The COVID-19 public health and economic crisis in the US has had particularly serious consequences for immigrant families because they are more likely to work in low-wage, front-line occupations without health insurance or family and medical leave.1,2 Immigrants represent a growing fraction of the workforce (17.4 percent in 2019)3 and the majority in essential sectors such as farm labor.4
Despite their importance to the economy and the disproportionate adverse effects of the pandemic and economic crisis on immigrant families (defined as those with at least one foreign-born parent), many immigrants and US-citizen spouses (1.4 million) and children (3.7 million) in immigrant families were excluded from the first COVID-19 relief measures.5 These exclusions were built on existing restrictions that limit immigrants’ access to the social safety net for mixed-status families (those with at least one noncitizen member).
The heightened anti-immigrant climate in the US has exacerbated the effects of public program restrictions. Recent surveys find that immigrant families are often reluctant to apply for social programs that can mitigate economic hardship and provide access to health care.6,7
Twenty-six percent of US children live in immigrant families, so these restrictions have the potential to affect the safety-net access and health of a sizable child population.8 Although 91 percent of children in immigrant families are US citizens,8 72 percent (13.7 million) live in mixed-status families.9 Therefore, although we focus on the implications of immigrant restrictions for citizen children, their access to the safety net is inextricably linked to the treatment of their families in social policy and must be examined through this relationship.
In the US, immigrants face a higher risk for socioeconomic adversity and stressors (for example, poverty and occupational hazards, which are among the social determinants of health) compared with the US-born population.10,11 The legality—or illegality—of immigration status is another important social determinant of health. Differential treatment by legal status is a form of social stratification in which lower legal status is associated with greater health risks (for example, deportation and family separation). Adverse exposures persist, albeit at lower levels, among immigrants with more secure legal status.11–14
We suggest that restricted access to the social safety net based on legality is a form of structural discrimination that applies to immigrant families and negatively affects US citizen children in these families by reducing human capital investments and opportunities for economic mobility. Although on its face legality stratification is race-neutral, it has been justified and implemented in a racialized way12,15 and has disparate impacts on Hispanics, who are much more likely to be low-income immigrants than other groups.1
A 2019 report from the National Academies of Sciences, Engineering, and Medicine showed that expansions of existing social programs can substantially reduce child poverty.16 However, even large expansions to existing safety-net programs that are effective overall in reducing child poverty would have lower poverty-reducing effects on children in immigrant families as a result of existing restrictions,1 which disproportionately harm Hispanic children, as 54 percent have at least one immigrant parent.8
As the nation’s leaders consider further economic relief to address the pandemic and build more equitable social policy,17 a careful analysis of immigrant restrictions and their potential negative effects on children is needed. The Earned Income Tax Credit (EITC) and the Supplemental Nutrition Assistance Program (SNAP) have positive effects on child and adult health.18,19 Therefore, removing restrictions may lead to improvements in the health of immigrants and their citizen children.18
This article has three objectives. First, we discuss immigration legality as one of the social determinants of health. We show that immigrant stratification and restrictions by legality extend to the treatment of immigrant families in US social policy. In turn, access to the social safety net is another important social determinant of health. Second, we use this framework of immigrant stratification by legality to review how immigrant exclusions affect US citizen children in mixed-status families. We focus on three safety-net programs: the EITC and SNAP, which are two of the most effective programs to reduce child poverty,16 and the Child Care and Development Block Grant program (also known as child care subsidies). The child care subsidies program is a much smaller poverty-reduction program than the EITC or SNAP but is an essential work support for low-income working families. Third, we outline policy recommendations to decrease restrictions that harm children in immigrant families.
