Standing Up For Immigrants’ Health and Wellbeing

With a new Republican-controlled White House and Congress taking power in January, champions for immigrants’ health and well-being are concerned about the many ways policymakers may attempt to restrict or deter immigrants from accessing federal programs. This blog breaks down some of the most likely tools they may use to do so, based on previous actions, campaign promises, and proposals from think tanks. We also outline how advocates can start planning to fight back.

Health insurance, food assistance, tax credits, housing assistance, and other economic support programs help immigrants, their families, and their communities thrive. Many of these programs have strong privacy protections, and changes to eligibility criteria would take time. NILC recommends that eligible immigrants continue to utilize these programs to the fullest extent now and in the coming days.

This analysis discusses threats by federal agencies and Congress to programs that improve health and economic well-being, including changes to the definition of “public charge,” enrollment and eligibility restrictions for health coverage, and funding cuts for safety net programs. It also addresses steps advocates can take now to prepare. However, all immigration policy impacts health. The policies discussed in this blog must be considered in the context of other immigration actions and policy changes the federal government may undertake, such as mass deportations, detention camps, worksite raids, and more. Fear of these actions is already impacting immigrants and must be unilaterally and vocally opposed by all of civil society.

Advocates should prepare to fight the following federal actions that will undermine immigrant access to safety net programs: 

Defending Immigrants’ Health and Economic Supports In Executive Actions

Opposing Expansion In Public Charge Determination Factors

The public charge ground of inadmissibility is the provision of federal law, originally passed in the same Congress as the Chinese Exclusion Act, under which immigration officials assess whether an applicant for a visa or green card might be primarily dependent on the government for subsistence. A person considered at risk of becoming a so-called “public charge” can be denied lawful permanent resident status. By law, public charge is not used in applications for citizenship. 

Until the first Trump administration, this law had been narrowly interpreted to include receipt of cash assistance or long-term institutional care at government expense. The Trump administration expanded it to broaden the circumstances where someone could be denied entry to the United States or adjustment of status. NILC sued the government over this baseless expansion, which caused widespread confusion and continues to chill immigrant communities across the country from accessing the services they need. The Biden administration reversed the Trump administration’s policy in 2021. Project 2025 envisions its return. 

Defending DACA Recipients’ Eligibility for the Affordable Care Act (ACA)

DACA recipients are now eligible for health insurance under the ACA, which specifies that all lawfully present immigrants are eligible for coverage. The Department of Health and Human Services (HHS) under President Trump could attempt to reverse the Biden administration’s decision to include DACA recipients in ACA eligibility based on distorted and false claims. Doing so would require a full regulatory review process, easily taking over a year or more. NILC recommends that DACA recipients continue to enroll in and utilize ACA coverage.

Ensuring Applying For Health Coverage Doesn’t Become More Difficult 

Recent policy changes have eased some challenges people faced accessing ACA and Medicaid coverage. Because good public health requires that all community members have access to care, advocates must be prepared to defend this progress during the incoming administration.   

• The Biden administration awarded Navigators – community based organizations that provide outreach and assistance for ACA coverage – a record $500 million, 5-year commitment. Since HHS dramatically cut Navigator funding in 2017, it may attempt to do so again. 
• Many eligible immigrants face challenges verifying their identity and immigration status in Medicaid due to system problems. Currently an applicant’s coverage may begin while they go through the sometimes complicated process of assembling and submitting the necessary documentation. The incoming administration may seek to end this policy.
• States are required to use electronic sources to reverify Medicaid recipients’ income and other information for their continued eligibility for coverage, sparing those up for renewal from lengthy and difficult paperwork that is particularly challenging for immigrants and limited English-proficient (LEP) recipients. Many states, however, underutilize use of this method, and the Centers for Medicare and Medicaid Services (CMS) has taken action to require improved compliance. If CMS discontinues this oversight of states’ compliance with renewals policies, it would make it harder for Medicaid recipients to keep their coverage. 

Continuing Progress on Language Access 

Section 1557 of the Affordable Care Act prohibits federal health agencies and recipients of federal health care funding from discriminating against certain classes of people, including those with limited English proficiency. The Trump administration repealed many Section 1557 protections for women and LGBTQ communities, as well as certain requirements that people with LEP be informed of their rights to access assistance in their language. The Biden HHS restored and strengthened those provisions. While the Trump HHS did take action to address language access during the COVID-19 response, Project 2025 promises to restore weaker Section 1557 regulations, which may include diluting protections for the 25 million Americans with LEP. 

Protecting Mixed-Status Families Access to Federally Funded Housing

The Trump Department of Housing and Urban Development proposed forbidding certain immigrants in mixed immigration status families from living with their family members in federally funded housing programs. While this proposal was never implemented, nearly 108,000 people would have been at risk of being evicted and displaced, and families would have to choose between staying together and shelter. Project 2025 envisions its return.

