A new HHS notice takes away critical care from legal immigrants and threatens retribution to providers who don’t verify immigration status prior to treatment.
The Trump administration has pulled the rug out from under America’s safety net: The Departments of Health and Human Services, Justice, Labor, Education and Agriculture issued notices in mid-July barring many legal immigrants, as well as those without legal status, from using numerous public services funded with federal dollars.
Should the new policies go into effect—reversing 30 years of law and policy—critical programs funded through HHS, including Head Start, community mental health services, suicide hotlines and emergency housing assistance, could be shuttered, and millions of people, including U.S. citizens, could be denied help when they need it the most.
HHS Secretary Robert F Kennedy Jr. called the revised policies necessary to end the diversion of “hardworking Americans’ tax dollars to incentivize illegal immigration.” A coalition of state attorneys general characterizes the revision as an unmitigated crisis in public health and safety, and has brought suit to block the changes, which are temporarily on hold until mid-September.
According to numerous affidavits filed by state officials as part of the lawsuit, states are predicting that the safety net protecting the poor and uninsured will collapse under the weight of new verification requirements. Programs are likely to lose all or part of their funds if they cannot comply; conversely, they may also lose funds if they turn people away, as funding is often tied to overall numbers served.
Regardless of their legal status, people will forgo care or turn to emergency rooms, leading to more severe health problems and more expensive healthcare costs borne by the government.
Many parents without legal status whose children are U.S. citizens may stop enrolling their children in medical insurance programs, instead taking them to free health clinics or sending them to Head Start because they fear exposure.
Practitioners note that people in need of housing assistance, as well as many people with mental health issues, may lack documentation or have difficulty providing it, which could keep many U.S. citizens from accessing vital emergency programs. And the administrator of New York’s mental health programs, including its suicide hotline, wonders how it would even be possible to verify legal status on the phone with someone who is contemplating taking their life.
The new policies are a dangerous and seismic shift in interpretation of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996, passed as part of a broader agenda to vilify the poor and others thought to be gaming the system. The PRWORA most famously tied federal funds for welfare assistance payments to work requirements, but it also consolidated and expanded the bars on access to a wide range of federally funded benefits, and programs, not only for people without legal status, but for many immigrants in the country lawfully.
Under the PROWRA, only “qualified aliens,” such as lawful permanent residents, asylees, refugees and other long-term residents may qualify for “federal benefits,” such as Medicaid and Social Security, which are considered forms of direct cash payment. The law also limited access to programs receiving federal funding if the delivery of services was equivalent to a cash payment. While undocumented immigrants had never been eligible for Medicaid, the law barred lawful permanent residents from Medicaid for 5 years, expanded bans on direct funding for post-secondary education, such as access to federal student loans, and created verification requirements for numerous federally funded programs.
The PRWORA immigration provisions are complicated, and contain so many exceptions that individual agencies had to examine the way federal dollars would be used, determining whether there was a direct cash payment or its equivalent that under the law would only be available to “qualified aliens.” It was necessary to closely analyze the origin of different programs, their authorizing statutes, and the interaction of the new ban against broader goals enshrined in law and policy.
The administrator of New York’s mental health programs, including its suicide hotline, wonders how it would even be possible to verify legal status on the phone with someone who is contemplating taking their life.
In 1998, HHS determined that 31 programs fell under verification requirements, but excluded programs such as Head Start, which fell under an access to education exception, and numerous community based services, such as access to community health centers, mental health programs, family planning, transitional housing services, transition services for foster youth and other programs that by statute or design best served the community by providing open access to those in need.
For almost thirty years, Democratic and Republican administrations continued to follow these determinations, confident in both the legality of the original notices and aware of two key principles. First, community safety and stability require a safety net that helps people in need, and second, when someone is in crisis, you don’t ask for their papers.
The Trump administration’s revisions target these previously excluded programs, arguing that the PROWA verification requirements are so clear that there should be virtually no exclusions. Thus, the HHS notice declares that the government is breaking the law, and the only remedy is an immediate revocation because “Any delay would be contrary to the public interest and fail to address the ongoing emergency at the Southern Border of the United States.”
It all goes back to the administration’s relentless desire to close the border, which itself is a tool sowing discord and consolidating power. By the end of the HHS notice, signed by RFK Jr., the authors can no longer contain themselves, solemnly intoning that Trump was elected by the American people to end illegal immigration and redirect resources to hardworking Americans.
In fact, the notice continues, the president’s mandate is so strong that anyone who dispenses federal funds should think twice about refusing to verify status, even non-profit providers who are specifically exempted by the PRWORA from verification requirements. Such providers are warned to be mindful of the clear national policies of this administration.
The threat of retribution is there for all to see.
Never mind that Congress just authorized $45 billion to ICE for immigration enforcement, much of it to build detention centers.
Never mind that this redirection of money inevitably means that many “hardworking Americans” will see cuts in services, including the loss of Medicaid, rural healthcare for pregnant women, food assistance and other safety net programs.
And never mind that, according to the states’ lawsuit, the costs and impracticality of verifying many emergency and other lifesaving services for everyone will mean that hardworking people, regardless of legal status, may suffer or die as programs collapse.
But perhaps wrecking the safety net is the point. The authors of Project 2025 hate Head Start, for instance, and want to eliminate it. A multi-flank approach, including changing HHS eligibility requirements, could help to bring it down. The same can be said for many other safety net programs. The recent tax and spending package set the wheels in motion—the new notices are just giving the train a hard push.
HHS is taking comments on the proposed changes through August 13. More than 7,800 people have already expressed their opinions, often sharing their firsthand knowledge of the impact of the new policies. An excerpt from one comment sums it up: “the short-sighted and mean-spirited restrictions proposed will not only harm the wellbeing of immigrants but also make the quality of life for all Americans worse.”
As with most Trump immigration policies, this is not what Americans signed up for.
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