WASHINGTON — The Trump administration on Thursday announced it would further curtail undocumented immigrants’ access to federally funded programs, including health care clinics, early childhood education, and nutritional support. The decision reverses a federal practice that has been in place for decades, and is likely to cause widespread fear among immigrant communities once it goes into effect on July 14, advocates say.
Advocates say the administration’s move will cut access to basic health care provided by federally funded clinics and result in worse outcomes — not just among undocumented people, but potentially for their children, who are often legal citizens by birth. The sweeping policy change could also affect immigrants who are authorized to be in the country, such as asylees, refugees, and children covered by the Deferred Action for Childhood Arrivals policy, or DACA. People with work or student visas, temporary protected status, or employment authorization may also be subject to the new rules.
“It’s a cruel and extreme measure that they seem to be moving towards,” said Stan Dorn, director of health policy at UnidosUS, a nonpartisan Hispanic civil rights and advocacy group. “The direction is very worrisome.”
In its announcement, HHS said cutting off services to undocumented people would redirect hundreds of millions of dollars annually toward U.S. citizens and qualified immigrants. However, transitioning operating procedures for all programs to align with the new policy could cost up to $175 million, according to preliminary agency estimates.
“For too long, the government has diverted hardworking Americans’ tax dollars to incentivize illegal immigration,” health secretary Robert F. Kennedy Jr. said in the press release. “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.”
Thursday’s move was among the clearest examples yet of Kennedy making sweeping decisions from the helm of HHS without public input — an approach that started in February, when he pared back the agency’s public participation process, angering some lawmakers, government watchdogs, and patient groups.
Undocumented people tend to use less health care overall, and have lower health care costs on average — in part because they tend to be younger and healthier. They are mostly ineligible for federal programs such as Medicare and Medicaid, and have been for decades.
However, the federal government (including lawmakers from both parties) have allowed immigrants to access public benefits like school meals — which will continue under the new rules — and community health centers, regardless of their status. Previous administrations considered such resources to be a community benefit, and therefore different from individual benefits, like food stamps, Medicaid, and unemployment or disability payments.
The administration’s new reading of the law changes that, interpreting the term “federal public benefit” to include a wide variety of programs, including block grants awarded to states to administer mental health services, housing supports, and nutrition resources. Nonprofit organizations are not affected by the new rules (they won’t be required to check immigration status), but a range of other service providers might be.
Perhaps most concerning to advocates, the Health Center Program that helps keep 15,000 community clinics running is one of the services being restricted for undocumented immigrants. That could mean health centers are unable to serve those patients, or won’t get paid for the services. Treatment of communicable disease symptoms may be exempt from the rule, according to the HHS document.
“A health clinic might be able to assert that everything they do is inextricably related to testing and treatment of communicable disease symptoms,” said Tanya Broder, senior counsel on health and economic justice policy at the National Immigration Law Center.
Still, many other types of care could be cut off. Among the programs affected are: mental health and substance use programs run by the Substance Abuse and Mental Health Services Administration or funded through block grants, community behavioral health clinics, homelessness assistance programs, and Title X family planning programs.
This change, and the confusion it breeds, will almost certainly spook some immigrants from seeking out preventive and primary care. Even people who qualify for programs might avoid them. During the first Trump administration, researchers found that a surge of anti-immigrant sentiment and misinformation, along with policy changes, caused a drop in “well child” visits, delayed prenatal care, decreased primary care usage, and increased overall fear of going to the doctor among undocumented and immigrant families.
HHS’ decision seems to undermine Kennedy’s pledge to improve the nation’s health, said Stephanie Ettinger de Cuba, lead author on the study about well child visits, and executive director of the nonpartisan research group Children’s HealthWatch.
“The rollout doesn’t match the goals and is actually creating more unhealthy people,” she said.
Cutting off access to affordable preventive care can result in more costly visits to emergency departments — which are required by law to treat patients regardless of coverage or immigration status. This also works against the bipartisan goal of slashing health care costs, experts told STAT.
At worst, public health advocates worry local clinics will close, including in rural areas that are home to many migrants but that lack meaningful health infrastructure as is.