Inside the Beltway is a member-only benefit developed by NAPNAP’s Health Policy Team to keep members up to date on key policy issues at the federal level.
The Potential Impact of Immigration and Customs Enforcement on Pediatric Access to Health Care
Contributed by Health Policy Committee Member Jessica (JD) Murphy, DNP CPNP-AC CPHON CNE
Ensuring that all children and adolescents have access to high-quality health care is a top priority of NAPNAP’s health policy agenda. Current U.S. policies and actions by Immigration and Customs Enforcement (ICE) officials may create significant access barriers for children and families who are immigrants, irrespective of their legal status. The Public Charge Rule is a policy used by ICE officials to determine whether an immigrant is likely to rely on government assistance programs to live in the U.S. and therefore become a “public charge.” In November 2025, the administration issued notice of plans to alter the Public Charge, rescinding the 2022 rule, and allowing for use of Medicaid and nutrition support programs as means to deny citizenship. Many immigrant families may avoid seeking health care or other social welfare supports due to fear that this could impact their current or future immigration status. Missed well child examinations and immunizations, as well as delays in care for acute or chronic conditions, may lead to poorer physical health outcomes and impact child and caregiver mental health.
NAPNAP recently issued a call to action to include the Protect Sensitive Locations Act in Department of Homeland Security funding. This act would codify previous past policies that prohibited enforcement actions by ICE agents within 1,000 feet of hospitals, health clinics and clinical practices, as well as schools, homeless shelters and child-centered community locations. This is a great example of an advocacy effort that supports children accessing health care without fear, so that they can receive the high-quality care they need to thrive.
Concerns have also been raised about the quality of pediatric-focused health care available to children detained by ICE. The Flores Settlement established national health and welfare standards for children within U.S. immigration custody. It requires the government to place children in the least restrictive facilities and return them to parents or guardians quickly. Recent media coverage and legal filings points to measles outbreaks and untreated respiratory illnesses in children living in government facilities, including the South Texas Family Residential Center in Dilley. Per the ICE Health Service Corps (IHSC) website, 18 ICE facilities are staffed directly by IHSC members, and they oversee compliance of over 160 contracted non-IHSC staffed facilities. NAPNAP continues to monitor these reports and advocate for improved access to high-quality pediatric health care by professionals with advanced training in pediatrics.
What you can do:
- Advocate policies to support safe access to medical and mental health care for all children, regardless of immigration status.
- Contact your local and state elected officials to enact laws barring entry to health care, schools and daycare facilities.
- Urge your U.S. Senators and Representatives to pass legislation that removes health care from the Public Charge rule.
- Consider joining your state legislative committee to advocate for laws to protect health care mental health access for all children.
Review NAPNAP’s prior Inside the Beltway edition from February 2025 for more information on the Impacts of Immigration Enforcement on Youth, as well as the AAP Policy Statement on Detention of Immigrant Children.
Key NAPNAP Advocacy Activities
- NAPNAP issued a call to action for members to submit individual comments on the Department of Education’s “Reimagining and Improving Student Education” proposed rule, urging the agency to include post-baccalaureate nursing in the definition of “professional degree” programs, and discussed the strategy for commenting on the proposed rule at the Feb. 4 Child Health Policy Learning Collaborative. NAPNAP also joined the NP Roundtable in issuing a statement urging the Department of Education to include nursing in the definition of “professional degree” programs in final regulations.
- NAPNAP submitted comments to the Department of Homeland Security expressing concern about its proposed rule, “Public Charge Ground of Inadmissibility” (USCIS-2025-0304), and the harmful impact it could have on children’s access to essential health care, urging the agency to withdraw the proposed rule.
- NAPNAP joined the American Academy of Pediatrics and other organizations in filing an amicus curiae brief in Flores v. Bondi, opposing the federal government’s attempt to terminate the 1997 Flores Settlement Agreement, which mandates minimum standards for the treatment, placement, and release of immigrant children in federal custody, including a 20-day limit on detaining children.
- NAPNAP supported Sen. Richard Durbin (D-IL) and Rep. Suzanne Bonamici (D-OR) in reintroducing the “Nurse Faculty Shortage Reduction Act” (S. 3707/H.R. 7279), authorizing grants to provide salary differentials for nursing faculty competitive with salaries in clinical practice, and endorsed the “Future Advancement of Academic Nursing (FAAN) Act” (S. 3435/H.R. 6607), reintroduced by Sen. Jeff Merkley (D-OR) and Rep. Lauren Underwood (D-IL), authorizing $1 billion to increase enrollment and expand nursing education programs.
Congress Maintains Funding For Nursing Workforce Programs
Four months after the 2026 fiscal year started, President Donald Trump signed into law a bundle of six appropriations bills that included full-year funding for the Department of Health and Human Services and provided level funding for all of the current nursing workforce and research programs, despite the administration’s efforts to eliminate most of those programs. The “Consolidated Appropriations Act, 2026” (H.R. 7148) included level funding totaling $305.47 million for all of the current nursing programs under Title VIII of the Public Health Service Act. The Nursing Workforce Diversity Program, eliminated in the president’s budget and the House version of the appropriations bill, received a $2 million reduction from its current funding, but appropriators offset that cut by increasing the Nurse Education, Practice, Quality, and Retention Program and the Nurse Practitioner Optional Fellowship Program by $1 each. The Nurse Faculty Loan Program, also zeroed out in the House’s appropriations bill, received level funding, as did all of the other Title VIII programs and the National Institute of Nursing Research at the National Institutes of Health.
