Children's hospitals bear largest brunt of Trump immigration crackdown

For decades, Blythedale Children's Hospital has prided itself on being a place all kids in New York could get the care they need. But a series of federal moves to cut rates of illegal and legal immigration have threatened their mission.

The immigration clampdown could cause American children of undocumented parents to exit Medicaid, policy insiders say. That worries Blythedale's CEO Larry Levine as the federal program is his biggest payer, accounting for 76% of his patient revenue this past year.

Low-income children who flee the Medicaid program likely wouldn't have their primary and chronic care needs met, making it more likely they'll end up in the emergency room. Hospitals must treat anyone that shows up in their emergency departments, under federal law.

"We're going to continue to care for those kids, but the end result is the hospital will have less revenue to cover its expenses," Levine said. "That will affect all programs and all children, not just those born to undocumented parents."

Other children's hospitals will face similar woes since the program accounts for at least half of their patient revenue on average, Levine said. Children's hospitals account for less than 5% of the nation's hospitals overall, but they cover 53% of all hospital stays for Medicaid children with medically complex conditions,according to the American Academy of Pediatrics.

On Tuesday, President Donald Trump said he plans to issue an executive order that would revoke birthright citizenship for babies born in the U.S. to non-citizens and unauthorized immigrants born in the U.S. The interview with Axios came weeks after the release of a proposed public charge rule that would penalize permanent resident applicants for using Medicaid. The U.S. has also ramped up deportation of undocumented individuals over the last year.

As many as 4.9 million individuals could leave Medicaid because of the public charge rule alone, according to the Medicaid and CHIP Payment and Access Commission (MACPAC). There are as many as 10.7 million citizen children in the U.S. living in families with one or more non-citizen family members, according to Manatt Health.

Measles, mumps, polio and other illnesses could skyrocket if kids forgo Medicaid coverage, according to Francis Rienzo, interim CEO of Medicaid Health Plans of America.

"You start to create this incentive for parents to voluntarily pull their kids out of Medicaid and CHIP and those kids are then not being vaccinated," Rienzo said. "That's a public health concern for not just these kids, but others as well."

Even before the executive order suggestion and public charge rule, healthy policy insiders noticed undocumented parents were growing reluctant to keeping their kids in either Medicaid or CHIP.

"I'm seeing more people being hesitant to sign up for benefits or to renew them," said Gerard Vitti, founder and CEO of Healthcare Financial, a company that connects low-income individuals to Medicaid. "They're being driven underground."

The CMS hasn't done anything to quell fears that Medicaid enrollment applications won't be used to find and deport individuals. The agency abandoned plans developed by the Obama administration to assure non-legal parents it would be okay to sign up their U.S.-born children for coverage.

Medicaid directors as well as managed care plans disclosed via reports last week that they were noticing the first drop in Medicaid enrollment in a decade. Researchers tied that trend largely to improving job opportunities, but some researchers like Joan Alker at The Center for Children and Families at Georgetown University, thinks that the drop may be due in part to the Trump administration's increased focus on immigration.

Her center is going through enrollment data now, and hopes to release a report in November on what role anti-immigration rhetoric is having on declining enrollment.

"These parents may be afraid to sign their kids up for Medicaid or CHIP or renew their coverage for which they are eligible," Alker said. "This is one of a number of factors that we think is contributing to the number of uninsured kids going up for the first time in a long time."

As parents jettison coverage for their children, there are already anecdotal reports of fewer kids getting care at community health centers.

Stories of increased Immigration and Customs Enforcement (ICE) activity has had a chilling effect on some parents in Boston, according to Bill Halpin, CEO of South Boston Community Health Center. Arrests of undocumented immigrants in the city rose more than 50% between fiscal years 2016 and 2017, going from 1,858 detentions to 2,834, according to federal data.

"I was being told by my providers that there was a pervasive fear in the immigrant community whether they were legal or not," Halpin said.