Changing Public Charge Immigration Rules: The Potential Impact on Children Who Need Care

Leah Zallman, Director of Research, Institute for Community Health
Karen Finnegan, Epidemiologist, Institute for Community Health


On October 10, the Trump administration published a proposed rule change (PDF) that would increase the chance of an immigrant being determined to be a public charge and therefore being denied legal permanent residency or entry to the US. The change would instruct officials to take a broadened array of public benefits — including health and nutrition programs such as Medicaid and the Supplemental Nutrition Assistance Program (SNAP) — into consideration, along with other factors, when making public charge determinations.

This change, if passed, is expected to cause large numbers of immigrant parents to disenroll themselves and their children from safety-net programs, in large part due to fear and confusion over the rule even among immigrant families to whom the rule does not apply. There have been reports that this is already occurring.

Changing Public Charge Immigration Rules: The Potential Impact on Children Who Need Care (PDF) analyzes how the rule change could impact Medicaid and Children’s Health Insurance Program (CHIP) enrollment among a particularly vulnerable group: low- and moderate-income children who are in need of medical attention.

The brief’s key findings include:

  • 4.8 million children in need of medical attention live in households with at least one noncitizen adult and are insured by Medicaid or CHIP.
  • The authors estimate that 700,000 to 1.7 million of these children are likely to be disenrolled from Medicaid or CHIP if the rule is changed. This includes (among others) approximately:
    • 143,000 to 333,000 children with at least one potentially life-threatening condition, including asthma, influenza, diabetes, epilepsy, or cancer
    • 122,000 to 285,000 children on prescribed medications
    • 102,000 to 238,000 newborns
    • 53,000 to 124,000 children with musculoskeletal and rheumatologic conditions like fractures and joint disorders

A 60-day public comment period is underway, after which the Department of Homeland Security is required to review and respond to comments prior to finalizing the rule.

The full issue brief is available for download under Related Materials. For more analysis, visit our collection of resources on the proposed rule change.