Texas is home to approximately 4.7 million immigrants (an estimated 17% of the state population), including approximately 317,000 immigrant children¹. Of these immigrants, approximately 1.7 million are naturalized US citizens, nearly 1 million are eligible to become naturalized US citizens, and nearly 2 million are undocumented immigrants^1,2. The number of US-born children in Texas who live with an undocumented family member is reported to be approximately 1 million, with approximately 500,000 children with an undocumented parent^1,3. Obtaining permanent residency status is a lengthy process and a source of anxiety for many immigrants. Recent changes to the US Department of Homeland Security (DHS) rules regarding which public benefits count negatively towards obtaining permanent residency may impact these families and children. Pediatric healthcare providers should be prepared to help immigrant families understand how the use of public benefits could impact changing their immigration status.

“Public charge” is an immigration law term referring to individuals who are dependent or likely to become dependent on the government for assistance. This dependence can negatively influence seeking permanent residency (i.e. green card). 

On August 14, 2019, the DHS published a final rule which expands what public benefits are considered for a “public charge” determination. The rule will take effect October 15, 2019, and it defines “public charge” as an immigrant who receives one or more of the defined public benefits in aggregate of 12 months within any 36-month period. The public charge analysis will be done for the individual immigrant seeking to change status, not broadly for use by the immigrant’s family or household members. 

The new rule specifically excludes the following benefits from the public charge analysis: 

• WIC program
• Medicaid and CHIP coverage of children under age 21 and pregnant women (up to 60 days postpartum) 
• Emergency Medicaid
• School-based programs providing assistance to children (e.g. Free and Reduced Lunch programs) 

The new rule specifically includes the following benefits in the public charge analysis:

• SNAP benefits
• Section 8 Housing Choice Vouchers, Section 8 Project-Based Rental Assistance, and other subsidized housing programs
• Non-emergent Medicaid for non-pregnant adults 
•  SSI, TANF, and similar cash assistance are still included as before

Reports of immigrants dropping Medicaid, WIC, and other public benefits have been reported since proposed changes were reported last year^6,7. One study published by the Urban Institute found that one in seven adults in immigrant families reported they did not participate in a benefit program because of fear of impact on green card application in 2018, with Hispanic adults twice as likely as non-Hispanic adults to report that they did not participate⁸. Many families, influenced by fear and lack of knowledge may forgo use of public benefits for themselves or their children without distinction between included and excluded benefits. 

In Texas, pediatric providers care for immigrant children with a diverse range of immigration statuses in the home. Providers can educate families and support the health of these vulnerable children.

Important Messages for Providers and Families:

1. You can read the American Academy of Pediatrics (AAP) official statement regarding the new “public charge” rule here.
2. Use of benefits is generally considered on an individual basis, not a family basis. Parents should be encouraged to utilize appropriate benefits for their qualifying children.
3. The new rule will not be retroactively applied. Benefits used prior to October 15, 2019 will not count against applicants.
4. Certain immigration statuses are excluded from public charge: current green card holders, asylees, refugees, victims of certain crimes/human trafficking, etc. 
5. This rule does not change the eligibility for the benefits programs.  The rule now considers the use of them for individuals on the pathway to permanent residency. 
6. You can find more resources here.  This includes ways for families to seek legal advice from an attorney.

References:

1. Immigrants in Texas. (2017). Retrieved from https://www.americanimmigrationcouncil.org/research/immigrants-in-texas.
2. Department of Homeland Security. Population Estimates. (2018). Retrieved from https://www.dhs.gov/sites/default/files/publications/18_1214_PLCY_pops-est-report.pdf.
3. Migration Policy Institute. Profile of the Unauthorized Population: Texas. (n.d.). Retrieved from https://www.migrationpolicy.org/data/unauthorized-immigrant-population/state/TX.
4. Proposed Rule: Inadmissibility on Public Charge Grounds. (2018). Retrieved from https://www.regulations.gov/document?D=USCIS-2010-0012-0001.
5. Rule: Inadmissibility on Public Charge Grounds. (2019). Retrieved from https://www.regulations.gov/document?D=USCIS-2010-0012-63740.
6. Baumgaertner, E. (2018). Spooked by Trump proposals, immigrants abandon public nutrition services. Retrieved from https://www.nytimes.com/2018/03/06/us/politics/trump-immigrants-public-nutrition-services.html.
7. Armus, T. (2018). A proposed federal policy won’t target immigrants for using welfare. In Texas, they might drop out anyway. Retrieved from https://www.texastribune.org/2018/09/28/public-charge-immigration-chilling-effects-texas/.
8. Bernstein H, Gonzalez D, Karpman M, & Zuckerman S. (2019). One in seven adults in immigrant families reported avoiding public benefit programs in 2018. Retrieved from https://www.urban.org/sites/default/files/publication/100270/one_in_seven_adults_in_immigrant_families_reported_avoiding_publi_7.pdf.

Hannah R Justice, MD