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 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."
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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.
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