Millions of eligible adults may not be signing up for medical and nutrition support programs because they live in areas where friends and neighbors are detained due to their immigration status.
According to a study published this month in Health Affairs from researchers at Drexel's Dornsife School of Public Health, people living in counties with the highest number of "detainer requests" - formal requests from the U.S. Immigration and Customs Enforcement agency for local authorities to take an individual into custody on suspicion that they are illegally residing in the United States - are less likely to enroll in Medicaid and the Supplemental Nutrition Assistance Program (SNAP).
"There are millions of legal residents of the United States eligible for these beneficial programs who are not enrolling for fear that signing up for a government program will put their household on the government's radar and put their loved ones at risk of deportation," said senior author Brent Langellier, PhD, an associate professor in the Dornsife School of Public Health. "A particular concern is the over five million U.S.-born children living with at least one unauthorized immigrant parent."
During a detainer request, or "immigration hold," local law enforcement may hold immigrants suspected to be unlawfully residing in the United States in custody until they can be released to federal immigration agents for possible deportation. The rate of these requests and compliance by local officials varies throughout the country, which enabled researchers to look more closely at the effects of these detentions on communities.
The researchers looked at the number of detainer requests issued in each U.S. county, as well as households' enrollment in Medicaid and SNAP in 2011, 2016 and 2019. The researchers found a statistically significant association between detainer requests and lower enrollment in both government programs in both U.S.-born and immigrant households, with a stronger association among adults in households with at least one immigrant in the household, compared to U.S.-born households.
The authors suggest that some eligible immigrants might forgo benefits for fear of jeopardizing their own legal status or that of a family member or friend.
"Although detainer requests happen behind-the-scenes, they can be indicative of an overall climate of enforcement that impacts the daily lives of immigrants and their neighbors as well," said lead author Caroline Kravitz, a doctoral student in the Dornsife School of Public Health. "This enforcement may instill fear among immigrants and their family members and friends who may fear that any interaction with law enforcement officers could increase deportation risk for someone who is undocumented."
Many studies on SNAP and Medicaid found the programs provide measurable benefits for enrollees. Among other benefits, SNAP is associated with decreased health care costs and better current and long-term health among its millions of participants nationwide, including decreased risk of heart disease and obesity, according to the Center on Budget and Policy Priorities. Funded by federal and state governments, and operated at the state level, Medicaid provides comprehensive health insurance for roughly 90 million low-income and disabled adults and children - totaling one in five Americans.
Despite these benefits, only about half of U.S.-born eligible households and 47% of eligible immigrant households participate in SNAP.
"This surprising link between detainer requests and program enrollment among US-born citizens speaks to the external consequences of local immigration enforcement activities," said Kravitz. "Even people in U.S.-born households but who may have grown up with parents or grandparents who are immigrants or who come from neighborhoods with a large immigrant population may experience residual fear of immigration enforcement."
Although those residing in the United States without legal permission are not eligible for federal funding for Medicaid or SNAP, six states and Washington D.C. fully fund health coverage to some low-income adults who would otherwise not be eligible due to immigration status.
The authors suggest that more investment in outreach programs that communicate to immigrant communities that personal information is not shared between either SNAP or Medicaid and ICE, may help rebuild immigrant communities' trust of government agencies and improve enrollment numbers.
The Drexel researchers found a stronger association in 2011 and 2019 than they found in 2016. The number of detainer requests was lowest in 2016, as the Secure Communities program - a Department of Homeland Security Program aimed to identify immigrants for deportation that are in the custody of local law enforcement agencies - was suspended from 2015 until January 2017.
Notably, they found a statistically significant difference in Medicaid enrollment between those living in the quarter of areas experiencing the most ICE detainer requests, compared to those residing in the quarter of areas that experienced the fewest detainer requests in 2019. In all years, among immigrant households, as the number of ICE requests increased, SNAP enrollment decreased.
Previous studies found associations between immigration enforcement and avoidance of services, or safety net programs, among immigrants and mixed immigration-status households, but the current study offers data on the role that "behind-the-scenes" administrative enforcement actions - in the form of detainer requests - has on safety net program enrollment.
In addition to Kravitz and Langellier, other authors contributing to this paper include Amy H. Auchincloss, Sofia Argibay, and Alexandra Eastus from Drexel and M. Pia Chaparro from the University of Washington.
In a related paper published this month in the Journal of Urban Health, the research team found that ICE detainer requests were also linked to poorer health among Latine adults. Latine adults living in areas with the highest quartile of requests reported 24% higher odds of fair/poor health, compared to respondents in areas with the fewest detainer requests.
"Our work marks the latest data point among others that show negative health impacts from ICE activities that extend to a broader Latine population - regardless of their socioeconomic status - than just those who are undocumented," said the paper's lead author Alexandra Eastus, a doctoral student in the Dornsife School of Public Health. "These findings suggest that some police departments might better support the health of their Latine community members by setting limits on when to coordinate with federal immigrations agencies."
Both papers were funded by National Institute of Minority Health and Health Disparities, National Institutes of Health (NIH) Award No. R01MD015107.
The paper, "ICE Detainer Requests Were Associated With Lower Medicaid And SNAP Enrollment Among Eligible Adults, 2011-19," is available online here.
The paper, "Detainer Requests Issued by ICE and Fair/Poor Self-Rated Health among Latines in the U.S., 2017-2020," is available online here.
