Trump rule would penalize legal immigrants for using Medicaid and CHIP

CRISTIAN MENDOZA, a 19-year-old college student, said his immigrant parents are nervous about a pending Trump administration proposal that would penalize legal immigrants for using public benefits like Medicaid.

The Mendozas, who live outside Los Angeles, have long received Medicaid, which paid for Cristian’s treatment for acute myeloid leukemia and covers his father’s diabetes care. The father, who owns a cell phone store, wants to renew his visa to stay in the U.S.

“My mother and father are concerned that he could be denied a green card because he uses Medi-Cal,” Mendoza said.

They’re hardly alone in their fears. Healthcare leaders warn that the Trump administration’s proposed rule, expected out in the coming weeks, would hurt public health efforts and reduce access for millions of low-income children and families.

Under the rule draft leaked in March, immigration officials could consider legal immigrants’ use of public health insurance, nutrition and other noncash aid programs as a negative factor in their applications for legal permanent residency.

If the proposal is finalized, the Kaiser Family Foundation estimated that up to 2 million children who are U.S. citizens with immigrant parents could drop out of Medicaid and the Children’s Health Insurance Program, and most would become uninsured. That’s because the parents would worry that their children’s use of those programs could jeopardize their legal status.

Healthcare leaders and advocacy groups say the changes could drive up uncompensated care costs, increase use of emergency care, endanger maternal and infant health and heighten the risk of infectious disease epidemics.

Dr. Benard Dreyer, director of pediatrics at Bellevue Hospital Center in New York, said rumors about the proposal already have chilled enrollment in the Women, Infants and Children nutrition program and free school lunches.

Currently, immigration officials can negatively weigh use of public cash benefits and Medicaid long-term-care benefits in evaluating applications for legal permanent residency and legal entry into the U.S. Non-cash benefits cannot be considered.

The leaked rule would broaden those factors to include individuals’ use of Medicaid health benefits, CHIP, Affordable Care Act premium subsidies, the Supplemental Nutrition Assistance Program, WIC, earned-income tax credits, and other state and local benefit programs in the previous three years.

“More than half of all immigrant households use one or more welfare programs, driving the federal debt and deficit and unfairly taking benefits away from vulnerable U.S. citizens and communities,” a Department of Homeland Security spokeswoman said.

The leaked draft stated, however, that native-born Americans use non-cash public benefits like Medicaid at about the same rate as immigrants—22.1% compared with 22.7%.

Dreyer said he and his Bellevue colleagues are already seeing a significant increase in food insecurity among their patients. He’s worried about a possible spike in premature births if pregnant women decline subsidized prenatal care.

Ken Janda, CEO of Community Health Choice, a managed-care plan serving Medicaid, CHIP and ACA exchange enrollees in the Houston area, said that for the first time in a decade, the plan has seen seven straight months of decreased Medicaid enrollment, as well as a 20% decrease in CHIP perinatal program enrollment. He thinks it’s because of the proposed rule.

Santiago, a 19-year college student in Houston who didn’t want his real name used, said he and his parents are worried that his use of Medicaid will jeopardize his father’s application for citizenship. Santiago has been on Medicaid since he was born in Texas with cerebral palsy.

The leaked draft would not affect people who already have permanent legal status and are seeking citizenship, such as his father, who works two jobs. But Santiago and his parents are still nervous.

“My father is concerned that we might end up being separated,” Santiago said. “I don’t even want to think about it.”●

“This is a major attack on the health of children in this country because 1 in 4 children live in an immigrant family.” Dr. Benard Dreyer

Director of pediatrics Bellevue Hospital Center