Children Living with Non-Citizen Parents May Lose Health Care Under New Rules Interview with: Interview with: Leah Zallman, MD, MPH Assistant Professor of Medicine Harvard Medical School Physician at Cambridge Health Alliance. Director of Research Institute for Community Health

Dr. Zallman

Leah Zallman, MD, MPH
Assistant Professor of Medicine
Harvard Medical School
Physician at Cambridge Health Alliance.
Director of Research
Institute for Community Health What is the background for this study?

Response: In October 2018, the U.S Department of Homeland Security published a proposed change to a longstanding immigration rule. The proposed change would increase the chance of an immigrant being deemed a “public charge”, and increase the chance of being denied legal permanent residency or entry to the United States. Up to now, enrollment in public food, housing and health insurance programs were not counted against immigrants applying for “green cards”; the proposed rule change drastically changes the intent of the rule and newly includes food, housing and health insurance programs as benefits that can be considered counted against immigrants. These proposed changes are expected to cause many immigrant parents to disenroll their families from safety-net programs, largely because of fear and confusion about the rule – even among families to whom the rule does not technically apply. What are the main findings? 

Response: We found that in 2015, 8.3 million children enrolled in Medicaid and the Children’s Health Insurance Program or receiving Supplemental Nutrition Assistance Program benefits lived with adults who may disenroll their families from benefits out of fear or confusion, even if the rule does not technically apply to them.  5.5 million of these children had medical needs including 615,842 with asthma, 53, 728 with epilepsy, and 583,700 with disabilities or functional limitation.   We estimate that between 0.8 million and 1.9 million such children currently enrolled in public health insurance and the food stamp program will lose these benefits, endangering their health. Most of these children are citizens living in households with a non-citizen immigrant parent or other family member. What should readers take away from your report?

Response: Most children who lose Medicaid or CHIP will become uninsured, and are likely to skip needed care. For many children, skipping care will lead to long term medical problems, and increased healthcare costs and school absenteeism.  It also means that their parents – many of whom play vital roles as caregivers in nursing homes and home care – will be forced to skip work. In short, the proposed public charge policy will threaten the health of millions of children and have negative repercussions for generations to come. What recommendations do you have for future research as a result of this work? 

Response: We need to continue to understand and document the negative impacts of this proposed rule. More importantly, we need to fight back by calling our representatives and letting the Trump administration know that we stand in solidarity with immigrants. Punishing children by denying them medical care and nourishment is a gross violation of medical ethics and common decency, and  millions of innocent children, will suffer as a result of this proposed rule. Is there anything else you would like to add?

Response: I think it is really important to note that the rule applies only to some non citizens who do not have greencards. It is not finalized, and not yet implemented. If it is implemented, immigration officials will not be able to use prior benefit enrollment in their review, so there is no reason for immigrants to disenroll from benefits now. For more information, get information from the Protecting Immigrant Families website here.

The study was made possible by funding  from the California Health Care Foundation. Study authors Dr Himmelstein and Woolhandler have served unpaid health policy advisors to several state and national political leaders; and were cofounder and board members of Physicians for a National Health Program, a 501c3 physician organization that advocates universal health care for the United States. .


Zallman L, Finnegan KE, Himmelstein DU, Touw S, Woolhandler S. Implications of Changing Public Charge Immigration Rules for Children Who Need Medical Care. JAMA Pediatr. Published online July 01, 2019. doi:10.1001/jamapediatrics.2019.1744


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