This article was originally written by David Velasquez, Jordan Kondo, Sarah Downer, and Emily Broad Leib and published by Health Affairs on July 28, 2020.
Many immigration advocates are calling for the release of detainees under US Immigration and Customs Enforcement (ICE) custody amidst concerns of COVID-19 outbreaks in detention centers. From March to May, ICE only reduced its detainee population by about 7,000 (in 2018, a daily average of 42,000 immigrants were held in detention), but a court order is expected to result in the release of more detainees at high risk of COVID-19 complications, including people older than age 55 and those with chronic health conditions. Yet, ICE does not offer any support to these detainees upon release, and they are not eligible to receive benefits under many programs that serve the basic needs of most Americans. This country should take steps to meet the basic needs of unauthorized immigrants in the US to protect them from the harms of COVID-19. Chief among those basic needs is that of food security.
Unauthorized immigrants, who are usually of Hispanic descent, have a one in four chance of being food insecure. In April, 30 percent of Hispanic adults and 42 percent of Hispanic adults with children reported being food insecure. There is no food insecurity data for newly released ICE detainees, but one group of unauthorized immigrants living in the US for less than 10 years had a food insecurity prevalence of 96 percent. The individual health consequences of food insecurity are concerning and are even more so for the detainee population since they are consistently fed unhealthy meals while in detention centers and have significant trouble finding employment and thus maintaining food security upon release.
Food insecurity is associated with myriad adverse health outcomes. Although no existing data implicates a direct connection between food insecurity and COVID-19, poorly nourished individuals in general are at greater risk for various bacterial, viral, and other infections than those who are well-nourished. People with diet-related chronic illnesses, such as diabetes and hypertension, also tend to have more severe complications from COVID-19. Those being released from detention are already older and sicker, making them more vulnerable to COVID-19.
Leaving anyone without adequate food is itself a horrifying human rights violation and counters the globally acknowledged right to food. Furthermore, if not supported in fulfilling their basic needs, unauthorized immigrants likely will disproportionately suffer from COVID-19 and hamper public health efforts to contain the virus. Many unauthorized immigrants continue to work through government shutdowns, as they are disproportionately in roles classified as “essential workers,” and therefore face a higher risk of contracting COVID-19. The following policy recommendations can help meet the basic food security needs of all people currently in this country, including unauthorized immigrants, to alleviate hunger and ill health in the US.
Supporting Emergency Food Organizations And State And Local Government Responses
Unauthorized immigrants have limited options to access food assistance and other social safety-net programs because of their immigration status, and thus rely heavily on emergency food organizations, such as food banks and food pantries. Feeding America, the nation’s largest domestic hunger-relief organization, reports that food banks nationwide have seen an average increased demand of 59 percent compared to this time last year and, from the beginning of March through early May, have distributed more than 947 million meals. To address growing food insecurity, Congress allocated $850 million in additional funding for the Emergency Food Assistance Program. Under the Emergency Food Assistance Program, the US Department of Agriculture (USDA) purchases surplus agricultural products from across the country to send to state agencies to distribute to emergency feeding organizations, such as food banks. On top of this, with funding from the Coronavirus Aid, Relief, and Economic Security (CARES) Act, the USDA will spend up to $3 billion on the Farmers to Families Food Box Program within the Coronavirus Food Assistance Program, which will support farmers with surplus product in delivering boxes of produce, dairy, and cooked meat to nonprofits, including food banks. These programs have the benefit of not only getting food to those who are struggling but also bolstering food producers and distributors who have lost their supply chains due to COVID-19 closures.
Despite these investments, many indicate that the existing federal stimulus packages are not enough to alleviate hunger throughout the pandemic. Feeding America estimates $1.4 billion dollars will be needed over the next six months to adequately address the increasing food insecurity across the nation. Based on 200 food banks surveyed in the Feeding America network, 95 percent of them reported higher operational expenses, with more than a third struggling with immediate funding. Over the coming months, Congress should be prepared to allocate additional funding to support the increasing operational costs of emergency food assistance programs and fill inventory gaps. Maximizing access to food banks is critical because they serve all individuals, regardless of immigration status, thus making them a vital resource for unauthorized immigrants and anyone else who is not eligible for other food assistance programs.
Additionally, state and local governments are closely positioned to identify needs and service gaps in communities and should consider distributing funding to food banks and agencies whose missions are inclusive of all immigrants. For example, Massachusetts formed a Food Security Task Force that identified urgent needs and food supply chain issues across the state. Based on the task force’s recommendations, Massachusetts has invested $56 million to combat food insecurity, of which a significant amount will go toward aiding food banks. To support states in filling identified gaps, the federal government should provide state-level funding or block grants to help local governments collaborate with community-based nonprofits to ensure that local needs are being met. For example, one bill recently introduced into the US House of Representatives would provide money to states to enable food banks to purchase and distribute surpluses from local food producers.
Health Care’s Role In Ensuring Food Security
While the US health care system remains a largely untapped vehicle for formally facilitating access to nutritious food for vulnerable people, nutrition-focused innovation within health care is becoming more common. Medicaid programs in California and Massachusetts are offering coverage for medically tailored meals and other nutrition support for people who meet certain eligibility criteria. Other states, in response to COVID-19, have proposed to initiate or expand Medicaid coverage of food for certain populations. Unfortunately, because unauthorized immigrants are largely unable to enroll in Medicaid, they are also shut off from these or other nutrition benefits through Medicaid. While states can use Medicaid waivers during times of emergency to increase coverage for categories of people who normally do not receive coverage, there has been no move to do so during the current crisis, even in the face of documented COVID-19 outbreaks among farmworkers.
