The Department of Health and Human Services has rescinded a policy from 1998 that gave undocumented immigrants access to certain federal health benefits, such as Head Start and mental health programs.
Issued by President Bill Clinton, the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 was passed into law and deemed a major welfare reform.
Among its provisions, the bill attempted to uniformly restrict eligibility of benefits for noncitizens, including green card holders and refugees, according to a Congressional Review Service report. This means noncitizens are not eligible for non-emergency Medicaid, the SNAP program, Affordable Care Act subsidies and other programs. They are also banned from many state and local benefits.
However, noncitizens can receive emergency Medicaid care, immunizations, disaster relief, certain housing and nutrition programs. Benefits can also be extended to immigrants through state or local funds, as has been accomplished in California, New York and Illinois.
Thursday, the HHS pulled back an interpretation of the bill they said sidestepped the law by giving too much access to federal benefits.
“For too long, the government has diverted hardworking Americans’ tax dollars to incentivize illegal immigration,” said HHS Secretary Robert F. Kennedy Jr. in a news release. “Today’s action changes that—it restores integrity to federal social programs, enforces the rule of law, and protects vital resources for the American people.”
The administration’s new policy (PDF) reverses “outdated exclusions,” and stresses that people are subject to eligibility restrictions. It also states that no programs are exempt from the bill’s list of exceptions.
Mental health and community services block grants, the Head Start program, the Title X Family Planning Program and three Title IV programs are now deemed federal benefits. As are community behavioral health clinics, certain workforce and homelessness programs, and substance use abuse programs and grants.
The HHS expects reclassifying Head Start will bring in $374 million annually, the agency announced.
Groups representing community health centers (CHCs) reacted to the regulatory shift, some uncertain how to best comply with federal law now.
"Federal law requires CHCs to accept 'all residents of the area served by the center,' the National Association of Community Health Centers said in a statement, noting they are consulting with policy and legal experts on how to best move forward.
"The policy announced today will drive people away from health care, make people and communities sicker, and strain costlier parts of the health care system," said Advocates for Community Health, another organization representing CHCs, in a statement.
In April, the American Civil Liberties Union and major reproductive groups sued the HHS for withholding more than $65 million in Title X federal family planning grants through frozen funding. These programs give access to contraceptive methods and preventive services.
"For more than 50 years, Title X has provided high-quality, confidential, and affordable sexual and reproductive health care to all, regardless of who they are or where they come from," said Clare Coleman, president and CEO of the National Family Planning & Reproductive Health Association, in a statement Thursday. "HHS’s policy change would upend longstanding Public Health Service Act interpretation, threaten public health, and foster discrimination against immigrant communities and others who can’t prove citizenship."
Under Kennedy’s leadership, the HHS is also undergoing a massive restructuring and consolidation of offices, leaving advocacy groups concerned about the future of substance use abuse, mental health and disease treatment support from the federal government.
The Trump administration broadly has used sensitive healthcare data to clamp down on illegal immigration, drawing more pushback from privacy experts and health plans. Twenty states are now suing over Medicaid data sharing with other federal agencies. Interest in restricting health benefits to noncitizens and funding deportation efforts was combined in passing Trump’s signature budget bill last week.
Updated: 5:28 p.m. ET July 10