Fear of Deportation is Keeping Kids from Getting Health Care

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Eleven-year-old Jaime was diagnosed with leukemia and is currently undergoing chemotherapy. He’s a U.S. citizen but his mother is an undocumented immigrant from Mexico.

“His mother told me that when they get home after his chemo, Jaime closes all of the curtains and locks the doors,” explained Jacqueline Casillas, my colleague and director of Pediatric Oncology at Miller’s Children’s Hospital in Long Beach. He’s afraid that his mother will be deported because she takes him to the doctor.

Jaime’s fears for his mother may be warranted – one reason is the current increase in capturing and deporting non-criminal immigrants, which wasn’t the practice of previous administrations. The second reason is the recent proposal to expand the definition of “public charge.”

Public charge refers to a person who is likely to become dependent on the government for support. Classification as a public charge could exclude an immigrant from ever attaining legal status in United States.

The U.S. Department of Homeland Security has proposed changes that broaden the definition of public charge to include immigrants receiving public benefits. The change would apply to lawfully residing individuals pursuing a green card, as well as their household members, including dependent children who are U.S. citizens.

Public benefits include enrolling in Medicaid or Child Health Insurance Program (CHIP). Other benefits include the assistance programs for housing and energy, using the Earned Income Tax Credit, and the food safety net programs of Women Infants and Children, WIC, and the Supplemental Nutrition Action Plan, SNAP (formerly known as food stamps).

Medi-Cal is California’s Medicaid program, the government-funded insurance for low-income individuals and people with disabilities. Nearly one-third of California’s population is insured through Medi-Cal. About 17 percent of the recipients are non-citizens, including lawful resident aliens and undocumented immigrants who have met eligibility criteria.

Nationally, more than 73 million people, about 20 percent of the U.S. population, have coverage from Medicaid and CHIP. More than half of our state’s 9 million kids younger than 20 are enrolled in Medi-Cal and CHIP, and legal status is not an eligibility requirement for children in California.

WIC helps low-income pregnant, postpartum and breastfeeding women and children through age 5 by providing vouchers for healthful food. Nationally, WIC served 7.3 million people in 2017, and 5.5 million of them were infants and children. In California, residency is required to participate in WIC, but WIC does not ask about citizenship status.

SNAP buffered food insecurity for 42 million people in the U.S. last year, the lowest number since 2010. Nearly 92 percent of SNAP households live in poverty and more than half include a working adult with low-paying job. Undocumented immigrants are ineligible for SNAP, but their citizen children do qualify for the program.

Both WIC and SNAP have proven merits, such as healthier pregnancies, decreases in pre-term births and childhood obesity, better eating habits and increases in immunization rates. SNAP also has proven benefits to the U.S. economy, workers’ health and responsiveness during natural disasters.

Jamie has a good prognosis but he needs treatments every week. He has health insurance through Medi-Cal, which makes it possible for him to go to the doctor but may also result in his classification as a public charge.

Even before the threat about changes in public charge, researchers at Kaiser Family Foundation found that fear of deportation was causing some immigrants to avoid going to the doctor. From March 2015 to March 2018 (the last data available), enrollments in Medi-Cal declined by more than 400,000, including 126,000 children.

Child advocates fear that even fewer children may seek health care if the proposed changes to the definition of “public charge” becomes a reality.

One in four children in the U.S. lives in an immigrant family. The new proposal could force parents to choose between risking deportation and accessing vital health and nutrition programs for themselves or their children. Medical professional groups, including the American Academy of Pediatrics and the American Academy of Family Physicians, among other professional organizations, have spoken out against the proposed changes.

With the current administration’s approach to immigrant families, Jaime has everything to lose – possibly his mother if he goes to his appointments or his life, if he doesn’t.

*Jaime’s name has been changed to protect his identity.