Drop out of nutrition programs

Immigrants, fearing Trump crackdown, drop out of nutrition programs

Both documented and undocumented immigrants fear that accepting federal aid could make them ineligible for a green card if rules are changed.

By HELENA BOTTEMILLER EVICH

Immigrants are turning down government help to buy infant formula and healthy food for their young children because they’re afraid the Trump administration could bar them from getting a green card if they take federal aid.

Local health providers say they’ve received panicked phone calls from both documented and undocumented immigrant families demanding to be dropped from the rolls of WIC, a federal nutrition program aimed at pregnant women and children, after news reports that the White House is potentially planning to deny legal status to immigrants who’ve used public benefits. Agencies in at least 18 states say they’ve seen drops of up to 20 percent in enrollment, and they attribute the change largely to fears about the immigration policy.

The Trump administration hasn’t officially put the policy in place yet, but even without a formal rule, families are already being scared away from using services, health providers say.

“It’s a stealth regulation,” said Kathleen Campbell Walker, an immigration attorney at Dickinson Wright in El Paso, Texas. “It doesn’t really exist, but it’s being applied subliminally.”

Health advocates say the policy change could put more babies who are U.S.-born citizens at risk of low birth weight and other problems — undermining public health while also potentially fueling higher health care costs at taxpayer expense. WIC — formally the Special Supplemental Nutrition Program for Women, Infants, and Children — serves about half of all babies born in the U.S by providing vouchers or benefit cards so pregnant women and families with small children can buy staple foods and infant formula. The program is also designed to support women who are breastfeeding.

Because it benefits babies, the vast majority of whom are U.S.-born citizens, WIC is among the least politically controversial programs that the administration is said to be targeting in its crackdown.

“The big concern for all of us in the WIC community is that this program is really about growing healthy babies,” said Rev. Douglas Greenaway, president and CEO of the National WIC Association. “When any population that’s potential eligible for this program is either driven away by changes in regulation or legislation or simply by political rhetoric inducing fear there are huge personal consequences to those babies and their families.”

The White House did not respond to requests for comment.

The immigration proposal, which White House officials are working on ahead of the midterms as a way to energize the Republican base, would primarily affect legal immigrants already in the U.S. who are seeking a green card and people applying for legal admission to the U.S. It could also affect undocumented immigrants if they want to seek legal permanent residency in the future — a change that would represent a substantial expansion of the definition of public charge.

Under a provision known as public charge, U.S. immigration law has for more than a century allowed officials to reject admission to the country on the grounds that potential immigrants or visitors might become overly reliant on the government. But until now, officials have looked narrowly at whether someone would need cash benefits such as welfare or long-term institutional care. Immigration hawks in the Trump administration are pushing to consider would-be immigrants’ use of a much broader array of services, including non-cash assistance like food stamps, Head Start, Medicaid and WIC, according to versions of the proposed rule that were obtained by news organizations earlier this year.

Undocumented immigrants do not qualify for most government aid programs, but such an expansion of public charge could apply to the whole family. In the past, if a mom was applying for a green card her own use of public benefits might be examined. Under the proposed change, her child’s enrollment in Medicaid or Head Start would weighed as a negative factor, even if that child is a U.S. citizen.

Trump administration officials have argued that they are simply trying to clarify and enforce current immigration law.

“The goal is not to reduce immigration or in some diabolical fashion shut the door on people, family-based immigration, anything like that,” said Francis Cissna, director of U.S. Citizenship and Immigration Services, at the National Press Club earlier this month.

Cissna said the rule the administration is working on is “rational and reasonable” and will go through the full and “proper” regulatory process.

Enrollment in WIC has been going down for a variety of reasons as the economy has improved and the birth rates decline. When Trump took office there were approximately 7.4 million women and children in the program. As of May, the last month for which there is data, the number had dropped to 6.8 million.

Government officials aren’t able to track exactly how many people have dropped from WIC or declined the benefits because they’re afraid of the public charge rule, in part because the program is immigration blind. But providers say anecdotal evidence shows the proposal is contributing to the drop-off.

POLITICO interviewed more than a dozen WIC providers nationwide who serve tens of thousands of children from Washington state, Kansas and New York state. Almost all said they have seen immigrant mothers and their children drop from WIC, citing public charge concerns. They also said they’ve fielded inquiries about whether participating in WIC could put a family at risk of either deportation or at a disadvantage in immigration proceedings.

Jennifer Mejias-Martinez, who works on WIC at the Shawnee County Health Department in Topeka, Kan., recalled getting a call earlier this year from a family who’d seen a report on Univision about public benefits being a threat to immigration proceedings.

“They were very, very scared,” Mejias-Martinez said of the family. She said she tried to calm them down and assure that the policy had not changed, but they dropped from the program anyway. “It made me very sad, and quite frankly upset,” she said.

In some cases, immigration attorneys are recommending that families drop out of all government programs, including WIC, to avoid any chance that using the benefits could negatively affect their chances of getting a green card — or even prevent a family member from being able to get a visa to visit, according to caseworkers.

