Researchers from the Urban Institute have documented the chilling effects of the Trump-era public charge regulation and other anti-immigrant policies for the past several years. Unfortunately, new research confirms that families are continuing to avoid public programs due to immigration-related concerns, despite having material hardships such as food insecurity, unmet medical needs, and problems paying rent and utilities.

Almost a third of families reported avoiding public programs for at least one of the following reasons: (1) worried it would disqualify them or a family member from obtaining a green card, (2) had other worries about immigration status or enforcement, (3) were unsure if they were eligible because of their or a family member’s immigration status, and/or (4) were asked to provide a Social Security Number (SSN) or other proof of citizenship when applying for a family member. Some of these concerns are directly related to public charge, but others reflect longstanding, systemic barriers immigrant families face when applying for benefits.

With respect to public charge, it is important to continually emphasize that many immigrants are not subject to public charge. For example, refugees, asylees, other humanitarian immigrants, and those who already have a green card and are applying for citizenship are not subject to public charge at all.

For those who may be subject to the public charge test in the future, the report findings show that more work needs to be done to inform impacted communities that the rules have changed. The Biden Administration finalized a public charge regulation that undoes the harmful Trump-era rule and returns to longstanding immigration policy for people seeking lawful permanent resident (LPR) status.

Under the Biden rule, which takes effect on December 23, 2022, the only public benefits that the Department of Homeland Security may consider as part of the public charge determination are cash assistance and long-term care at government expense. Other benefits, such as SNAP, WIC, Medicaid/CHIP, and housing supports will not be considered. Moreover, benefits used by an applicant’s family members will not be considered. And past benefit use is just one part of the overall test – therefore even if an applicant has used cash assistance or long-term care benefits in the past, s/he could still gain LPR status based on the totality of the circumstances.

The other concerns that prevented immigrant families from applying for needed public supports – unsure of their eligibility and asked to provide an SSN when applying for a family member – predate the public charge debates of the past few years and stem from confusing eligibility rules and unnecessary red tape.

There’s no doubt that the Medicaid/CHIP eligibility rules are complex. The eligibility section of MACPAC’s “Medicaid 101” series is proof enough. For people in immigrant families, the rules are so complex that even experts in Medicaid/CHIP eligibility struggle to keep up. That’s part of why we and others have called for needed simplifications such as lifting the 5-year bar, ending the requirement to be ‘qualified’ in addition to ‘lawfully present,’ and allowing all income-eligible people to enroll regardless of immigration status.

The issue of requesting SSNs of nonapplicants on Medicaid/CHIP applications is also a longstanding problem. While states are only allowed to require information necessary to complete an eligibility determination, states do sometimes ask for additional information. In some cases, this is for a reasonable purpose, such as to verify income electronically, but it can also be a major deterrent as this research shows. Families may not realize that they can decline to provide an SSN, use another method to verify income (such as by providing paystubs), and still enroll their eligible family members.

Clearly, we have a lot of work to do. Medicaid coverage for children is associated with improved health, higher educational attainment, and greater financial security. Similarly, the benefits of SNAP extend beyond improving food security and nutrition to promoting better health and lower health care costs. And yet, this new research shows that families are continuing to avoid these programs.

Helpfully, the brief offers some specific steps policymakers can take to improve participation in public programs:

• Ease families’ concerns about public charge considerations by informing them that the Trump-era rule is no longer in effect,
• Assure families that children’s public benefits participation will not affect their parents’ immigration statuses,
• Address burdensome documentation requirements for applicants and remove citizenship-related questions for nonapplicants,
• Improve enrollment and customer service experiences in safety net programs by treating people with respect and offering materials and assistance in multiple languages, and
• Relax eligibility restrictions based on immigration status for Medicaid/CHIP and other safety net programs.

While 9 out of 10 children in the US are citizens, more than a quarter live in immigrant families. Continued avoidance of needed public programs could have widespread and lasting consequences. Empowered by the facts, families should be reassured that they can enroll their children in Medicaid and CHIP without fear of immigration consequences.