'Public Charge' Changes Could Mean Fewer Children Receiving Medicaid And CHIP, Study Says

Dec 4, 2018

A new study suggests a proposed Trump administration policy could discourage immigrant families from enrolling their citizen children in public health insurance programs like Medicaid and the Children’s Health Insurance Program, also known as CHIP.

The Urban Institute study suggests changes in how the federal government makes so-called public charge determinations – which could impact whether some noncitizens get lawful permanent residency or temporary visas – could have a "chilling effect" on families seeking public assistance.

The Trump administration could start considering an applicant’s future or current enrollment in some health programs, housing assistance programs, as well as the Supplemental Nutrition Assistance Program, or SNAP, when determining eligibility for legal status. The proposed changes could also consider factors such as age, income and household size. 

In the Federal Register, the Trump administration wrote that:

the primary benefit of the proposed rule would be to help ensure that aliens who are admitted to the United States, seek extension of stay or change of status, or apply for adjustment of status are not likely to receive public benefits and will be self-sufficient, i.e., individuals will rely on their own financial resources, as well as the financial resources of the family, sponsors, and private organizations.

Read the proposed rule in the Federal Register here.

Researchers at the Urban Institute project, if the White House institutes those changes, it could cause more families to withdraw their children from public assistance programs altogether. Earlier this year, advocates in Texas reported a rise in immigrant families withdrawing their eligible children from health programs during the Trump administration's crackdown on immigration. Those reports suggested the possibility that the same could happen because of possible changes to the public charge rules.

Jennifer Haley, a researcher with the Urban Institute Health Policy Center, said she fears the proposed rules could lead to a dip in an enrollment among eligible families – or dropouts among those already enrolled.

“This could have a large effect because, in Texas, 31.5 percent of all Medicaid/CHIP-covered children were citizen children living with one or more noncitizen parents,” Haley said.

Nationwide, the study found, 6.8 million citizen children with Medicaid or CHIP coverage were living with one or more noncitizen parents in 2016. In Texas, 1.1 million citizen children with non-citizen parents are receiving Medicaid or CHIP, nearly 32 percent of recipients overall.

Read the Urban Institute study here.

Historically, children whose parents are noncitizens are less likely to have health insurance or to be enrolled in Medicaid or CHIP in the first place, compared to children whose parents are citizens. Haley said noncitizen parents don’t always know their kids are eligible for certain services. They are more likely to have language barriers that preclude them from seeking help, and they are more likely to have a job that doesn’t provide health insurance.

“So, increases in un-insurance among that group could serve to widen rather than narrow the gap,” Haley said.

There are also longer-term effects for children who lose their health insurance, she said.

A loss of health coverage could mean increased financial strain on a family, which could also have a negative effect on a child’s long-term development, as well.

The last day for public comment on the proposed rule change is Dec. 10.