On October 10, 2018, the administration proposed a major change to immigration policy through an expanded definition of “public charge.” The proposed public charge rule would make it more difficult for applicants to secure lawful permanent residency (“green cards”) or temporary visas by negatively weighing recent or potential participation in safety net programs such as Medicaid during the immigration admissions process. Applicants whose benefit use exceeds a certain threshold or have other characteristics that officials would consider likely to lead to reliance on public assistance could be deemed a potential “public charge” and denied permanent residency in or admission to the United States.
Prior experience suggests that immigration policy changes can lead to broader “chilling effects” on program participation among populations beyond those at whom the policy change is directed. The public charge rule could lead immigrant families to opt out of public benefit programs for which they remain eligible—and avoid interactions with government authorities altogether.
The public charge rule would not consider children’s public benefit use in their parents’ public charge determinations, but it is expected to discourage immigrant families from seeking public health insurance coverage through Medicaid or the Children’s Health Insurance Program (CHIP) for their citizen children.
Using data from the American Community Survey, this brief examines trends in Medicaid/CHIP participation and uninsurance rates among citizen children living in a household with any noncitizen parents and those with only US-citizen parents between 2008 and 2016, a time when policies such as the Affordable Care Act, Medicaid expansion, and CHIP reauthorization were implemented to increase health insurance coverage among the general population and also included targeted investments in outreach and enrollment for immigrant families.
From 2008 to 2016, citizen children with any noncitizen parents experienced substantial declines in uninsurance and, among those eligible for Medicaid/CHIP, accompanying increases in Medicaid/CHIP participation. The proposed public charge rule could erode these gains because parents may drop coverage or fail to enroll their children in Medicaid or CHIP out of fear of immigration-related consequences. Our key findings include the following:
• Between 2008 and 2016, the uninsurance rate fell 10 percentage points among citizen children with noncitizen parents and 3.5 percentage points among those with only citizen parents. The gap in uninsurance rates between children with and without noncitizen parents narrowed from 9.0 to 2.6 percentage points.
• Between 2008 and 2016, Medicaid/CHIP participation increased 15.5 percentage points among citizen children with noncitizen parents and 10.5 percentage points among children with citizen parents. The gap in participation between these two groups nearly closed—with 93.3 percent of Medicaid/CHIP-eligible citizen children who have noncitizen parents and do not have other insurance coverage being enrolled in Medicaid/CHIP compared with 94 percent for those who have citizen parents.
• In 2016, nearly half of all citizen children with noncitizen parents resided in California (2.6 million), Texas (1.6 million), and New York (733,000).
• Nationally, 6.8 million citizen children living with noncitizen parents were enrolled in Medicaid/CHIP in 2016. Citizen children with noncitizen parents represented one in five Medicaid/CHIP-enrolled children, nationwide.
• In California, 1.9 million citizen children with noncitizen parents were enrolled in Medicaid/CHIP, making up just over 40 percent of all Medicaid/CHIP-enrolled children statewide. In Texas, 1.1 million citizen children with noncitizen parents were enrolled in Medicaid/CHIP, constituting nearly 32 percent of all Medicaid/CHIP-enrolled children statewide. And in New York, nearly 500,000 citizen children with noncitizen parents were enrolled in Medicaid/CHIP, making up about 24 percent of all Medicaid/CHIP-enrolled children statewide..
• Medicaid/CHIP-enrolled citizen children with noncitizen parents accounted for more than one in five Medicaid/CHIP-covered children in nine states: Arizona, California, Colorado, Illinois, Nevada, New Jersey, New York, Texas, and Washington.
• The impacts of the proposed public charge rule are likely to be even greater for Medicaid/CHIP-enrolled citizen children who have noncitizen parents who are enrolled in Medicaid because their parents may drop coverage and become uninsured. In 2016, an estimated 2.2 million Medicaid/CHIP-enrolled citizen children nationwide had at least one noncitizen parent with Medicaid coverage.