The fear of family separation is nothing new for many immigrants already living in the U.S. In fact, that fear, heightened in recent weeks, has been forcing a tough decision for a while. Advocates say a growing number of American children are dropping out of Medicaid and other government programs because their parents are not citizens.

Marlene is an undocumented resident of Texas and has two children who are U.S. citizens who qualify for Medicaid, the federal-state program for low-income people. (Kaiser Health News is not using Marlene’s last name because of her immigration status.) One of her children has some disabilities.

“My son is receiving speech therapy,” she said in Spanish. “But it’s been difficult.”

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It was a long journey to get the right evaluations and diagnoses, and her son is finally making progress, Marlene said. But she braces for a day when he might have to do without this therapy and others that are paid for through Medicaid. Because she’s undocumented, she’s extremely nervous about filling out applications for government programs like this.

Already, she has decided to stop receiving food stamps, now known as SNAP, which her children, as citizens, are entitled to based on the family’s income.

She dropped it because the application to receive those benefits changed, she said.

“They are asking a lot of questions,” she said. “They are investigating one’s life from head to toe.”

Marlene said she was nervous, in particular, about being asked to provide years of pay stubs and other eligibility requirements she had not experienced before. Marlene said the application alone made her “sick from stress.”

Repeated calls and emails to Texas health officials to ask about the changes in the benefits application process went unanswered.

Marlene’s son has Medicaid for the next several months. But she is worried how that application will change, too, next time she has to apply.

Health care groups say they’ve observed other immigrant families making similar choices, and they think it will accelerate if a proposed change to green card eligibility becomes law. Under the proposed change, if family members receive government services — even if those family members are citizens — it would ding the applicants’ chances of approval for permanent residency.

“We are seeing families having to make this impossible choice,” said Maria Hernandez, the founder of Vela, a nonprofit in Austin that helps parents who have children with disabilities.

Hernandez instructs parents how to advocate for their children and how to find the appropriate health care and therapies for their kids, and helps them find community support, among other things.

She conducts many of these classes in what used to be an elementary school on the east side of Austin, known as one of the most diverse areas of the city. She said about seven in 10 of the families she works with are immigrants — mostly from Mexico.

“We are working with families who the parents are immigrants but the children are born here,” Hernandez said.

Parents tell Hernandez they feel like they can’t risk any attention from the government, even if that means losing badly needed benefits for their kids.

In the first year of the Trump administration, Central Texas experienced an uptick in immigration raids and deportations. Since then, Hernandez said, a lot of people in the immigrant community have been making critical choices out of fear.

“It’s out of fear of deportation,” she said. “It’s out of fear of having their children being penalized in some way and potentially losing a parent that until this point has been their fierce advocate.”

In Texas, this is a decision that is bound to affect a significant number of children, said Anne Dunkelberg with the Center for Public Policy Priorities in Austin. Dunkelberg has been closely watching various immigration proposals and their effect on access to government services.

“A quarter of Texas children have at least one parent who is not a U.S. citizen,” she said. “Now, I am sure that not a hundred percent of those kids — and it’s about 1.8 million kids — not a hundred percent of them are using a public benefit, but a very high percentage will be.”

Dunkelberg said families opting out of Medicaid could further raise the number of uninsured in Texas, which is already the highest in the nation.

Hernandez said parents who have children with disabilities have told her that without Medicaid they’ll rely on emergency rooms “as needed.”

“We know that that is not a good plan for kids that for forever have been followed by a neurologist because they have seizures or have been going to occupational therapy for years and are finally making progress,” she said.

Approximately 10 million citizen children in the U.S. have at least one non-citizen parent.

This story is part of a partnership that includes KUT, NPR and Kaiser Health News. Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.