One student stands out in Dr. Viju Jacob’s mind when he thinks about all the patients he’s seen in his 15 years at school-based health clinics: a Central American immigrant enrolled at a Bronx high school in 2012.
The student did not have insurance, which Jacob said is common for new immigrants, but the clinic offers free care regardless of a student’s immigration or insurance status. That’s thanks to Medicaid funding from other students’ claims.
Over the next four years, the student returned to the clinic, located in his school, when he needed a physical or simple treatment. But it wasn’t just his physical health that improved.
“He got a lot of soft emotional support,” Jacob said. “Coming to us, having people who spoke his language or his native language to sort of encourage him, help him with filling out forms.”
Jacob and immigrant advocates worry students like this may not get the support they need under a new federal proposal that would make it tougher for immigrants to successfully seek green cards if they rely on public benefits.
“Especially in New York City and in the New York City public school system, a large portion of the student population in some shape or form is on Medicaid or Medicaid managed care,” Jacob said. “That is such a large pool that could be affected if this rule gets implemented.”
To receive a green card, immigrants currently have to prove they won’t be a burden on the government, so officials already consider the cash benefits that they receive when reviewing applications. But now, for the first time, the Department of Homeland Security wants to expand the rule so that green cards can be denied to immigrants who rely on benefits such as non-emergency Medicaid, Medicare Part D, food stamps or forms of housing assistance.
Researchers and immigration advocates believe that even though a final decision on the proposal is months away, news of this rule could persuade large swaths of immigrants to halt their public benefits, out of fear it will affect their ability to become permanent U.S. residents. In a recent analysis, the city estimated that 75,000 New York City immigrants may have to choose between benefits and a green card.
And fewer Medicaid enrollees means fewer dollars rolling into clinics that serve at least 387 schools across the system, since they operate through partnerships with healthcare providers and depend, in part, on Medicaid funding that students may claim. It’s too early to tell the exact impact, but advocates, analysts, and even the federal government have acknowledged that the rule change could result in loss of funding.
“It’s bad enough for the families, and it’s even worse for us because we rely heavily on that funding stream,” said Jacob.
Clinics were a big part of Mayor Bill de Blasio’s first-term education agenda, which involved providing more schools with wrap-around services.
“Taking away services that keep children well-fed and healthy is wrong,” said Jaclyn Rothenberg, a spokeswoman for de Blasio, in a statement to Chalkbeat. “We’ll continue to ensure that our children, regardless of their and their family’s immigration status, have the resources they need to succeed in and out of the classroom.”
It’s not clear how many children are enrolled in the school-based clinics or how many, on average, use them. The city’s Department of Education didn’t respond to requests for comment about the rule change, including what portion of Medicaid funds buoy school health clinics, which are run by medical centers, local hospitals and community organizations.
According to Jacob, who is also board chairman of New York School Based Health Alliance, it’s typical for clinics to receive between two-thirds to half of their funding from Medicaid. The rule is expected to threaten the livelihood of similar clinics in other states, such as Colorado.
If enough people pull out of Medicaid, clinics could seek specific grant funding instead, Jacob said.
This is the latest immigration issue that New York City’s top education officials have had to grapple with. In the past, they’ve been quick to respond, such as reassuring families that their information is safe with the school system. Last year, a school in Queens turned federal immigration agents away after they showed up and asked about a fourth-grader. (U.S. Citizenship and Immigration Services said it was an administrative inquiry.)
Last March, the school system updated guidance for principals on immigration issues, stating that only local law enforcement can enter a school unless without a warrant or unless imminent harm is expected.
The Department of Homeland Security touts its proposal by saying its primary benefit would “help ensure that aliens who apply for admission to the United States, seek extension of stay or change of status, or apply for adjustment of status are self-sufficient, i.e., do not depend on public resources to meet their needs but rather rely on their own capabilities and the resources of their family, sponsor, and private organizations.”
The rule change wouldn’t include free and reduced-price lunch, which is universal in New York City. The rule also wouldn’t apply to families making less than 15 percent of the federal poverty level, refugees, asylum-seekers, legal immigrants in the military or immigrants who receive assistance after natural disasters.
Still, the Kaiser Family Foundation estimates that a “chilling effect” could even dissuade people who are enrolled in the Children’s Health Insurance Program, which is not included in the proposal, from continuing to receive the benefit. Other analyses come to a similar conclusion, including a June report from by the Migrant Policy Institute.
“In theory people should understand that they don’t need to disenroll their child from benefits because that’s not going to affect them,” said Mike Greenberg, senior fellow at the Migration Policy Institute, which did an analysis of the “chilling effect” this rule could have. “In practice it may still have that effect because this is very complicated, and we’re operating in an environment of so much fear and uncertainty.”
Beyond clinics losing funding, immigrant parents might be too scared to let their children go to an in-school clinic. Advocates said there is a fear among immigrants over what information government institutions are collecting and how it could be used against them.
Christina Samuels, manager of education policy at the New York Immigration Coalition, said her organization has raised these concerns with the education department, which has said it would protect families’ information. School health clinics don’t ask about immigration status.
In Jacob’s experience, students of different ages use the school health clinics for different reasons. Elementary-school students tend to show up because their parents’ work hours are at odds with doctors’ appointment times, and they can’t afford to take a day off. Those children may have an injury looked at, receive treatment for a stomach ache, or get an immunization.
Middle-schoolers usually get their shots or physicals, and some start to ask about reproductive health. And in high school, students receive a number of services, and preventative and emergency contraception may be addressed.
Outside organizations help staff counselors and social workers at some city schools, which staffers say are already stretched thin. Those, too, could also see more demand as students lose reliable access to food and healthcare, Samuels said.
She also pointed to the mental stress on immigrant students digesting another immigrant-related proposal out of Washington, such as the proposed ban on travelers from certain Muslim countries.
“Now we’re getting into a period where we’re really concerned about the mental health and behavioral health of students,” Samuels said.
City Hall officials have blasted the proposed rule, but have also cautioned that no changes have gone into effect. In a recent press conference, De Blasio said President Donald Trump is trying to “hurt the very people who are contributing to our economy and our future. It makes no sense and we are going to fight it.”
Last week, the federal government opened a 60-day period that allows public comment on its rule. After that, officials will take another 60 days to make a final decision.