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In 2018, the Trump administration proposed sweeping changes to the “public charge” rule that would make it more difficult for applicants to obtain green cards or temporary visas if they have used noncash public benefits such as the Supplemental Nutrition Assistance Program (SNAP), Medicaid, or housing assistance. Though the rule was not implemented until February 2020, research indicates that “chilling effects,” whereby immigrant families avoided programs specified in the rule as well as other public programs out of fear of immigration-related consequences, were widespread even before implementation.

Public program avoidance is particularly worrisome in families with children because the entire family could face financial hardships, psychological distress, and problems accessing needed health care if they avoid critical benefit programs and their essential needs are not met. Moreover, food insecurity and uninsurance among children are not only harmful to their well-being in the short term: they can also have long-term consequences on their learning, growth, and development. Although the public charge rule excludes benefits used by children as a factor in their parents’ public charge determination, reluctance to participate in public programs out of fear or confusion about immigration consequences could make it even harder for immigrant families with children to address their basic needs. This could place immigrant families’ health and well-being at risk, especially during the current COVID-19 pandemic and recession.

This brief draws on the Well-Being and Basic Needs Survey (WBNS), a nationally representative, internet-based survey conducted in December 2019. Our main findings are as follows:

• One in five adults in immigrant families with children (20.4 percent) reported that they or a family member avoided a public benefit such as SNAP, Medicaid or the Children’s Health Insurance Program (CHIP), or housing subsidies in 2019 for fear of risking future green card status; 10.0 percent of those without children avoided such a program. Among adults in low-income immigrant families with children, over 3 in 10 (31.5 percent) reported these chilling effects.
• In 2019, 10.2 percent of adults in immigrant families with children reported that they or someone in their family avoided SNAP, 9.6 percent reported avoiding Medicaid/CHIP, and 7.0 percent reported avoiding housing subsidies. This was higher among adults in low-income families with children, of whom 17.1 percent reported avoiding SNAP, 14.8 percent reported avoiding Medicaid/CHIP, and 10.6 percent reported avoiding housing subsidies. Further, some reported spillover chilling effects for other programs not included in the public charge rule.
• Overall, 11.4 percent of adults in immigrant families with children reported they or a family member avoided a nutrition program (SNAP; the Special Supplemental Nutrition Program for  Women, Infants, and Children, or WIC; or free or reduced-price school lunches) and 10.6 reported they or a family member avoided a medical program (Medicaid/CHIP, programs that provide free or low-cost medical care, or health insurance purchased through the Marketplaces created by the Affordable Care Act) because of green card concerns. Among those with low incomes, chilling effects for nutrition programs and medical programs were even higher, at 17.1 percent and 16.1 percent, respectively. Most who reported chilling effects indicated avoiding more than one public benefit program.
• The majority of adults in immigrant families with children (69.8 percent) were aware of the public charge rule, and over 6 in 10 of those aware of the rule were very or somewhat confident in their understanding of it. But nearly 4 in 5 adults in immigrant families with children who were confident in their understanding of the rule did not understand that children’s Medicaid enrollment is not a factor in their parents’ public charge determination.
• Respondents identified several information sources as trustworthy, including US Citizenship and Immigration Services (63.3 percent), legal professionals (60.2 percent), state government agencies (53.0 percent), and local government agencies (49.0 percent), although those were not their main sources of information about the rule.