A Trump administration proposal to increase the odds that immigrants will be deemed "public charges" ineligible for government health benefits may result in millions of kids becoming uninsured, a study suggests.
The proposed changes are expected to cause many immigrants to disenroll their children from safety-net programs like Medicaid and the Children's Health Insurance Program (CHIP) out of fear and confusion, even among families to whom the rule would not apply.
Nationwide, 8.3 million children who have Medicaid and CHIP, or roughly one in four kids currently enrolled, are at risk of being disenrolled in health and nutrition benefit programs if the proposed rule changes take effect, the study authors estimate. This includes 5.5 million kids with specific medical needs like ADHD, asthma, cancer or diabetes.
More than nine in ten of the kids who could lose their benefits are U.S. citizens, researchers estimate.
When an immigrant applies for entry to the U.S. or for permanent resident status, they may be denied if they're likely to become a "public charge" dependent on public benefits, researchers note in JAMA Pediatrics. Few benefits traditionally led immigrants to be considered a "public charge," but rules proposed by the Trump administration last year would expand the list to include a wide array of benefits including programs for health insurance, housing and food assistance.
"For a century, only individuals on cash assistance or who were institutionalized were considered to be a `public charge,'" said lead study author Dr. Leah Zallman, a researcher at the Cambridge Health Alliance and Harvard Medical School in Boston.
"The proposed rule drastically expands the definition to include benefits that many use for short periods of time," Zallman said by email.
Children born in the U.S. are citizens and eligible for health and other public benefits even when their parents are not citizens. The rule changes are still under review and haven't taken effect, but fear and confusion about the proposal already appear to be reducing enrollment in safety net benefits programs even among immigrant families who should still quality for government support, the study authors note.
"The concern is that parents will disenroll or not enroll in health and nutrition benefits," Zallman said. "Most children who lose Medicaid or CHIP due to this proposed rule will become uninsured, and are likely to skip needed care."
To calculate how many kids might lose benefits, researchers focused on children living with at least one noncitizen parent. They counted kids insured by Medicaid or CHIP or living in a household where one or more people are enrolled in the Supplemental Nutrition Assistance Program (SNAP), formerly known as food stamps.
The study may have underestimated the number of kids who could lose benefits by only focusing on children with one noncitizen parent, researchers note. Disenrollment scenarios may also be higher than researchers anticipated because the proposed rules might threaten families' immigration status, the study team also points out.
Complicating matters, the proposed rule changes do not directly affect eligibility for Medicaid, SNAP (food stamps), or housing assistance, so the rules wouldn't remove children from public benefits programs, said Steven Wallace, associate director of the Center for Health Policy Research at the University of California Los Angeles.
"What they do is change the implication of receiving those benefits for people who are applying for a green card (permanent residency)," Wallace, who wasn't involved in the study, said by email.
"What will be needed, however, is a great deal of outreach and legal assistance to inform parents about the implications (about both real risks and false rumors) of using the services," Wallace added. "The problem is that when rules like these change, it makes it clear that today's rules may not be tomorrow's rules, and so many families will try to minimize both current and future immigration status risks by avoiding needed health care."
SOURCE: http://bit.ly/30343Pn JAMA Pediatrics, online July 1, 2019.