Changes in Safety-Net Participation Among Children in Noncitizen Families, 2022-2025: A Nationally Representative Repeated Cross-Sectional Study

Importance: Most children living with noncitizen adults are US citizens and eligible for safety-net programs that support their health and development. Intensified immigration enforcement and proposed restrictions in 2025 may have deterred enrollment, but national estimates for children are lacking.Objective: To determine whether safety-net participation declined among children in noncitizen families in 2025, relative to children in naturalized-citizen families.Design: Repeated cross-sectional study with a difference-in-differences design using the 2022-2025 National Health Interview Survey (NHIS), comparing 2025 with 2022-2024.Setting: Nationally representative survey of US households.Participants: Of 29,565 sample children (ages 0-17), 24,479 met inclusion criteria. The analysis compared 3,098 children in noncitizen families with 2,733 in naturalized-citizen families.Exposure: Living in a noncitizen family (sample adult not a US citizen) vs a naturalized-citizen family (sample adult a naturalized citizen) in 2025.Main Outcomes and Measures: Medicaid or Children’s Health Insurance Program (CHIP) coverage at interview; Supplemental Nutrition Assistance Program (SNAP), free or reduced-price school meal (ages 5-17), and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) receipt in the past 12 months.Results: The 5,831 children had a weighted mean age of 9.0 years (47.2% female; 53.8% Hispanic). Of children in noncitizen families, 74.3% were US citizens. In adjusted models, relative to children in naturalized-citizen families, Medicaid or CHIP coverage among children in noncitizen families declined by 7.4 percentage points (95% CI, −14.3 to −0.5), SNAP receipt by 6.4 points (95% CI, −12.8 to −0.03), and school meal receipt by 8.2 points (95% CI, −16.1 to −0.2). WIC receipt did not change significantly (0.1 points; 95% CI, −5.9 to 6.1). There were no differential pre-trends, and declines were generally consistent across sensitivity analyses.Conclusions and Relevance: In this repeated cross-sectional national study, safety-net participation among children in noncitizen families, most of whom were US citizens, declined in 2025 relative to children in naturalized-citizen families, before eligibility restrictions took effect. Reduced health coverage and nutrition assistance during childhood may have lasting consequences for health and development. Outreach and protections for enrollee data may help keep eligible children enrolled.