A federal immigration policy taking effect Sept. 18 will expand the benefits that officers may consider when deciding whether some immigrants could become a “public charge,” raising concerns that mixed-status families will avoid health care, food assistance and housing programs. The U.S. Citizenship and Immigration Services guidance applies to people seeking green cards, certain visas or admission to the United States. It rescinds Biden administration rules issued in 2022 that generally barred immigration officers from considering many noncash benefits used by low-income families. Under the new policy, enrollment in Medicaid, the Children’s Health Insurance Program and the Supplemental Nutrition Assistance Program — commonly known as SNAP — can be considered in public-charge determinations. Public-charge findings are a potential basis for denying admission or adjustment to lawful permanent resident status under federal law. The policy affects some applicants seeking to adjust their status to permanent residency, including certain relatives of U.S. citizens, widows and widowers, foreign medical graduates, members of the U.S. armed forces and some highly educated workers. USCIS lists exemptions for several groups, including refugees and asylees, people seeking temporary protected status, certain Afghan and Iraqi nationals who assisted the U.S. government, trafficking survivors and Violence Against Women Act self-petitioners. The effects could extend beyond people applying for immigration status. In mixed-status households, immigrants without lawful status may decide not to enroll their U.S. citizen children or other eligible relatives in public programs because of fear that the benefits could affect a family member’s immigration case. KFF estimated this summer that between 1.4 million and 4.1 million people enrolled in Medicaid or CHIP and living with a noncitizen family member could disenroll because of the public-charge policy or related immigration fears. The estimate includes eligible U.S. citizens and other people who could lose coverage even though the rule is aimed at immigration applicants. The U.S. Department of Homeland Security previously acknowledged that the policy could affect U.S. citizens in mixed-status households. The agency estimated that reduced enrollment or failure to enroll could lower federal and state spending on public benefits by nearly $9 billion annually, while warning of broader economic effects. Those effects could reach hospitals and nonprofit health providers that receive Medicaid payments, medical-supply and pharmaceutical companies, grocery stores and farmers participating in SNAP, and landlords involved in federally funded housing programs, the agency said in proposed guidance. Research on the first Trump administration’s public-charge policy found that families became less likely to apply for food assistance or seek medical care. Pediatric health advocates say those decisions can be particularly damaging for children. “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,” Dr. Sural Shah, chair of the American Academy of Pediatrics’ Council on Immigrant Child and Family Health, said at a news conference. “Without accessing WIC, babies and young children will miss out on critical nutrition supports that are important for brain development in the first 1,000 days of life. Medicaid and CHIP are lifeline programs.” Clinicians have also reported that heightened immigration enforcement and uncertainty are contributing to fear, isolation and delayed care among families. Children with disabilities or complex medical needs could face especially serious consequences because their households are more likely to rely on public benefits. The Autism Self Advocacy Network said immigrants with disabilities may be disproportionately affected because they use public programs at higher rates than other immigrant groups. President Donald Trump has defended his administration’s immigration policies as a way to protect benefits for U.S. citizens and limit government spending. But health advocates say discouraging eligible families from seeking assistance could leave children without preventive care, adequate nutrition and treatment, while shifting costs onto hospitals, states and local communities.