Immigrant Status As A Social Determinant Of Health
Increasing evidence shows the complex influences on immigrant health, including social determinants of health in their country of origin and destination country, as well as continued ties with their country of origin after migration.20 Immigrants to the US and their children face higher health and developmental risks than nonimmigrants.10 Conversely, they show health resilience to these adverse factors, possibly because healthier people are more likely to migrate.20 For example, although in general infants of women with low educational attainment have worse birthweight outcomes, babies of immigrant women with less than a high school education have favorable birthweight outcomes.21 However, although children of immigrants are more likely to have healthy birthweights, adverse childhood experiences can lead to unfavorable outcomes later. For example, children of immigrant mothers have higher rates of obesity than comparable children of US-born mothers. Immigrant mothers have healthier prepregnancy weight, but this protective factor against childhood obesity is later offset by risks associated with their families’ immigrant status—for example, food insecurity, which is associated with obesity and has been linked to exclusion from nutrition assistance programs.22,23
‘Illegality’ As A Social Determinant Of Health
Racism and discrimination are increasingly recognized as social determinants of health.24 “Legality” or “illegality”—an expression of structural discrimination—is another social determinant of health that contributes to immigrants’ vulnerability to poor health, injury, and violence.14,25,26 Health risks associated with illegality, which extend to citizen children in mixed-status families, include psychosocial stressors (for example, fear of deportation), direct physical threats (for example, family separation), and diminished access to health-promoting resources such as health care. These stressors are associated with adverse child developmental and health outcomes.27–30
When it was initially proposed by researchers in the 2000s, the construct of illegality as a social determinant of health was centered on undocumented immigrant status. However, starting about a decade ago, illegality has been proposed as a continuum of health vulnerability that reflects the precariousness and reduced access and opportunities associated with lack of citizenship. These vulnerabilities extend to people with legal immigration status, not just to those with undocumented status. Children with undocumented status face unique health vulnerabilities associated with immigration enforcement, but this threat also extends to citizen children in mixed-status families.12,31–34
Legality does not correspond to the dichotomy of legal versus undocumented status as defined in US immigration policy.
For this analysis, we define legality as an axis of stratification that classifies immigrants into categories and assigns these categories different degrees of access to social policies and programs, which has health implications (see online appendix exhibit 1).35 However, legality does not correspond to the dichotomy of legal versus undocumented status as defined in US immigration policy.
Symbolically, stratification by legal status reflects judgments about the deservingness of immigrant families. Lower deservingness is associated not only with undocumented immigrant status but also with more recent classifications codified in social policy—for example, nonqualified immigrants and recently qualified immigrants still under the five-year bar (a five-year waiting period that begins when one receives qualified immigrant status), as well as US citizen children living with immigrants in nonqualified and recently qualified immigrant categories (appendix exhibit 1).35 This stratification is not only symbolic but is also embedded in policy and has exclusionary and discriminatory effects. Legality also has implications for social inclusion, as it reinforces the assumption that immigrant families do not fully belong socially in the US and that legal immigrants and even US citizens who live with immigrants are less deserving.
Illegality And Exclusion Of Children From The Safety Net
US social policy has evolved toward excluding not only undocumented immigrants but also legal immigrants and US citizens in immigrant families.36 Limited access to the safety net reduces access to health-promoting resources (for example, nutrition assistance), income supplements (for example, tax credits for lower-income families), and work supports (for example, child care), which are associated with better health outcomes.37
Previous work has provided a detailed description of various immigrant restrictions across social programs.38 Here we offer a social determinants of health framework to examine immigrant restrictions as an expression of structural racism.
Historically, safety-net programs did not consistently include immigrant eligibility criteria.39,40 Over time, US social policy has increased restrictions for various classes of immigrants. Starting in the 1970s undocumented immigrants were denied access to social programs.39,40 To date, they remain ineligible for most federal benefits with very few exceptions, such as emergency Medicaid.40
Furthermore, lawfully present immigrants also face many restrictions that limit their access to social programs. Until 1996 legal immigrants were essentially treated as US citizens in terms of eligibility for social programs. This eligibility changed in 1996, when the Personal Responsibility and Work Opportunity Reconciliation Act, known as “welfare reform,” explicitly limited access to most federal benefits for legal immigrants.16,40,41 The act radically altered the treatment of legal immigrants in US social policy by creating further stratification along a continuum of legality.
Stratification by legal status includes legal immigrants, naturalized citizens, and even US citizen children and spouses who live in mixed-status families (appendix exhibit 1).35 Citizen children in immigrant families are denied the full benefits of citizenship because their well-being is conditioned on the status of their parents.42
Low-income immigrant families have higher work effort and experience significantly higher poverty rates than nonimmigrant families, yet they have lower access to critical safety-net programs, which results in economic hardship.1
Restrictions On Access To Three Safety-Net Programs
In this section we show how three safety-net programs (the EITC, SNAP, and the Child Care and Development Block Grant) penalize US citizen children for living in mixed-status families through exclusionary eligibility criteria, reductions in benefit levels, administrative burdens, and application of the public charge rule.
