20 attorneys general sue to keep health centers, Head Start and other programs open to all

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Hey kids -- what's your immigration status?

20 state attorneys general (including DC’s) have sued the Dept. of Justice, Dept. of Health and Human Services, Dept. of Education and Dept. of Labor seeking to void a series of orders issued in mid-July that abruptly ended a host of social programs’ exemptions from a federal ban on serving broad categories of immigrants, both lawfully present and undocumented. The ban was established by the so-called Personal Responsibility and Work Opportunity Act (PRWORA), enacted in 1996.

The complaint documents that programs decreed this month to have suddenly lost their exemption from PRWORA’s limiting of benefit eligibility to citizens and “qualified aliens” have been excepted based on rules put in place as soon as PRWORA was enacted in 1996. Many exempted programs, such as the community health center, drug treatment, and Head Start programs, are premised on not checking beneficiaries’ immigration status, and some (e.g., the CHCs) are required by statute not to check immigration status. 

Trump admin newly excludes many immigrants from a host of benefits

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CHC in Davenport, Iowa

Over the weekend, I learned third-hand that employees at a network of Federally Qualified Health Centers (FQHCs) in New Jersey had been told by management that the feds had forbidden them to treat undocumented immigrants.

That conclusion may be somewhat premature, but it’s grounded in abrupt and sweeping administrative action. In its latest barbaric assault on immigrants, the Trump administration has issued a series of orders banning access to most of the narrow range of federally funded benefits and programs not already off-limits to the undocumented - or to the many categories of lawfully present immigrants who are not “qualified aliens” (i.e., green card card holders, refugees, asylees and a few other categories*).

On July 10, three federal agencies — HHS, DOL and Education — issued notices (here is HHS’s) cutting off access for most non-green-card-holding immigrants to various benefits and services that had been excepted from a sweeping ban established in 1996. HHS’s list of benefits that will lose excepted status is as follows: 

Mitigating the Medicaid cuts

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Look for the helpers

The enactment of the Republicans’ monstrous budget bill in one sense sets politics and policy at odds, at least for Democrats. Annie Karni, congressional report for The New York Times, frames a political problem for Dems:

A challenge for Ds who expect the passage of this bill to help them win elections is that it may take a while for people to feel the full negative effects. Rs front loaded some temporary tax cuts for working people and backloaded cuts to Medicaid to hit after the midterms.

As KFF’s Larry Levitt points out in response, funding cuts and some impediments to enrollment in the ACA’s private-plan marketplace kick in immediately or almost immediately, i.e., for OEP 2026, beginning Nov. 1 this year (and Charles Gaba has tallied provisions in both Medicaid and marketplace that will take effect before the midterms). That said, Republicans will of course exploit the time lag, which extends to other benefit cuts as well (SNAP, student loans, energy credits), using it to add plausibility to their claims that, as MAGA go-along Tom Kean Jr. (NJ-7) boasted, “we protected Medicaid for every intended beneficiary in New Jersey and across the country.” That is, the bill does not change Medicaid eligibility for anyone (except various classes of lawfully present noncitizens, who are just human waste in Republican parlance). Instead, Republicans set up a thicket of administrative enrollment impediments and cuts to state funding (mostly delayed) that will increase the uninsured population by some 12 million by CBO’s estimate (with another 4 million losing coverage due to Republicans’ refusal to extend the enhanced ACA marketplace subsidies funded through 2025*). If enrollment reductions on that scale don’t happen — as many Republicans claim — neither will the cuts to federal spending that help fund the bill’s gargantuan tax cuts.

All that said, I’d like to consider Democrats’ alleged political “challenge” from the opposite end of the telescope. To what extent can Democrats in state government — and, more speculatively, in Congress — mitigate the coverage and funding losses? Administrative barriers can be erected with steel or Styrofoam — though Trump’s CMS, led by people whose chief passion in life is to ensure that someone somewhere doesn’t get a benefit to which they’re not technically entitled**— will doubtless work to insist on steel. If Democrats take the House, they may be able to delay or reduce some spending cuts — the annual ratchet-down of the provider tax safe harbor, for example, strikes me as the kind of thing Congress is prone to pause.