The final bill also included bipartisan health policies that extend Medicare telehealth flexibilities, increase funding for community health centers, delay scheduled Medicaid payment cuts to safety-net hospitals, and implement new rules for pharmacy benefit managers. The agreement also included the “Accelerating Kids’ Access to Care Act” (S. 752/H.R. 1509), streamlining Medicaid and CHIP enrollment for out-of-state pediatric specialists to deliver care across state lines.
Nurses Demand “Professional Degree” Recognition in Student Loan Rule
NAPNAP members are joining thousands of nurses in submitting comments to the Department of Education calling for post-baccalaureate nursing to be included in the definition of “professional degree” programs eligible for higher levels of student financial aid under annual and aggregate limits on graduate and professional degree programs adopted by Congress last year. That legislation caps assistance for graduate (non-professional) students at $20,500 a year and an aggregate of $100,000, while limiting professional students to $50,000 a year and an aggregate of $200,000. The proposed rule argues that post-baccalaureate nursing degrees do not meet the definition of “professional” degrees.
In addition to submitting its own comments urging the agency to include post-baccalaureate nursing degrees (MSN, DNP, PhD) in the list of professional degrees, NAPNAP is calling on its members to submit their own individual comments, providing information and examples from their personal experience on the impact that limiting nursing students to lower graduate-level caps would have on their ability to pursue careers as pediatric advanced practice registered nurses. The deadline for submitting public comments on the proposed rule is Monday, March 2.
In Other News
Immigration Disputes Block Homeland Security Funding
Demands to reform immigration enforcement following the fatal shootings of two Minneapolis residents, including ICU nurse Alex Pretti, forced senators to pull the bill providing funding for the Department of Homeland Security from the consolidated fiscal 2026 spending bill. Leaders replaced it with a two-week funding extension as Democrats pressed the Trump administration to agree to prohibit immigration officers from wearing masks, require them to show visible identification, and mandate the use of judicial warrants to enter private property to make arrests. NAPNAP joined other public health and immigration advocates in calling on members to urge congressional negotiators to include the “Protecting Sensitive Locations Act” (S. 455/H.R. 1061) in any Homeland Security funding agreement.
With negotiations at a standstill, the Federal Emergency Management Agency, the Transportation Security Administration, the U.S. Coast Guard, and other Homeland Security departments could be facing a prolonged shutdown, although Immigration and Customs Enforcement would remain in operation thanks to funding in last year’s budget reconciliation bill.
CMS Targets “Sex-Rejecting” Procedures In Medicaid Rules
In two rules proposed in December, the Centers for Medicare & Medicaid Services sought to restrict access to gender-affirming care for minors and regulate medical decision-making. If finalized, the rules would effectively eliminate hospital-based gender related care nationwide, threatening Medicare and Medicaid payments that account for nearly half of hospital reimbursements.
In one rule, the agency proposed to amend Medicare and Medicaid hospital conditions of participation to prohibit facilities enrolled in those programs from providing gender-affirming treatments to individuals under 18, including puberty blockers, cross-sex hormones, and gender-transition surgeries. The prohibition would apply even if services were covered by private insurance or paid for in cash, threatening all federal reimbursement to hospitals if they provide those services. The second rule would prohibit Medicaid and the Children’s Health Insurance Program from covering gender-related procedures for children under 18 (or 19 for CHIP). The proposed rule defines the restricted procedures as “any pharmaceutical or surgical intervention that attempts to align an individual’s physical appearance or body with a stated identity that differs from the individual’s sex.” Only limited exceptions for individuals with medically verifiable disorders other than gender identity alignment are provided.
As Premiums Rise, Efforts to Restore Subsidies Falter
The prospects of reviving Affordable Care Act premium tax credits, which expired on Jan. 1, appear increasingly bleak, with negotiators at odds over efforts to strengthen restrictions on federal funding for abortion services. Republicans led by Ohio Sen. Bernie Moreno have demanded tougher enforcement of the Hyde Amendment, the long-standing policy that prohibits the use of federal funds to provide abortion services, such as requiring audits of states’ adherence to the requirement. But Democrats balked when Moreno sought to expand the policy to apply to health savings accounts eligible for subsidies under the proposed deal.
Meanwhile, studies suggest that more Americans are turning to cheaper ACA plans to avoid premium increases. But shifting to less costly plans exposes policyholders to thousands of dollars in higher deductibles and additional out-of-pocket costs that researchers say could make people hesitate to get medical care when they are sick or injured. The expiration of the subsidies caused annual premiums to spike more than $1,000 on average for subsidized enrollees, according to an estimate from the health research organization KFF.
