guardians of nearly 90,000 noncitizen children and 800,000 citizen children could be pressed by the proposed policy change to forgo nutrition assistance through SNAP, a program known to reduce poverty and improve children’s health.4

On October 10, 2018, the Department of Homeland Security issued a Federal Register notice announcing the proposed rule change and seeking public comment about the proposal.The notice acknowledges that changes to the rule may result in negative outcomes for families. Disenrollment or forgoing enrollment in public benefits programs by those otherwise eligible for them could lead to:

  • Worse health outcomes, including increased prevalence of obesity and malnutrition, especially for pregnant or breastfeeding women, infants, or children.
  • Increased use of emergency rooms and urgent care as a method of primary health care due to delayed treatment.
  • Increased prevalence of communicable diseases, including among members of the U.S. citizen population.
  • Increases in uncompensated care in which a treatment or service is not paid for by an insurer or patient.
  • Increased rates of poverty and housing instability.
  • Reduced economic productivity and lower levels of educational attainment.

The public comment period is open until December 10, 2018, and the public is encouraged to submit comments on the proposed rule.

 

Method for Measuring Children at Risk Under the Proposed Policy

To evaluate the at-risk population, we used data from the American Community Survey for the years 2014 to 2016. We grouped children ages 0 to 17 into four categories based on both child and parent citizenship status. The categories are defined as follows:

  1. Child and parent(s) citizens: Children living in households in which the child and all co-resident parent(s) are citizens. This category includes children living with a single parent (if that parent is a citizen), as well as children living with both parents (both citizens).
  2. Child citizen living with noncitizen parent(s): Children living in households in which the child is a citizen and one or both co-resident parents is a noncitizen. This category includes children living with a single noncitizen parent, one noncitizen parent and one citizen parent, or both parents (both noncitizens).
  3. Child citizen not living with either parent: Children who are citizens and do not live with either parent. This category includes children living in group quarters such as college dormitories, as well as children and youth in foster care, those who live with non-parent relatives or with non-relatives, and those who have already formed their own household.
  4. Child noncitizen: Children who are noncitizens, regardless of their living arrangement or presence of parents. These children may live with citizen or noncitizen parent(s), may live in another household (with no parent present), or may live in group quarters such as college dormitories.

We then determined whether each child was listed as participating (at the time of the survey) in Medicaid, CHIP, and other means-tested public health insurance programs. We also determined whether each child was living in a household where at least one household member had received benefits from SNAP at any point in the 12 months prior to the survey. We cross-tabulated participants by the child and parent citizenship categories listed above.

References

  1. Krista Perreira, Hirokazu Yoshikawa, and Jonathan Oberlander, “A New Threat to Immigrants’ Health — The Public-Charge Rule,” The New England Journal of Medicine 379, no. 10 (2018): 901-903.
  2. Homeland Security Department, Notice of Proposed Rule, “Inadmissibility on Public Charge Grounds,” Federal Register 83, no. 196 (Oct. 10, 2018): 51114.
  3. Samantha Artiga, Anthony Damico, and Rachel Garfield, Potential Effects of Public Charge Changes on Health Coverage for Citizen Children, Kaiser Family Foundation (2018), accessed at www.kff.org/disparities-policy/issue-brief/potential-effects-of-public-charge-changes-on-health-coverage-for-citizen-children/, on Oct. 31, 2018. A citizen is defined as a person who is a citizen of the United States by birth or naturalization. Anyone who is not a citizen of the United States by birth or naturalization is considered a noncitizen, including legal permanent residents and people who are in the United States with a student or work visa.
  4. Lucile Packard Foundation for Children’s Health, “CalFresh (Food Stamp) Participation,” September 2015, accessed at www.kidsdata.org/topic/742/food-stamps/table#fmt=2261&loc=2&tf=84&sortColumnId=0&sortType=asc, on Oct. 31, 2018.
  5. Homeland Security Department, Notice of Proposed Rule, “Inadmissibility on Public Charge Grounds.”
 

Related