President Donald Trump has revived a public charge policy that gives immigration officers broad authority to deny green cards and certain visas when applicants or their families have received public benefits. The change took effect Sept. 18, extending the administration’s immigration crackdown into health care, nutrition, and other assistance programs.

The policy serves two of the administration’s priorities: restricting immigration, including legal immigration, and reducing enrollment in government assistance programs. Children, including many who are U.S. citizens, could face some of the greatest harm when those priorities collide.

Twenty one states and Washington, D.C., all led by Democrats, have sued to stop the change. Their lawsuit says the Trump administration’s own estimates indicate that the policy will have “catastrophic” effects on immigrant families.

“Congress never intended for the public charge ground to be weaponized against immigrants and their family members who merely use supplemental or temporary amounts of public assistance to which they are lawfully entitled,” the lawsuit states. Leaders from major U.S. cities and counties have also filed suit, led by New York City Mayor Zohran Mamdani.

Only certain legal immigrants, including lawful permanent residents and some humanitarian parolees, can enroll in government assistance programs. Those programs include Medicaid, which covers lower income Americans, and the Supplemental Nutrition Assistance Program, commonly known as food stamps.

Advocates expect the policy to frighten immigrant parents away from enrolling eligible children in assistance programs, even when those children are U.S. citizens. Fear could therefore accomplish what the policy itself does not directly require.

“We’ll primarily see disenrollment from these programs out of fear from individuals who are eligible, like U.S.-citizen children in immigrant families who have immigrant parents,” said Maddie Geschu, director of policy and advocacy at Protecting Immigrant Families.

The federal government defined public charge status after former President Bill Clinton overhauled social safety programs in 1996. That definition covered participation in Supplemental Security Income, support through Temporary Assistance for Needy Families, and Medicaid benefits for long term care in facilities such as nursing homes and mental health facilities.

In 2019, Trump’s Department of Homeland Security expanded the benefits immigration officers could consider. The expansion added SNAP, federal housing assistance, and nonemergency Medicaid benefits, while allowing officers to examine past use and possible future reliance on those programs.

Federal courts blocked those changes, and former President Joe Biden reversed them. Yet a 2021 Protecting Immigrant Families analysis found that nearly 80% of immigrant families did not know the reversal had occurred, showing how fear persisted even after the policy was gone.

Colleen Putzel Kavanaugh, an analyst at the nonpartisan Migration Policy Institute, said officials previously examined an applicant’s overall reliance on benefits. Under the revived approach, participation in one program could endanger an application while officers receive considerably more discretion.

KFF estimated last year that between 10% and 30% of Medicaid and Children’s Health Insurance Program participants, approximately 1.4 million to 4.1 million people, could disenroll because of the change. That estimate includes between 560,000 and 1.7 million children who are U.S. citizens.

Nutrition programs could experience similar losses. Dr. Sural Shah, chair of the American Academy of Pediatrics’ Council on Immigrant Child and Family Health, warned, “When a child is hungry, it can affect every aspect of their development and lead to chronic conditions like heart disease and diabetes, even into adulthood.”

The public charge rule is only one administration policy affecting children. Mobile Pathways told The Guardian that almost 200,000 children have been ordered removed from the country since Trump took office, while family separation continues among families with mixed immigration statuses.

During Trump’s first term, at least 5,000 children were separated from their families at the border between the U.S. and Mexico. As of March 2024, as many as 1,360 children still had not been reunited, according to government data.

The Brookings Institution estimates that approximately 205,000 children, including 145,000 U.S. citizens, have likely experienced the detention of at least one immigrant parent since Trump’s second term began. Tracking current separations is more difficult because the Department of Homeland Security does not maintain or release data about them.

The administration also stopped paying more than 100 legal groups representing unaccompanied migrant children after those groups refused to provide confidential information. Lawyers estimated that about 26,000 children were left without representation, according to news reports.

Trump also rescinded guidance limiting immigration enforcement at sensitive locations, including schools, churches, and hospitals. Although public schools do not have to help ICE or admit agents into private areas without a judicial warrant, heightened enforcement has prompted immigrant parents to keep children away from school.

Republicans’ July 2025 spending law also excluded several categories of legal immigrants from Medicaid and SNAP. Another administration policy sought to bar immigrant children without legal status from Head Start, but federal courts blocked it, and a Rhode Island judge issued a permanent injunction last week.