We focus on three programs, but it is important to note that these types of restrictions apply to immigrants’ participation in nearly every form of essential supports for low-income families, such as housing subsidies and Supplemental Security Income. Exhibit 1 shows variations in eligibility restrictions, benefit restrictions, public charge rule applicability, and administrative burden by different categories of immigrants on the continuum of legality in the EITC, SNAP, and child care subsidies programs.
|Exclusionary eligibility criteria|
|Programs||Program benefits||Eligibility restriction for immigrant parentsa||US citizen children’s eligibility restricted by parents’ immigration status||Stricter income eligibility resulting from sponsor “deeming”||Benefit restrictions based on proportion of ineligible noncitizens||Subject to public charge rulec||Subject to administrative burden|
|EITC||Cash: refundable tax credit||Social Security number required for all family members||Yes||No||No||No||Yes|
|SNAP||Noncash: assistance to purchase food||Most qualified immigrants are subject to five-year barb||No||Yes||Yes||Yes (Feb 2020–Mar 2021)||Yes|
|Child Care Development Block Grant||Noncash: assistance to purchase child care||None, eligibility based on child||No||No||No||No||Yes|
Exclusionary Eligibility Criteria
Both stratification by legality and eligibility based on immigration status vary by program. Depending on the program, low-income US citizen children can be eligible even if their noncitizen parents are not (examples of inclusive eligibility are SNAP and child care subsidies), whereas entire immigrant families can be deemed ineligible on the basis of parents’ immigrant status even if the children or one of the spouses has US citizenship (an example of exclusionary eligibility is the EITC).1
‘Deeming’ Of Sponsors’ Income
Immigrants may also face more stringent income eligibility criteria, which harms entire immigrant families, including US citizens.41 To enter the US, legal permanent residents have a sponsor, who signs an affidavit promising enough economic support to maintain the sponsored immigrant’s income above 125 percent of the federal poverty level. In a practice called deeming, which has become increasingly strict after welfare reform, the sponsor’s household income is included in the immigrant family’s income eligibility determinations16 (see appendix exhibit 2c for more detail).35 Deeming often renders immigrants ineligible for benefits by making their income appear to be over the program threshold, which may result in lack of access to these programs for US citizen children in immigrant families.41 Of the programs reviewed here, deeming applies to SNAP.
The Five-Year Bar
Welfare reform divided noncitizens into “qualified” and “nonqualified” categories (appendix exhibits 2a and 2b)35 for most in-kind programs, such as SNAP. These categories do not correspond to immigration status in the immigration code but instead create a new hierarchy of immigrants by degree of program access.40 Qualified immigrants include legal permanent residents (for example, green card holders), refugees, asylees, and other categories. The Personal Responsibility and Work Opportunity Reconciliation Act further stratified qualified immigrants by length of qualifying status (appendix exhibit 1).35 With few exceptions, qualified immigrants who have had a qualifying status for fewer than five years cannot access federal safety-net programs even if they would otherwise be eligible.40
Of the three programs reviewed here, the five-year bar applies to the participation of most adult immigrants in SNAP. Intense advocacy after welfare reform led to the recognition that the restrictions on SNAP were extremely punitive. The five-year bar on SNAP benefits was lifted for qualified immigrant children in 2003, but it still applies to their legal permanent resident parents, which reduces the SNAP benefits that immigrant families receive.40 Eligibility for a Child Care and Development Block Grant is based on the child’s immigration status and does not consider parental immigration status.
