A proposal by the Trump administration to weigh immigrants’ use of certain public programs when deciding whether to approve applications for permanent residency threatens the health of hundreds of thousands of California children, according to a new report.

Changes to the so-called public charge rule would, if approved, push already-wary immigrant families in the state to dis-enroll their children from Medi-Cal and other public health insurance programs, or not enroll them in these programs in the first place, according to the report by The Children’s Partnership, the Population Reference Bureau, and Kidsdata.org. The result would be a loss of health insurance coverage for between 269,000 to 628,000 California children, increasing the state’s uninsured rate for minors from 3 percent to as high as 8 percent, the analysis estimates.

In addition to losing health coverage, as many as 311,000 children in California would lose access to CalFresh, the state’s name for the federal Supplemental Nutrition Assistance Program (SNAP), commonly known as food stamps, the report stated. The result would be increased family hardship, food insecurity and poor health among children in the state, said Mayra Alvarez, president of The Children’s Partnership, an advocacy organization.

“There is a real chilling effect that will likely lead to disenrollment in the very programs that support families and their wellbeing,” Alvarez said. “That’s directly linked to a child’s ability to succeed in school, a child’s ability to graduate high school and go on to college, and long-term repercussions for our state’s economy.”

Proposed Oct. 10 and currently open for public comment, the rule change would expand the range of programs immigration officials consider in the so-called public charge test. The test is used to decide whether or not legal United States residents applying for permanent residency or green cards are likely to become reliant on the government for support. Under existing rules, the test only examines use of cash assistance and long-term, government-funded institutional care. The new rule would expand this to more widely used programs, primarily Medicaid (Medi-Cal in California), SNAP and housing assistance.

A small number of legally present, non-citizen children could be directly impacted by the rule change, but analysts predict many more children who are U.S. citizens will also suffer. Half of all children in California have at least one foreign-born parent, and about one in six have at least one undocumented parent, according to the report. Researchers predict fear and confusion over the rule will prompt immigrant parents to disenroll their citizen children from programs they’re entitled to.

“Most people who use these services are doing so because they need them,” Alvarez said. “We are punishing legal immigrants for taking care of their families by putting this regulation forward.”

Other analyses have predicted similar consequences if the rule change takes effect. A report by the Kaiser Family Foundation in May estimated up to 2 million citizen children nationwide would lose Medicaid and Children’s Health Insurance Program coverage.UCLA researchers recently estimated hundreds of thousands of adults and children would drop out of Medi-Cal and CalFresh if the changes move forward, prompting billions of dollars in losses to the state’s economy.

Many providers who work with immigrants report that families are already dropping out of public programs in anticipation of the rule change.

However, Katharine Weir-Ebster, a spokeswoman for the state’s Department of Health Care Services said there has been no marked decrease in Medi-Cal enrollment so far.

“DHCS cannot speculate regarding the potential impact of the proposed rule,” she wrote in an email. “Medi-Cal enrollment changes monthly as a result of new enrollments, re-enrollments, disenrollments for ineligibility, and/or individual requests for discontinuance.  Based on the most recent reliable enrollment data, as of May 2018, there has been no marked difference between the rate at which undocumented beneficiaries have disenrolled and the rate of disenrollment among all Medi-Cal beneficiaries.”