Immigrants Intimidated by New Public Charge Guidelines?

Immigrants served by community health centers appear less inclined than in the past to seek public aid to help them with their medical problems.

And community health center staff believes this is the result of confusion and fear as a result of changing federal immigration policies.

As stated in the Kaiser Family Foundation issue brief “Impact of Shifting Immigration Policy on Medicaid Enrollment and Utilization of Care among Health Center Patients,”

  • Health centers reported that, in recent months, immigrant patients have declined to enroll or reenroll themselves and/or their children in Medicaid for fear of public charge.
  • Health center respondents reported patients are confused about the new rule and are afraid to provide identifying information.
  • According to respondents, the public charge rule is creating a “chilling” effect, leading to decreased enrollment in other programs not subject to public charge.
  • About half of health centers reported a drop in utilization by immigrant patients, especially among pregnant women.
  • Health centers are training staff to answer questions on public charge and are working to ensure access to care for their patients.

This can pose a challenge for private safety-net hospitals:  low-income individuals who avoid public aid programs often end up receiving uncompensated care from those hospitals.

Learn more in the Kaiser Family Foundation issue brief “Impact of Shifting Immigration Policy on Medicaid Enrollment and Utilization of Care among Health Center Patients.”

NASH Seeks Medicaid Exemption From New Public Charge Regulation

Congress should exempt Medicaid enrollment from the criteria in a new federal regulation that defines “public charge” or even overturn that regulation entirely, the National Alliance of Safety-Net Hospitals has declared in a new position statement.

The new statement, developed to coincide with NASH Advocacy Day in Washington, D.C. last week, notes that the fear of being designated a public charge will discourage many immigrants, including those to whom the new regulation does not even apply, from obtaining the medical care they need.  As a result, as many as 13 million legal immigrants are expected to disenroll from Medicaid out of fear of being labeled a public charge or choose not to enroll in the program even though they are entitled to Medicaid benefits.  Those found to be public charges risk losing green card status or even deportation.

Such individuals, NASH believes, will inevitably turn to private safety-net hospitals and others for care when they are sick or injured, placing great financial stress on these hospitals and potentially jeopardizing their ability to serve their communities.  For this reason, NASH has urged Congress to remove Medicaid participation from the criteria defining a public charge or to overturn the new regulation completely.

Learn more in the new NASH position paper “Challenges Posed by the New Public Charge Regulation.”

 

NASH Advocacy Day

Friday September 20, 2019 is NASH Advocacy Day in Washington, D.C.

Today, leaders of private safety-net hospitals have traveled to the nation’s capital from across the country for NASH Advocacy Day, during which members will meet with members of Congress and congressional and committee staff to discuss federal health care policy issues that affect the ability of private safety-net hospitals to serve their communities.

For the occasion, NASH has introduced three new policy position statements:  on the importance of delaying Medicaid disproportionate share (Medicaid DSH) cuts, surprise medical bills, and the new federal regulation governing so-called public charges.  See the new position papers here.

In addition, the National Alliance of Safety-Net Hospitals is presenting its “Champion for Health Care Award” to Representative Joe Kennedy III (D-MA) for “his tireless advocacy of access to care for his constituents, the residents of Massachusetts, and all Americans.”  See the news release announcing the award here.

New Public Charge Rule Could Affect Immigrants, Providers

Legal immigrants may become reluctant to seek government-sponsored health care and providers may find themselves delivering more uncompensated care in the wake of the adoption of a new federal “public charge” regulation that seeks to define more narrowly the kinds of individuals who should be granted entry to the U.S. in the future.

The new Department of Homeland Security regulation, while focused on applicants for entry into the U.S., could have the unintended effect of discouraging legal immigrants from enrolling in Medicaid, CHIP, and other government programs and even lead them to disenroll from such programs out of a mistaken concern that participating in such programs could jeopardize their status as legal immigrants.  The Kaiser Family Foundation, in fact, estimates that two to three million people will leave Medicaid and CHIP because of the new regulation.

More than a quarter of a million interested parties responded to the proposed regulation, which was published last October, and since its release last week a wide variety of groups, ranging from the American Hospital Association and America’s Essential Hospitals to the American Council of Pediatrics, have noted the new regulation’s potential impact with alarm.  Hospitals, in particular, are concerned that if people disenroll from Medicaid and CHIP, they will end up providing more uncompensated care to patients who previously had health insurance through those two public programs.

This could be especially challenging for private safety-net hospitals because many are located in communities with large numbers of low-income legal immigrants.

Learn more about the new public charge regulation and health care providers’ reaction to it in the Fierce Healthcare article “Healthcare industry groups warn final ‘public charge’ rule could impact immigrant health, drive up costs.”

Proposed Immigration Rule Discouraging Medicaid Enrollment

A proposal by the U.S. Department of Homeland Security is discouraging participation in Medicaid and other government safety-net programs.

A proposed Homeland Security regulation would establish new criteria for determining whether individuals seeking admission into the U.S. might eventually become “public charges”:  people who would depend on public resources to meet their needs rather than the resources of friends, family, sponsors, or private organizations or be able to provide for themselves or their families.  Among those criteria are past use of government aid programs and current income and health status.

Since the regulation was proposed last October, many legal immigrants, including those who already have green cards, have grown fearful of its implications and have shied away from seeking assistance from public aid programs and have even chosen to withdraw from programs in which they were already participating.  Among the survey’s findings:

  • 13.7 percent of adults in immigrant families reported family members dropping out of non-cash aid programs.
  • 17.4 percent of adults in immigrant families with children under the age of 19 were more likely to avoid public benefit programs.
  • Among those who reported avoiding public aid programs, 46 percent reported choosing not to participate in the federal Supplemental Nutrition Assistance Program (formerly food stamps), 42 percent reported someone in their household not participating in Medicaid even though they were eligible for the program, and 33.4 percent did not participate in housing subsidies.

Any withdrawal of legal residents from Medicaid or unwillingness to enroll in the program when eligible could leave hospitals with increased uncompensated care when serving low-income patients who otherwise lack the means to pay for their care.  This could pose a particular challenge for private safety-net hospitals because they serve communities with especially large numbers of low-income residents.

Learn more about the proposed public charge regulation and its apparent impact on participation in government safety-net programs among legal immigrants in the Urban Institute report “With Public Charge Rule Looming, One in Seven Adults in Immigrant Families Reported Avoiding Public Benefit Programs in 2018.”