Social Security Numbers
Immigrant eligibility restrictions also apply to tax credits, which are the most effective antipoverty programs.16 The EITC has the most restrictive eligibility along the legal status continuum—that is, citizen children are completely denied access to the EITC if even one of their parents lacks a Social Security number.40 The EITC is not considered a federal public benefit under welfare reform, but the tax code was changed during welfare reform to restrict immigrants’ EITC eligibility by requiring that all tax filers and claimed dependents have Social Security numbers. Before welfare reform, immigrants who filed taxes could apply for tax credits if otherwise eligible. This included undocumented immigrants, most of whom work and pay taxes.43
In some programs, benefit amounts are different for some immigrant families on the continuum of legality in a way that is punitive. For example, SNAP regulations require the proration of assistance to families according to the proportion of ineligible noncitizens in the household (for example, undocumented immigrants or qualified immigrants still under the five-year bar),44 which decreases benefit amounts for the entire family, including US citizen children.18
The Public Charge Rule
Immigrants seeking legal permanent residence must show that they are not likely to become a “public charge,” defined as becoming primarily dependent on government benefits (see appendix exhibit 2c for details).35 Prolonged reliance on public programs can result in an immigrant being labeled a public charge.45 Research suggests that confusion and fear associated with being a public charge has deterred immigrants from participating in safety-net programs.46
The deterrent effect of the public charge rule was exacerbated in 2017, when a draft rule was expanded to include the use not only of cash programs but also of some in-kind public programs such as SNAP and Medicaid.7,45 Although the rule change expanding the reach of public charge was withdrawn in March 2021,47 that change and the perceptions surrounding it have likely further decreased immigrants’ enrollment in public programs.7 National surveys show that even legal permanent residents, naturalized citizens, and US-born citizen children and spouses are forgoing benefits, including programs not named in the proposed changes to the rule, as a result of widespread confusion and fear.6,7
For immigrant families, high administrative burden (the compliance costs involved in interactions with government)48 is a policy design feature meant to have exclusionary effects.15 It may lower use in some programs, with potentially negative health consequences.37 Procedures to check citizenship and immigration status to determine eligibility are subject to discretion at the state and local levels, which can limit participation. For example, Child Care and Development Block Grant regulations make it clear that child care subsidies target children, so their immigration status must be verified, but parents’ immigration status cannot be considered. However, of the thirteen states that contain 80 percent of the Hispanic population, twelve requested the Social Security numbers for household members in Child Care and Development Block Grant applications, and seven of these states did not indicate that providing the Social Security numbers was optional. The lack of clarity can deter immigrant families from applying even though their children qualify.49
Lower Program Participation
As a result of exclusionary eligibility, high administrative burden, and other disincentives to participate, immigrant families have significantly lower participation across safety-net programs.1,15,40 The reach and exclusionary effects of immigrant restrictions are potentially large because 36 percent of children in poverty (3.5 million) live in mixed-status families.9
As shown in exhibit 2, among income-eligible families, 56 percent of all income-eligible citizen families receive the EITC compared with 44 percent of families with at least one noncitizen family member. Immigrant participation in SNAP is higher, but only 74 percent of eligible citizen children living with noncitizen adults participate in SNAP, compared with 84 percent of all eligible families. Participation in child care subsidies for low-income children of immigrant mothers is only 6 percent, compared with 15 percent for children of US-born mothers. Appendix exhibit 3 contains more detailed findings.35
Estimates of immigrant and nonimmigrant participation in the Earned Income Tax Credit (EITC), Supplemental Nutrition Assistance Program (SNAP), and child care subsidies program
SOURCE Authors’ analysis based on data from the following sources: Dana Thomson, senior research scientist, Child Trends, personal communication, 2021 Mar 24; Thomson D, Gennetian LA, Chen Y, Barnett H, Carter M, Deambrosi S. State policy and practice related to Earned Income Tax Credits may affect receipt among Hispanic families with children [Internet]. Bethesda (MD): Child Trends; 2020 Nov [cited 2021 May 17]. Available from: https://www.childtrends.org/wp-content/uploads/2020/11/EITCPolicy_ChildTrends_November2020.pdf; Vigil A. Trends in Supplemental Nutrition Assistance Program participation rates: fiscal year 2010 to fiscal year 2017 [Internet]. Washington (DC): Mathematica Policy Research; 2019 Sept [cited 2021 May 17]. Available from: https://mathematica.org/publications/fy-2010-to-2017-trends-in-supplemental-nutrition-assistance-program-participation-rates; Johnson AD, Han W-J, Ruhm CJ, Waldfogel J. Child care subsidies and the school readiness of children of immigrants. Child Dev. 2014;85(6):2140–50. NOTE Details on program participation estimates are in appendix exhibit 3 (see note 35 in text).
Neither an inclusive pandemic recovery nor an inclusive social safety net is possible if policies exclude large swaths of low-income families.
Neither an inclusive pandemic recovery nor an inclusive social safety net is possible if policies exclude large swaths of low-income families. The American Rescue Plan Act of 2021 made millions of children newly eligible for relief measures such as stimulus checks and the refundable child tax credit. However, the act’s measures are temporary.50 Over the long term, the racial/ethnic inequities embedded in US social policy must be addressed.
Below we outline eight policy recommendations to guide more inclusive social policy and improve the social determinants of health for children in immigrant families.