However, unauthorized immigrants can and do benefit from health system efforts to coordinate and collaborate with community-based social services. More hospitals and other health care organizations around the country are screening patients for food insecurity and connecting people to food assistance programs and other nutrition resources. Many unauthorized immigrants receive health care from community health centers (CHCs), some of which have adopted food insecurity screening protocols and are linking patients to services. CHCs also frequently administer food support programs, funded by municipal grants or philanthropic funding, that are available to all patients regardless of immigration or insurance status.
For example, some hospitals and health centers are opening their own on-site food pantries. These are typically stocked with food that is appropriate for diet-related health conditions such as diabetes and accessed via referral from a medical provider. Other health centers and hospitals are operating healthy mobile markets that travel through high-risk communities or to their health care sites to offer free or heavily discounted produce and healthy groceries. The Centers for Medicare and Medicaid Services and the Health Resources and Services Administration can support these initiatives by issuing guidance and offering technical assistance on how to establish co-located food pantries and mobile markets, which should be accessible to unauthorized immigrants.
Yet, reductions in services offered through CHCs and other health centers due to COVID-19-related budget woes threaten access to safety-net programs such as these. In the next relief package, Congress should include additional funding for CHCs to deliver much-needed social services. Municipalities can also assist CHCs in continuing to offer food support by ensuring that they receive support from COVID-19 emergency funds (such as Community Development Block Grants and Federal Emergency Management Agency [FEMA] funds) to do so.
Expanding Access To Food Through Federal Food Assistance
As many more individuals are facing economic crisis, and food banks struggle to meet increased demand, the federal government has faced growing calls to expand food benefits through the Supplemental Nutrition Assistance Program (SNAP). SNAP is the largest federal food assistance program, and participation in the program significantly reduces food insecurity and mortality. Increased benefits would not only promote food security for SNAP recipients but also help stimulate the economy, since every $1 billion in SNAP benefits creates a $1.79 billion economic benefit in the community. States have instituted emergency SNAP benefits through USDA waivers and eased participation rules because of COVID-19. However, despite their contributions to the workforce and their high rates of food insecurity, unauthorized immigrants continue to be excluded from SNAP eligibility.
Instead of making SNAP more accessible to those in need, the current administration has actually placed barriers in the way of immigrants accessing SNAP benefits by expanding the US Citizenship and Immigration Service’s (USCIS) Public Charge determination policy. In a 2019 rule, the USCIS announced it now will consider whether an individual received SNAP or Medicaid benefits in the decision about whether that individual can upgrade their immigration status to a more permanent authorization, on the theory that use of such programs would mean the individual is likely to become a “public charge.” This new rule is one of the biggest barriers to SNAP enrollment for immigrants because they fear losing the ability to change their status or to remain in the US. At the outset of the COVID-19 pandemic, the USCIS announced that no use of “treatment or preventative services” related to COVID-19 would be considered in making a public charge determination, but the statement did not remove use of SNAP benefits from the determination. The USCIS should eliminate SNAP from the public charge determination during the duration of the COVID-19 crisis, if not permanently.
For those able to participate in SNAP, the benefit remains quite low, an average of $1.40 per meal. Congress should pass the HEROES Act to increase monthly SNAP benefits, similar to actions taken during the 2008 financial crisis. States should simultaneously request approval to operate Disaster SNAP (D-SNAP). D-SNAP allows states to increase benefits for existing SNAP beneficiaries, as well as offer applicants who might not normally qualify for SNAP, potentially including unauthorized immigrants, to receive one month of SNAP food assistance benefits in the setting of a disaster. The COVID-19 pandemic should fall under the purview of D-SNAP and qualify as a disaster.
While nonprofit organizations and health systems play some role in addressing food security needs for unauthorized immigrants, the federal government should bear the primary responsibility of doing so. SNAP was intended as our nation’s first-line program to address hunger; for every meal served by America’s largest food coalition Feeding America, SNAP provides nine.
Although SNAP is not an option for many immigrants, because of lack of eligibility or fear of the Public Charge rule, several other food assistance programs offer promise. One example is Pandemic EBT, a program tailored to support children who would have received free or reduced-priced meals at school but can’t because schools are closed. Through this program, EBT cards are sent to eligible households regardless of immigration status. However, the program has only reached a small percentage of eligible children. States should improve the distribution of Pandemic EBT, and states not currently offering this program should do so.
The FEMA Public Assistance (PA) Program also provides funding for the purchase and distribution of food as an emergency protective measure. FEMA PA funding can go to state or local governments (and certain private, nonprofit organizations). Governments may partner with organizations such as food banks to provide emergency food aid and use PA funding to reimburse the organizations. In April, West Virginia secured 300,000 meal kits from FEMA. Because many of the entities distributing the food procured by FEMA, such as food banks, do not restrict their recipients, FEMA PA funds offer an avenue to support those in need, regardless of immigration status.
Feeding The Most Marginalized Through The Pandemic
Access to healthy food is a basic human need, one that is recognized as a right in 170 countries and is vital to any public health response to COVID-19. Furthermore, supporting unauthorized immigrants and their well-being is important to effectively combat the public health challenges brought on by the coronavirus. Ensuring immigrant health by addressing food insecurity will protect unauthorized immigrants, especially those filling essential roles in our response to COVID-19, and move us toward health equity. Robust funding for emergency food services and food assistance programs accessible to unauthorized immigrants, such as food bank services and programs administered via CHCs, must be a priority. But we can go further. As our health care system increasingly evolves toward integration of nutrition into care delivery and financing, we must ensure that reforms can reach unauthorized immigrants and are not limited to programs that exclude them. Over time, we should also ensure that SNAP benefits, as our primary food assistance program, are available to anyone in this country. Following these recommendations can help the US guarantee one of the most fundamental human rights to our most marginalized communities.