Ensuring Immigration Enforcement Stays Out of Hospitals and Schools

The Biden administration Department of Homeland Security issued guidelines restricting when Immigration and Customs Enforcement and Customs and Border Protection will operate at or near sensitive locations that could harm the public interest. This policy ensures that immigrants can feel safe accessing essential services without fear of immigration enforcement while avoiding actions that force providers to choose between their ethical obligations and government directives. In order to facilitate their deportation goals, as well as making immigrants fear everyday interactions, the Trump administration could end these restrictions, though health providers continue to have basic responsibilities for their patients. 

Defending Immigrants’ Health and Economic Supports In Congress

In 1996, Congress passed the Personal Responsibility and Work Opportunity Reconciliation Act, drastically restricting immigrants’ access to health coverage and economic supports. The incoming Congress could similarly use reconciliation, a process that allows the Senate to pass spending and revenue legislation with only 50 votes, to make further restrictions. Reconciliation does have a series of rules, including allowing only policy changes that have the primary purpose of changing spending or revenue, which place some guardrails on what can be included. Other “must pass” pieces of legislation, such as annual spending packages and addressing the debt limit, also present opportunities to oppose anti-immigrant policies. 

Addressing Equity in Eligibility for Tax Credits

In 2017, Congress made dramatic tax cuts for the wealthy and ended access to the Child Tax Credit (CTC) for children with Individual Taxpayer Identification Numbers (ITINs), which allow people who don’t have Social Security numbers to file taxes. This exclusion has denied immigrant taxpayers the poverty-reduction effects of the CTC. If Congress takes no action, this provision will expire after 2025, restoring access for nearly 1 million children. However, some have pushed for going beyond this provision and excluding U.S. citizen children whose parents file taxes with ITINs from the CTC and other tax credits, raising taxes on immigrant workers. Congress is expected to start consideration of a tax reconciliation bill in early 2025.

Maintaining Hospitals’ Ability to Serve Immigrant Patients

Federal law requires hospitals to provide emergency care to patients regardless of immigration status or ability to pay. For patients who are uninsured or can’t afford their hospital bill, they also receive federal funds to help cover the cost of care, including Emergency Medicaid, which provides some reimbursement for immigrants who would be otherwise eligible for regular Medicaid if not for their immigration status. The Republican House Budget Committee has criticized this funding, while Florida and Texas now require hospitals to question patients about their immigration status, creating a chilling effect. Avoiding medical treatment only exacerbates health conditions and creates longer-term financial costs for families and communities. Restricting federal funding for hospitals, or depriving them of patients through invasive questions, threatens their financial stability, especially in already vulnerable communities, such as in rural areas.   

Sustaining Federal Funding for Immigrant Friendly Jurisdictions

In September the House of Representatives passed the No Bailout for Sanctuary Cities Act, which would end federal funding that could conceivably be used for undocumented immigrants by cities and states that do not cooperate with federal immigration enforcement entities. These jurisdictions would be forced to end their policies or forgo federal funding for health centers, emergency aid, domestic violence programs, school lunch programs, and other forms of federal support. Local law enforcement collaboration with immigration enforcement is associated with housing instability, chronic student absenteeism, low birth weight, negative child wellbeing outcomes, and decreased use of preventive and prenatal care for immigrant communities and their children. Affected jurisdictions will see harm to their communities should this bill become law.

Other Restrictions on Public Benefits

Republicans have indicated they plan to cut programs that help low-income families, such as Medicaid and nutrition assistance (SNAP). While immigrants are already heavily restricted from accessing these programs, Congress may attempt to make it worse. For example, they may use unproven claims of enrollment fraud to enact further paperwork barriers or work requirements, which deter enrollment because they add complexity. The Republican Study Committee, in a more extreme scenario, proposes limiting public assistance programs to only U.S. citizens.

Steps To Take Now

Immigrants enrich the United States in myriad ways, paying billions of dollars in taxes, disproportionately working in essential industries, and leading communities. We can show policymakers that limiting immigrant access to health care, safety net and social service programming will harm the whole country. Advocates, leaders, and community members looking to stand in support with immigrant communities can: 

• Ensure funding goes to community-led organizations, which are crucial support centers, service providers and information hubs for their community members;
• Identify and train spokespeople from impacted communities who can share their experiences and expertise to speak to the harm that policies will do;
• Look to faith institutions, hospitals, health providers, food banks, business leaders, and other influential entities to demonstrate solidarity now and in times of crisis; 
• Distribute Know Your Rights resources; and
• Partner with advocacy organizations like NILC to oppose harmful policies and divisive anti-immigrant rhetoric.