Last week, the U.S. Department of Health and Human Services (HHS) announced that it is restricting undocumented immigrants’ access to numerous federal benefits, causing an outcry from advocacy organizations focused on health and immigration.
HHS rescinded a 1998 interpretation of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), which extended certain federal public benefits to undocumented immigrants. It provided a revised list of programs now classified as federal public benefits, which includes certified community behavioral health clinics, Head Start, the Title X Family Planning Program and more. The new restrictions went into effect on July 14 with a 30-day comment period ending August 13.
“For too long, the government has diverted hardworking Americans’ tax dollars to incentivize illegal immigration,” said HHS Secretary Robert F. Kennedy, Jr, in a statement. “Today’s action changes that—it restores integrity to federal social programs, enforces the rule of law, and protects vital resources for the American people.”
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Several health and immigration advocacy organizations have come out against the decision, arguing that these programs are lifesaving for immigrant families. And it’s not just undocumented immigrants that will be harmed by this decision.
Under PRWORA, “qualified immigrants” are eligible for federal public benefits programs. This includes lawful permanent residents or people with a green card, refugees and people granted asylum. However, numerous lawfully present immigrants are not listed as qualified immigrants and are therefore ineligible for these programs, such as people with Temporary Protected Status who have fled an emergency, domestic violence survivors with special “U” visas and child abuse survivors with “Special Immigrant Juvenile Status,” according to Protecting Immigrant Families (PIF), a coalition advocating for immigrant rights.
Those who have been approved for lawful permanent residency but have not yet been issued a green card are also not listed as qualified immigrants.
HHS’ decision will also harm U.S. citizens in immigrant families, PIF argued. It’s common, for example, for a parent to be undocumented and for the kids to be U.S. citizens. If someone in the family is ineligible for federal health programs, then it’s less likely for other family members who are eligible to access those services.
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“This change could have a huge impact on the 27% of the US population living in immigrant families,” said Esther Reyes, campaign strategist of PIF, in an email. “That includes not only people who are undocumented, but also lawfully present immigrants and US citizens in immigrant families. Immigrant families typically include people – often children – who are US citizens, people who have green cards or other lawful statuses, and people who are undocumented. Our experience with exclusionary policies – especially confusing policy changes like this one – is that they harm whole families.”
These comments were echoed by Isha Weerasinghe, director of public benefits justice at the Center for Law and Social Policy (CLASP), a nonprofit focused on advancing policy for people with low incomes. HHS’ change will also make it difficult for healthcare and social service facilities to determine who is eligible for services, “potentially refusing to care for many more than those who are deemed ‘qualified,’ making it harder for everyone to access services,” Weerasinghe added.
“If our health care system is less efficient for U.S. citizens it’s not because an immigrant went to a health clinic — rather it’s because this administration has laid off thousands of HHS staff who help to administer programs and just signed a $4 trillion bill into law with the largest Medicaid cuts in the program’s history. This change in interpretation of longstanding law would be devastating for public health and have widespread impacts on the well-being of our entire country,” Weerasinghe said.
Reyes added that health centers are a “lifeline” for families with low incomes, including many immigrant families, providing basic care like mammograms as well as more complex care like cancer treatment.
An executive at UnidosUS, a Hispanic civil rights and advocacy organization, agreed with this, arguing that providing immigrant families access to these programs has been beneficial to communities. She particularly called out the Women, Infants and Children program, which provides food assistance to pregnant women, new mothers and young children.
“These are people that are part of the workforce. These are people who are contributing,” said Carmen Feliciano, vice president of policy & advocacy at UnidosUS, in an interview. “These are children that are being born here. So all these years, almost 30 years of policy that has been working correctly, to just come out with this very broad policy without any data backing this up that it has been detrimental or harmful to the communities, that doesn’t make any sense.”
What can be done
Many advocacy organizations are taking advantage of the 30-day comment period, including Families USA, which supports healthcare consumers.
“This opportunity is critical for a broad coalition of stakeholders including employers and small businesses, immigrants, their families, their neighbors, and people who serve or work with immigrant communities to weigh in and raise concerns with HHS’s interpretation, and advocate for continued access to these vital programs,” said Staci Lofton, senior director of health equity at Families USA. “If enough pushback is generated, HHS may revise its position.”
UnidosUS will also be submitting comments about the harm this policy could have on the U.S., Feliciano said.
“No one will benefit from having underdeveloped children or people that are hungry and that cannot go to work,” she said. “That’s not a benefit to anyone.”
Reyes of PIF also called on states and Congress to take action.
“States understand that denying people access to care doesn’t eliminate their need for care – it just shifts the costs to emergency rooms and, by extension, state taxpayers and employer-sponsored insurance,” she said. “States should be documenting the harm resulting from this HHS policy and pushing their congressional delegations for action.
“And I’ve been concerned that this came out a few days ago, and there’s been no public response from the Democrats on the House Energy and Commerce Committee or the Senate HELP Committee,” she continued. “This policy is a major threat to the nation’s health, and the folks running the nation need to be taking action.”
Photo: Philip Rozenski, Getty Images