The Trump Administration is pursuing changes that, for the first time, would allow the federal government to take into account use of Medicaid, CHIP, subsidies for Marketplace coverage and other health, nutrition, and non-cash programs when making public charge determinations. These changes would likely lead to decreased participation in Medicaid, CHIP, Marketplace coverage, and other programs among legal immigrants and their citizen children, even though they would remain eligible. This brief provides an overview of citizen children with a noncitizen parent potentially affected by the changes and analyzes three Medicaid/CHIP disenrollment scenarios to illustrate how the changes could potentially affect their health coverage and uninsured rate. In 2016, there were 10.4 million citizen children with at least one noncitizen parent. Nearly nine in ten of these children live in a family with a full-time worker, but these workers often are in low-wage jobs, leading to lower family incomes and more limited access to health coverage. As such, over half (56%), or 5.8 million, citizen children with a noncitizen parent had Medicaid or CHIP coverage in 2016. (See Appendix tables for state data.) We illustrate the potential impact of different Medicaid/CHIP disenrollment rates and show that, if the policy leads to disenrollment rates from 15% to 35%, an estimated 875,000 to 2 million citizen children with a noncitizen parent could drop Medicaid/CHIP coverage despite remaining eligible. The majority disenrolling would become uninsured, increasing their uninsured rate from 8% to between 14% and 22% and the uninsured rate for all children from 5% to between 6% and 7%.Although it is difficult to predict the effect of the policy change, these disenrollment rates illustrate the potential impact and draw on previous research on the chilling effect welfare reform had on enrollment of immigrant families. However, unlike the current draft policy, welfare reform did not affect immigration status. Thus, this illustrative analysis may underestimate the policy's impact on Medicaid/CHIP participation. In addition, this analysis does not account for coverage losses that would result from decreased participation in Marketplace coverage. Coverage losses would negatively affect the health of children and their families' financial stability. Coverage losses would reduce access to care, contributing to worse health outcomes. Moreover, reduced participation in nutrition and other support programs that are also proposed to be considered as part of public charge determinations would likely compound these effects.
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