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Fewer Immigrants Enrolling in Medicaid, Utilizing Community Health Centers Amid Change to Public Charge Rule

Laura Joszt
The change to the public charge rule has had a negative impact on immigrant patients, who are disenrolling or declining to enroll in Medicaid and are delaying or avoiding care, according to a survey of community health centers.
As the Trump administration has implemented a range of policy changes focused on enhancing immigration enforcement, health centers have seen a drop in utilization by immigrant patients, a decrease in immigrant patients enrolling in Medicaid, and other impacts on enrollment and utilization of care, according to a Kaiser Family Foundation (KFF) issue brief.

The most recent policy came in August 2019, when the administration published a final rule that would penalize legal immigrants for accepting healthcare services, food stamps, heating assistance, and other noncash assistance as they have applications pending to become permanent residents. Following the rule’s announcement, a column in The New England Journal of Medicine noted that the change would have dire consequences in the form of low infant birth weight, infant mortality, and maternal morbidity.

The new KFF report included results from 511 health centers surveyed between May 2019 and July 2019, after the rule was proposed, but before it was finalized. The brief also includes interviews from 16 directors and senior staff at health centers in California, Massachusetts, Missouri, and New York. These interviews were conducted after the rule was finalized.

“Given their role serving immigrant families, the experiences of health centers and their patients can provide early insight into the potential effects the public charge rule and other immigration policies are having on health coverage and use of services by immigrant patients,” the authors of the brief explained.

The survey results showed that 28% of health centers had already seen declines among some or many adult immigrant patients seeking healthcare in the past year. Nearly all centers that provide obstetric care reported that pregnant immigrant women, who are exempt from the rule, were delaying prenatal care or seeking it less frequently. In the interviews, health center directors noted that some patients with chronic conditions were not getting preventive care. For instance, a health center in New York reported a decline in use of pre-exposure prophylaxis among immigrant patients at risk of HIV exposure.

In addition, 32% of health centers said many or some immigrant patients disenrolled from or did not renew their Medicaid coverage and 38% reported many or some immigrant patients decided against enrolling their children in Medicaid compared with the previous year. The follow-up interviews confirmed this decline in Medicaid enrollment.

The interviews also revealed that immigrant patients are confused by the rule and are not sure which programs the rule applies to and who the rule applies to. Interviews showed that immigrants who are not subject to the rule have also disenrolled or declined to enroll in Medicaid. These patients are also declining to enroll in programs that are not subject to the rule, such as some housing programs and certain nutrition programs (eg, the Women, Infants, and Children Program; school lunch).

“Decreased coverage and declines in health care use could have a negative impact on the health and well-being of families and children, and will likely have longer-term consequences. Moreover, these changes carry the potential for broader, community-wide implications as decreases in coverage increase financial strain on health centers, thereby adding to challenges to providing care,” the authors concluded.

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