Before the current wave of immigration policy changes, America’s children were already in crisis. Youth mental health had deteriorated to the point that in 2021, the U.S. Surgeon General issued a public health advisory and the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association took the extraordinary step of declaring a national emergency in child and adolescent mental health. Now four years after these measures, millions of school-aged children and their families face the additional mental health toll of worrying about the impact of new immigration and health coverage policies on their families.
About half of all children in the United States receive health coverage through Medicaid and the Children’s Health Insurance Program (CHIP) and one in four children across the country has at least one immigrant parent, with the vast majority of these children being U.S. citizens. Medicaid and CHIP also play a vital role in small towns and rural areas where children are more likely to be covered by Medicaid and CHIP.
And perhaps most importantly, when it comes to Medicaid/CHIP and school-aged children, it’s important to keep in mind that one out of three individuals enrolled in Medicaid are between ages 5 and 18. As a result, when policies targeting both health coverage and immigration enforcement shift simultaneously, students are often the ones at the frontlines.
Converging Policy Changes
It’s important to remember that undocumented immigrants are not eligible for traditional Medicaid. Yet, H.R. 1, signed into law in July 2025, includes numerous policies cutting Medicaid and other health programs, including ones targeted at immigrant families. Most notably, the law narrows the categories of immigrants eligible for Medicaid coverage beginning in October 2026 (e.g., groups of lawfully present immigrants like refugees become ineligible for Medicaid). This is on top of numerous other policies resulting in nearly a trillion dollars in federal cuts to state Medicaid programs, including new policies like work reporting requirements and administrative burdens that will kick millions of Americans off of coverage.
As discussed previously on the Say Ahhh! Health Policy Blog, the November 2025 proposed public charge rule dramatically expands circumstances under which immigration officers can deny permanent residency or admission to individuals who use—or are deemed likely to use—public benefits including Medicaid and the CHIP. Critically, The Department of Homeland Security’s (DHS) own analysis acknowledges the rule may lead to “public confusion or misunderstanding” that could result in “decreased participation in public benefit programs by individuals who are not subject to the public charge ground of inadmissibility.” This includes U.S. citizen children in mixed-status families whose parents are too frightened to enroll them. Again, one in four children (most of whom are U.S. citizens) across the country has at least one immigrant parent.
Moreover, this chilling effect is projected to significantly drive up the child uninsured rate. According to recent KFF estimates, the public charge rule could cause between 600,000 to 1.8 million U.S. citizen children to lose Medicaid or CHIP coverage despite remaining eligible. The analysis projects that between 50,000 to more than 150,000 additional eligible citizen children could forgo enrollment altogether—all due to fear and confusion among their parents about the immigration consequences of enrolling their U.S. citizen children in health coverage programs.
The January 2025 revocation of the “sensitive locations” policy, which had protected schools from immigration enforcement, has also created a climate of fear extending well beyond schools. While DHS maintains U.S. Immigration and Customs Enforcement (ICE) isn’t conducting raids inside schools, the policy change sends a clear message that reverberates through entire communities including reports of enrollment declines at schools.
Adding to these concerns, CMS plans to share enrollee data with ICE, a practice being challenged in court by advocacy organizations warning of devastating impacts. Such data sharing is likely to heighten fears among immigrant families about enrolling in or maintaining health coverage, even when they, or more likely, their children are fully eligible.
And the chilling effect of these policies is playing out in real time. According to a November 2025 KFF/New York Times survey, three in ten immigrant parents report their children delayed or skipped health care in the past year, including due to immigration concerns or lack of coverage. These are children going without preventive checkups, treatment for illness, or management of chronic conditions at a critical time in their development. This impact is likely to be particularly acute in rural communities, where Medicaid coverage rates are higher and families already face significant barriers to accessing mental health care due to provider shortages and long travel distances.
The Mounting Mental Health Toll
So, what does all of this policy complexity mean for the children sitting in classrooms across America? Children’s mental health is also taking a serious toll.
Research documents psychological and behavioral impacts among students affected by immigration enforcement: sleep disturbances, appetite changes, behavioral problems, heightened anxiety, depression, and symptoms consistent with PTSD. And according to the KFF/NYTimes survey, about one in five immigrant parents of a child under 18 years old said their child’s well-being has been negatively impacted by immigration-related worries since January 2025, including sleeping or eating difficulties, changes in school performance or attendance, or behavioral problems
The loss of health coverage compounds these mental health challenges by eliminating access to care precisely when it’s needed most. Without Medicaid or CHIP coverage, many families cannot access counseling services, medication, or other mental health supports. School-based services, while critically valuable, cannot alone substitute for comprehensive coverage providing continuity of care and access to specialized treatment.
A Crisis That Demands Recognition
The children affected by these policies aren’t abstractions—they’re students in every state, sitting in classrooms trying to learn while managing fears that no child should carry. They’re U.S. citizen children losing access to health coverage, not because they’re ineligible, but because their parents are too afraid to enroll them. They’re high achievers whose grades are slipping not from lack of ability but from worry and stress that no amount of studying can overcome. And they’re young people already struggling with unprecedented rates of anxiety and depression now facing additional layers of instability and fear. They’re also the classmates sitting beside them—children worrying about their friends who seem scared or sad, wondering if their friend will be at school tomorrow, and carrying their own anxiety about what’s happening to people they care about.
The convergence of these health care and immigration policy changes are creating the perfect storm affecting and exacerbating mental health for millions of children and students across the country. When about half of children depend on Medicaid and CHIP for coverage, and a quarter have an immigrant parent (predominantly U.S. citizens), it’s important to understand how these policy threads weave together—and how they intensify an already dire situation for student mental health.