Proposed Public Charge Rule Could Jeopardize Recent Coverage Gains among Citizen Children

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.

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