The U.S. Health Department’s Strategy To Limit Services To Undocumented Immigrants

By Benjamin J. Hulac | Washington Correspondent For the NJ Spotlight News

WASHINGTON — A change this summer in how the federal government interprets a policy from the late 1990s is complicating national health, education and social programs, leveling a blow against undocumented immigrants, including kids, under pressure from the Trump administration.

The new legal interpretation from the U.S. Department of Health and Human Services restricts undocumented residents from accessing more than a dozen health and education programs, such as Head Start, already under threat in New Jersey.

Those restrictions mark a shift from federal policy established in 1998 and carried out by Republican and Democratic administrations.

Winners and losers under Trump’s signature law“It’s a deviation in the kind of reasonable interpretation of the statute that has been followed all these years,” Laura Waddell, health care program director at New Jersey Citizen Action, an advocacy group, said in an interview with NJ Spotlight News. “This is such a blow to the public health system.”

The HHS policy change affects 13 federal programs within the department’s reach, including Head Start, mental health programs and the Title X program, which delivers reproductive and preventive health services for people, regardless of their immigration status. Together, the programs represent about $27 billion in funding for the current federal budget cycle.

Robert F. Kennedy Jr.’s position

National health secretary Robert F. Kennedy Jr. criticized the former policy, saying the programs HHS was narrowing were examples of how the U.S. government has “diverted hardworking Americans’ tax dollars to incentivize illegal immigration.”

The shift over health policy is one of several steps federal policymakers and Republican members of Congress have taken under the second Trump administration to squeeze undocumented residents, an estimated 11 million of whom live in the country with about at least 500,000 in New Jersey, according to researchers. The majority of people without documented status work and pay taxes, but they largely do not qualify for federal benefits, such as Social Security. Some states, including New Jersey, provide medical coverage for children regardless of legal status.

‘People who are unable to access preventive health care inevitably enter the health care system at more complex and expensive points. Consequently, New Jersey hospitals will absorb more uncompensated care, threatening their financial viability.’ — Renée Steinhagen, executive director, New Jersey Appleseed Public Interest Law Center

The administration’s signature legislative achievement, a new budget law, cuts more than $1 trillion from Medicaid, the national health insurance program for the poor and disabled, and $285 billion from the country’s largest food program.

In addition to HHS, two other federal agencies — the Labor Department and the Education Department — this summer moved to restrict certain immigrants from federal benefits, specifically technical education programs and workforce grants.

Platkin and other attorneys general sue

Twenty-one Democratic attorneys general, including New Jersey Attorney General Matt Platkin, sued in federal court to block the new policies of HHS and the labor and education departments.

Trump administration delays Head Start ban on undocumented childrenBy altering a “decades-old understanding” of federal law, the administration has “wreaked havoc, affecting dozens of vital community programs, millions of people, and billions of dollars in funding” to the states, the attorneys general said in an updated complaint filed Monday.

In their court papers, the states said the new policy threatens to close health clinics, a national suicide-prevention hotline, shelters for people fleeing domestic abuse and housing for homeless people.

Trump administration attorneys dismissed those arguments as “threadbare” and said it is unlikely programs will close.

Filed in late July, the lawsuit is pending in federal court in Rhode Island.

Targeted by HHS

The HHS policy change threatens how entities known as “federally qualified health centers” — medical sites that disproportionately serve undocumented and low-income patients, and treat patients regardless of immigration status, insurance or ability to pay — function, said Waddell.

“They’re a big, important part of our health care system,” she said, adding that these centers will have to choose whom to treat in order to financially survive. “It puts these entities in a terrible spot.”

Patients will still likely be able to get care, at least in the short term. But federally qualified health centers may not get reimbursed for treating those who are undocumented, and they’ll be stuck with an added cost, Waddell said.

“Then those facilities will have to figure out what they would have to do to offset that.”

There are 23 federally qualified health centers in New Jersey with 138 locations across the state. There is at least one in every county. They served 624,678 people in 2024, according to Marilyn Cintron, CEO of Alliance Community Health Care.

Excluding undocumented patients from accessing HHS programs will not stop them from seeking medical treatment, said Renée Steinhagen, executive director of the New Jersey Appleseed Public Interest Law Center.

“People who are unable to access preventive health care inevitably enter the health care system at more complex and expensive points,” Steinhagen said. “Consequently, New Jersey hospitals will absorb more uncompensated care, threatening their financial viability.”