With Mom鈥檚 Green Card On The Line, Family Forgoes Autism Services For Citizen Child
Children of Mexican immigrants wait to receive a free health checkup inside a mobile clinic at the Mexican Consulate in Denver, Colo., in 2009. The Trump administration wants to ratchet up scrutiny of the use of social services by immigrants. That's already led some worried parents to avoid family health care. (John Moore/Getty Images)
As U.S. immigration enforcement becomes stricter under the Trump administration, more immigrant families are cutting ties with health care services and other critical government programs, according to child advocates who work with such families.
In Texas, researchers studying the issue say it鈥檚 a major reason why more children are going without health insurance.
Ana, who lives in Central Texas with her husband and two children, has been increasingly hesitant to seek help from the government. In particular, she鈥檚 worried about getting help for her 9-year-old daughter, Sara, who was diagnosed with autism a few years ago.
Ana entered the country without documentation about 10 years ago, which is why NPR and KHN have agreed not to use her last name. Both of her children were born in the United States and have been covered by Medicaid for years. But ever since President Donald Trump took office, Ana has been using the program only for basics 鈥� such as checkups and vaccinations for the kids.
This decision to forgo care comes at a cost. Managing Sara鈥檚 behavior has been challenging, even after the autism diagnosis brought her parents some clarity. Sara acts out and has tantrums, sometimes in public places. Ana finds it difficult to soothe her daughter, and the situation has become more awkward as Sara grows.
鈥淭o other people, Sara just seems spoiled or a brat,鈥� Ana said.
After the diagnosis, Ana felt unsure about her next steps. She eventually went to a nonprofit in Austin that guides and supports parents whose children have disabilities. It鈥檚 called听听(鈥渃andle鈥� in Spanish).
At Vela, Ana learned about a range of services Sara could get access to via her Medicaid plan 鈥� including therapy to help the child communicate better.
However, the thought of asking for more government services for her daughter increased Ana鈥檚 anxiety. 鈥淚 am looking for groups who are听not associated with the government,鈥� Ana explained.
Ana is in the middle of the long, expensive legal process of applying for permanent resident status, known informally as a 鈥済reen card.鈥� Recently, the Trump administration announced that it may tighten part of this process 鈥� the听听assessment. The assessment scrutinizes how many government services a green card applicant currently uses 鈥� or听尘颈驳丑迟听use later in life. If a person uses many government services, they could pose a net financial burden on the federal budget 鈥� or so goes the rationale. The government鈥檚听algorithms are complex, but 鈥減ublic charge鈥� is part of the determination for who gets a green card and who doesn鈥檛.
The rule change proposed by the Trump administration 鈥� which might not come to pass 鈥� has already led many applicants, or would-be applicants, to be wary of听all听government services, even those that wouldn鈥檛 affect their applications.
鈥淚 am afraid they will not give me a legal resident status,鈥� Ana said.
Her husband already has a green card, and the couple is determined to not jeopardize Ana鈥檚 ongoing application. So they have decided 鈥� just to be safe 鈥� to avoid seeking any more help from the government. That鈥檚 even though their daughter, who is a citizen, needs more therapy than she鈥檚 getting right now.
鈥淚 feel bad that I have to do that,鈥� Ana said.
She says she would love to treat her daughter鈥檚 autism, but has decided that there is nothing more important than getting that green card, in order to keep the family together in the U.S.
鈥淚鈥檓 running into families that, when it鈥檚 time for re-enrollment or reapplication, they are pausing and they are questioning if they should,鈥� said Nadine Rueb, a clinical social worker dealing with Ana鈥檚 case at Vela.
Rueb said a range of fears are behind immigrants鈥� avoidance of government services. Some are staying under the radar to avoid immediate deportation. Others are more like Ana 鈥� they just want to be in the best position possible to finally get permanent legal status and move on with their lives.
鈥淭he climate of fear is so pervasive at this point, and there is so much misinformation out there,鈥� said听, a senior policy associate with the Children鈥檚 Defense Fund in Texas.
Anderson said she thinks the parents鈥� fears have led to an uptick in children going without health coverage in Texas.
听from Georgetown University鈥檚听found that 1 in 5 uninsured kids in the U.S. lives in Texas. And a big percentage of those uninsured children are Latino.
The听听shows that after years of steady decline, the number (and percentage) of uninsured children in the U.S. increased in 2017, the first year of Trump鈥檚 presidency. Nationally, 5 percent of all kids are uninsured 鈥� and in Texas the rate rose to 10.7 percent, up from 9.8 percent in 2016.
, author of the Georgetown report, said the Trump administration鈥檚 effort to crack down on both legal and illegal immigration is one of many factors driving up the uninsured rates. And it鈥檚 especially perceptible in Texas, where a quarter of children have a parent who is either undocumented, or who is trying to become a legal resident.
鈥淔or these mixed-status families, there is likely a heightened fear of interacting with the government, and this may be deterring them from signing up their eligible children for government-sponsored health care,鈥� Alker said in a phone call with reporters in November, when the report was released.
Anderson, of the Children鈥檚 Defense Fund in Texas, said the repercussions fall hardest on kids with disabilities 鈥� kids who need services.
鈥淭exas is proud to be Texas in so many ways, but this is one way in which we are failing ourselves,鈥� she said.
From the perspective of Rueb, a disability rights specialist, timing is an essential issue for these children.
鈥淭he sooner you catch [the diagnosis or condition], the sooner you support the child [and] the sooner you support the family,鈥� Rueb said. 鈥淚 think it鈥檚 just a win-win for everybody. You are supporting the emotions of the family, and then that supports the child.鈥�
For now, said Ana, she鈥檚 relying on the services offered by her daughter鈥檚 public school 鈥� which aren鈥檛 counted in the federal government鈥檚 鈥減ublic charge鈥� assessment. And she鈥檒l keep doing that until she gets that green card.
This story is part of a partnership that includes , and Kaiser Health News.