AUSTIN, Texas -- As U.S. immigration enforcement becomes stricter under the Trump administration, more immigrant families are cutting ties with health care services and other critical government programs, according to child advocates who work with such families.
In Texas, researchers studying the issue say it's a major reason why more children are going without health insurance.
Ana, who lives in Central Texas with her husband and two children, has been increasingly hesitant to seek help from the government. In particular, she's worried about getting help for her 9-year-old daughter, Sara, who was diagnosed with autism a few years ago.
Ana entered the country without documentation about 10 years ago, which is why NPR and KHN have agreed not to use her last name. Both of her children were born in the United States and have been covered by Medicaid for years. But ever since President Donald Trump took office, Ana has been using the program only for basics -- such as checkups and vaccinations for the kids.
This decision to forgo care comes at a cost. Managing Sara's behavior has been challenging, even after the autism diagnosis brought her parents some clarity. Sara acts out and has tantrums, sometimes in public places. Ana finds it difficult to soothe her daughter, and the situation has become more awkward as Sara grows.
"To other people, Sara just seems spoiled or a brat," Ana said.
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After the diagnosis, Ana felt unsure about her next steps. She eventually went to a nonprofit in Austin that guides and supports parents whose children have disabilities. It's called Vela ("candle" in Spanish).
At Vela, Ana learned about a range of services Sara could get access to via her Medicaid plan -- including therapy to help the child communicate better.
However, the thought of asking for more government services for her daughter increased Ana's anxiety. "I am looking for groups who are not associated with the government," Ana explained.
Ana is in the middle of the long, expensive legal process of applying for permanent resident status, known informally as a "green card." Recently, the Trump administration announced that it may tighten part of this process -- the "public charge" assessment. The assessment scrutinizes how many government services a green card applicant currently uses -- or might use later in life. If a person uses many government services, they could pose a net financial burden on the federal budget -- or so goes the rationale. The government's algorithms are complex, but "public charge" is part of the determination for who gets a green card and who doesn't.