A mother at Mary’s Center last week wanted to enroll her child, a US citizen, in benefits. But when the moment came, she decided against it. With her partner’s immigration status on the line, it was too much of a risk.

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She has not been alone in choosing to go without healthcare for her American child out of a climate of fear currently surrounding immigration in the US and fears that parents of those child citizens will be deported.

Jessica Kaufman, social services manager at the Washington DC-based community health center, has watched for months as immigrant families have questioned whether to access much-needed benefits. That includes programs that US children rely on for vaccines, safe homes and food, she said. Millions of American children, who have one or more immigrant parent, could be impacted.

“There’s a lot of fear, and there is a lot of hesitancy to enroll in programs,” said Kaufman. “Things are changing so quickly, and there’s so much confusion.”

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Much of the chaos is thanks to a proposed public charge rule that was announced in September but was rumored long before. A brainchild of the Department of Homeland Security (DHS) under Donald Trump, the revised rule if implemented would dramatically limit what public benefits non-citizens in hopes of a visa or green card could access.

Already, using cash benefits such as Temporary Assistance for Needy Families (TANF) and supplemental security income (SSI) can hurt a person’s petition to enter and remain in the US. But under the proposed rule, far more programs will be implicated, including Medicaid, the Supplemental Nutrition Assistance Program (Snap), Section 8 housing vouchers and public housing.

Use of any of those benefits for more than a short period of time will be considered “a heavily weighted negative factor” that makes most people ineligible to live legally in the US. The DHS says the rule’s purpose is to make sure legal immigrants, most of whom pay taxes, are “self-sufficient”.

“It’s very unfair and chilling that you’ve contributed into something, just like any American citizen, and when you have a time of need that you cannot tap into those benefits out of fear,” said Alma Rosa Nieto, vice-chair of the American Immigration Lawyers Association’s media committee.

And, of course, many of those benefits could go to help the children of those immigrants, who are often US citizens.

Confusion around the public charge rule’s parameters has caused what Nieto called “pandemonia” among the immigrant community. One of her clients who relies on benefits for herself and her US citizen son has decided to delay her application for citizenship, though the rule as it stands should not affect applications.

“The fear is quite great, and I’ve heard of many saying they’re terminating their benefits,” said Nieto.

Even if someone has all of the facts, there’s still the sense of what’s going to happen tomorrow? Jessica Kaufman

She is fielding a lot of questions about whether immigrants should get their US citizen children off of whatever assistance they are receiving. Though the proposed rule has not been finalized and could still be revised, the answer to that question should be “no”: even in the rule’s announcement, the DHS said it would not consider “benefits received by an alien’s US citizen children” as part of a public charge inadmissibility determination.

But that doesn’t seem to matter in practice.

“Even if someone has all of the facts, there’s still the sense of what’s going to happen tomorrow? What’s going to happen in a month? Who is to say that there isn’t going to be another change?” said Kaufman.

If only a small percentage of families who rely on benefits stop using them, the impact could still be huge. A recent report by the Urban Institute found that 6.8 million citizen children with non-citizen parents relied on Medicaid or the Children’s Health Insurance Program (Chip) in 2016. That’s out of 10.3 million citizen children in total with at least one non-citizen parent – 13% of kids in the US.

“The stakes are high,” said Genevieve M Kenney, a senior fellow at the Urban Institute and one of the report’s authors.

Kenney has been studying health insurance coverage and public benefits take-up for decades. She watched as, between 2008 and 2016, the uninsured rate fell 10% for citizen children with non-citizen parents partly because more of them participated in Medicaid and Chip. Then, she watched in 2017 as the number of uninsured kids went up – not by a lot, she said, but by enough to be notable.

Though the proposed rule was only announced months ago, previous, more expansive versions were leaked and reported in the press. Nieto said that people remember the broadness of earlier drafts, and that broadness is informing their decisions.

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“I think what it does is it makes it clear that immigration policy is not set in stone and can be changed. So from a family’s perspective, I suppose it could be rational to think, ‘Well if they’re proposing this, what’s to stop [it] from changing further?’” said Kenney.

Though the public comment period on the proposal only closed on 10 December and the rule is not yet in place, advocates say non-citizens are already choosing not to enroll in benefits for their US citizen children. If that trend continues, experts are worried that a pattern similar to what happened during welfare reform in the 1990s could manifest.

Between 1994 and 1998, use of food stamps by US citizen children with a non-citizen parent fell by 53%, according to the Department of Agriculture. Similarly, if the proposed public charge rule goes into effect, Kaufman predicts US citizen kids will experience food insecurity, poor living conditions and decreased healthcare coverage.

“I think we haven’t even seen the tip of the iceberg,” Kaufman said, “in terms of how this will impact the population.”