Public health and immigration advocates say they now find themselves debating the ethics of encouraging people to enroll in the program to improve their children’s health while there’s so much fear the benefits might one day jeopardize their ability to stay in the United States.

“Without a draft rule being released, we don’t think it’s wise to frighten people or tell them that they’re in the clear,” said Zach Hennessey, vice president of programs and services at Public Health Solutions, a large health non-profit in New York City.

The leaked version of the proposed rule suggests benefits used before the rule is final wouldn’t be used against an applicant.

Nearly two-thirds of WIC providers, from 18 different states, reported they have noticed a difference in immigrant WIC access in the wake of the news about potential changes in the public charge rules, according to a March survey by the National WIC Association. Seventeen of the agencies reported that participants had asked to dis-enroll or be deleted from WIC records.

An agency in Longview, Texas, reported it’s losing an estimated 75 to 90 participants per month to public charge fears. In Beacon, N.Y., an agency estimated it’s lost 20 percent of its caseload. In St. Louis, Mo., a provider said it’s seen a few dozen drop in the last year.

Public Health Solutions, the largest WIC provider in New York state, said WIC caseloads fell after press coverage of the proposed public charge changes. The non-profit said it saw more than six times the normal attrition rate after initial news reports about a potential executive order in the first quarter of 2017. The drop rate spiked again twice more in the wake of additional news reports about the coming proposed rule.

The group cautioned that the numbers don’t prove that public charge fears drove households from the program, but said that the unusually large declines appeared to correspond with the timing of the news reports.

The USDA, which oversees the WIC program, is conducting several studies to explore why eligible families are either not enrolling in WIC or discontinuing their participation, according to a spokesperson.

“The USDA is committed to the health and well-being of all WIC eligible mothers, infants and children and supports families seeking assistance,” a spokesperson said in a statement to POLITICO.

The department did not comment on whether officials are concerned about public charge fears driving participation down.

The drops in WIC enrollment stemming from public charge concerns come alongside broader fears about the Trump administration’s crackdown on both legal and illegal immigration.

Maria Isabel Rangel, a graduate student at the University of California, Berkeley, recently interviewed ten farmworker families in California whose households included both legal and undocumented immigrants. She said they described dealing with “constant anxiety,” even when they’ve decided to keep using programs like WIC, Medicaid and food stamps.

“They’re worried that their documentation status will be somehow be jeopardized by participating in these health programs,” Rangel said. “They say: ‘I can’t stop using these programs because my children need them, but I know I’m risking my future and the future of my children.’”

“They’re making these decisions basically based off fear,” she said.

WIC has been largely immigration-blind since it was created in 1974, most of the infants it serves are citizens born in the U.S. regardless of their parents’ immigration status. Despite that, providers say parents’ fear of deportation may also be driving declining enrollment in WIC.

False rumors that federal agents are planning to raid WIC clinics have circulated in immigrant communities, to the point that providers in places like King County, Wash. have posted signs designating their clinics as “private” areas and have statements on their websites that immigrants should access services “without fear.”

Aliya Haq, a nutrition supervisor at International Community Health Services, a large health non-profit in Washington state, recalled a terrified father calling in earlier this year asking that his wife be dropped from WIC, citing fears about getting deported.

“He was literally begging us requesting that we remove his family from the WIC program. … it was very heartbreaking,” Haq said.

The WIC program is broadly supported on both sides of the aisle because it’s been shown to lead to better health outcomes for mothers and babies, and pays dividends in savings to Medicaid. A 1988 USDA study found that for every dollar spent on WIC, there is between $1.77 and $3.13 in Medicaid savings for the infant and mother in the first 60 days after birth.

Rep. Roger Marshall, a conservative Kansas Republican who was an obstetrician before he ran for Congress in 2016, says the program is “crucial.” When he saw pregnant women during his three decades in practice, he said, “This nutrition helped prevent birth defects, led to healthier outcomes, and healthier infants.”

Marshall noted he hasn’t seen the changes the administration is considering. “I will stand beside WIC and say they’ve been a great use of federal dollars,” he said.

Even as they’re considering the proposed rule change, Trump officials have already begun enacting some new restrictions. In January, the State Department instructed embassies and consulates to look at potential use of nutrition and health benefits when deciding whom to admit to the U.S.

A spokesperson from the State Department said the changes “clarify current regulations and policy guidance.”

Immigration lawyers are watching very closely to see whether the updated guidance leads to more denials based on public charge grounds.

Immigrant advocates are expected to mount a court challenge if the expanded public charge rule is finalized, but public health advocates say the damage is already being done to women and families who are afraid to use WIC.

“One way or another society is going to pay for this,” said Hennessey of Public Health Solutions in New York City. “It’s very expensive for a baby in the NICU. It’s very expensive when a child’s developmental needs aren't met, or there’s a severe maternal morbidity event.”