Eligibility for tax credits and pandemic cash assistance should be based on the health and developmental needs of the child, not the immigration status of the household. Restricting the access of US citizen and lawfully present children to social programs based on families’ mixed immigration statuses rather than need is punitive and harms children’s health.
Provide Emergency Cash Assistance
In a national crisis, all children with Social Security numbers should be eligible for economic impact payments (or stimulus checks), even if their parent or parents file taxes without a Social Security number. Although this population became newly eligible for economic impact payments under the American Rescue Plan Act, the change came one year into the pandemic, after millions of children in immigrant families had already suffered economic hardship and food insecurity.
Make EITC Eligibility Follow Economic Impact Payment Precedent
The exclusion of citizen and lawfully present children from initial COVID-19 relief packages replicated existing EITC restrictions. At a minimum, otherwise-qualified children with Social Security numbers should become eligible for the EITC—regardless of the form of identification their parents use to file taxes—to remain consistent with economic impact payment eligibility precedent under the American Rescue Plan Act. Beyond the pandemic, access to the EITC is important because the program reduces poverty and improves child health.51
Provide Child Tax Credit For All Children Of Income-Eligible Taxpayers
Under the American Rescue Plan Act, an estimated twenty-seven million children became newly eligible for the fully refundable portion of the child tax credit, and the credit amount was also temporarily increased.50 There is growing interest in making these child tax credit changes permanent, which would have large poverty-reducing effects. Permanent changes should follow pre-2018 eligibility rules for the child tax credit—that is, include children without Social Security numbers—to avoid worsening poverty disparities between children without Social Security numbers and their peers who have them.
Address Benefit Levels
Safety-net program benefit levels, especially regarding nutrition, should be based on children’s needs, not families’ immigration status.
Safety-net program benefit levels, especially regarding nutrition, should be based on children’s needs, not families’ immigration status. Access to basic nutrition is so essential to child development that no immigration restriction is justified. The most extreme Personal Responsibility and Work Opportunity Reconciliation Act eligibility restrictions were lifted in 2002, but citizen and lawfully present children in families with nonqualified members are still penalized in the calculation of benefit size—that is, if the household includes noneligible immigrants, the benefit level for the household, and thus the benefit per child, is lower than if all household members were eligible. Benefits should be calculated based on children’s nutritional needs regardless of immigration status.
End The Five-Year Bar
The five-year bar on qualified immigrants exacerbates financial hardship for immigrant families along the continuum of legality, including citizen children. Ending the bar would increase access to the safety net, with potential health benefits.
Reexamine The Utility Of Public Charge
The Biden administration restored the public charge rule to the status quo before the 2020 proposed change, which would have excluded programs with important health benefits such as SNAP and Medicaid. However, the public charge rule still applies to receipt of Temporary Assistance for Needy Families and Supplemental Security Income—two important programs that supplement families’ income and reduce poverty. Given the rule’s potential danger to child and public health,52 as well as its discriminatory origins and implementation,53 the pandemic should prompt a reassessment of the utility of public charge in US social policy.
Social policy reforms should be accompanied by robust outreach and implementation to reduce the administrative burden created by complex eligibility rules, chilling effects resulting from the public charge rule, and language barriers. For example, language access can be improved in SNAP and the Child Care and Development Block Grant, for which program information and applications in Spanish are not widely available.49,54
The safety net for immigrant families is substantially more restricted than that for comparable nonimmigrant families. For children in immigrant families, the vast majority of whom are US citizens, this has serious negative effects on access to social programs and potential negative effects on their health.
The COVID-19 pandemic presents a unique opportunity to lessen the harmful effects of stratification by legal status, starting with ensuring access to the safety net for all US citizen children in mixed-status families. In the short term, this can be modeled largely after the treatment of immigrant families in programs with relatively inclusive provisions and after more inclusive eligibility in the recent past (for example, before welfare reform, before the 2017 tax law, and before the 2020 public charge rule change). In the longer term, the Biden administration’s recent executive order on racial equity17 creates a framework for infusing inclusion and equity into the treatment of immigrant families in US social policy.
The authors gratefully acknowledge funding from the W. T. Grant Foundation and the Spencer Foundation (Including Children of Immigrants in the Post-Pandemic Economic Recovery Efforts and Safety Net, Grant Nos. 201535 and 202100092; Dolores Acevedo-Garcia, principal investigator; Pamela Joshi, co–principal investigator).
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