Children currently enrolled in Medicaid are among those at risk of losing their benefits. (Photo: John Moore/Getty Images)

A Trump administration rule proposed last year that would make it harder for immigrants who receive public benefits to acquire green cards would also harm millions of children. Although the rule applies only to adults seeking green cards, researchers expect fear and confusion will prompt some immigrant families to go without benefits—and, in some cases, to disenroll their kids from programs providing food and medical assistance.

A new study estimates that as many as 8.3 million kids are at risk of losing benefits from Medicaid, the Children's Health Insurance Program, or the Supplemental Nutrition Assistance Program. This might be because one of their parents is seeking a green card, or because they fear deportation, study author Leah Zallman says—even though the rule itself only applies to people seeking permanent status.

"Parents may recognize that, without Medicaid or CHIP, they'd be unable to afford insurance, and without food stamps they'd be unable to afford food, but they're weighing that against the possibility of jeopardizing their ability to change their immigration status in the future," says Zallman, an assistant professor of medicine at Harvard Medical School and the director of research at the Institute for Community Health. For a family member who's worried about losing their immigration status, "it might make a lot of sense for that family to disenroll from benefits, because, in the end, they get to keep their family together." (The rule, however, is not yet finalized, and even when it is, researchers are recommending that families remain enrolled.)

It's a difficult choice—one that Zallman predicts (based on studies from changes to welfare rules in the 1990s) that around 25 percent of families will decide is not worth the risk: If a parent is denied a green card, and the family is separated, this would of course also impact their children's health and well-being.

For many of these kids, losing health care through CHIP—or food assistance through SNAP—could seriously harm their health. The researchers found that 5.5 million of the children at risk for disenrollment have conditions with specific medical needs, including asthma, epilepsy, and cancer. Out of all those at risk, Zallman expects that 1.9 million will be disenrolled from CHIP or SNAP.

Under current United States immigration policy, anyone who has used cash assistance or who's been institutionalized for long-term care that's being paid for by the government (such as a nursing home), is considered a public charge, meaning they could be denied admission to the country or risk a green card in the future. But in October of 2018, the Trump administration proposed including several food and medical assistance programs under this test—which, as the study authors note, would significantly increase the chance that an immigrant will be denied entry.

Although the change does not directly affect most immigrant families living in the country, fear of losing a green card has already prompted people to pull out of these programs: In May, a report from the Urban Institute found that about one in seven adults in immigrant families reported "chilling effects" last year. The effect was even stronger for adults in low-income families, particularly those with children. According to the survey, more than 20 percent of adults in low-income immigrant households disenrolled from a non-cash public benefit program in 2018.

Trump's policy, while not finalized, is now undoing recent gains to the insurance rate among children with non-citizen parents. "The gap had been reduced since 2008 to 2016, but in 2017, we found that overall uninsurance ... was starting to increase," says Jennifer Haley, research associate in health policy for the Urban Institute.

The chilling effect has even reached the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), a program that's not covered under the expanded public charge test. "In general, the immigration threats continue, as families are still concerned about participating in public programs," California WIC Association's executive director Karen Farely wrote in an email in May, after a new report showed a record decline in participation that many advocates believe is tied to Trump. "It takes significant time to turn around a change in participation in a large program, which is why, related to the immigration threats, the damage is so long-lasting and impactful."