Public Charge Rule Led to Delayed Healthcare Among CA Immigrants

Avoiding public programs due to the public charge rule, such as Medicaid and the Supplemental Nutrition Assistance Program (SNAP), was linked to higher rates of delayed healthcare among immigrants in California, according to a study published in JAMA Network Open.

The public charge rule allowed the US to deny admission or citizenship to immigrants who were likely to become primarily dependent on the government to meet basic needs.

The rule was established in the 1880s, but the Trump Administration expanded the definition of a “public charge” to include immigrants who rely on Medicaid, SNAP, and some housing assistance programs.

The changes were implemented in 2019, but the Department of Homeland Security revoked the expanded public charge rule in March 2021.

When the expanded rule went into effect, immigrants began avoiding public programs due to concerns that their participation would impact their immigration status. Lower participation in Medicaid and SNAP may negatively affect health outcomes and access to healthcare.

Researchers used data from the 2019 California Health Interview Survey to assess the association between avoiding public programs and accessing healthcare services among low-income immigrant adults in California.

Adults were considered low-income if their income was less than 200 percent of the federal poverty level (FPL).

The study sample consisted of 1,394 immigrants. Nearly 70 percent were Latino and 23.2 percent were non-Latino Asian. The majority (92.8 percent) lived in urban areas and 22.9 percent were uninsured for all or part of the past year.

Among the study population, 13.7 percent reported avoiding public programs for fear that it would adversely impact their immigration status. Almost 15 percent of immigrants reported delaying needed medical care.

Researchers found that low-income immigrants who avoided public programs were more than twice as likely to delay healthcare services and prescription fills compared to those who did not avoid public programs.

The findings are consistent with previous studies, one of which found that 16 percent of immigrant adults avoided Medicaid or SNAP in 2019 due to the public charge changes. Other research revealed that the change led to declining children’s enrollment in Medicaid and the Women, Infants, and Children (WIC) assistance program.

The public charge rule may have also impacted uninsurance rates among children, a Health Affairs study found. Between 2016 and 2019, there was a 2.33 percentage point reduction in children’s Medicaid enrollment in the five states with the highest number of children enrolled in public health programs. This translated to nearly 79,000 children losing Medicaid coverage across the five states.

Even though the expanded public charge rule is no longer in effect, it continues to impact immigrants and their families regarding healthcare.

For example, 20 percent of immigrant adults with children and 28.8 percent of low-income immigrant families with children avoided accessing public programs in 2020, according to data from Urban Institute. The most common benefit avoided was food assistance, followed by Medicaid and the Children’s Health Insurance Program (CHIP).

In addition, 6.3 percent of immigrant adults with children avoided public payer benefits, leading many adults to report that a family member had foregone care due to costs.

To combat misinformation and misunderstandings surrounding the public charge rule, public payers should ensure their applications clearly state in multiple languages that the rule does not impact access to coverage through Medicaid, CHIP, or the Affordable Care Act marketplace.

Payers should also leverage social media, online platforms, and existing campaigns to circulate accurate information about the public charge rule.

In September, DHS released its public charge final rule, which aims to minimize the impact that accessing public benefits can have on the immigration process. Under the rule, immigrants and those who have applied for admission to the US can receive most Medicaid benefits and SNAP benefits without fear of penalization.