The Trump administration put forth a proposal that, if put into action, could jeopardize the legal status of immigrants who sign up for select government funded programs, including Medicaid. The proposal, which will change the definition of Public Charge, aims to curb immigration to only those who can “support themselves financially.” Trump's proposed change would allow the federal government to consider immigrants' use of an expanded list of public benefit programs, including Medicaid, food stamps and Section 8 housing, as a reason to deny lawful permanent residence. If passed, this ruling could potentially force patients to choose between healthcare and their green card.
The proposal has faced intense criticism from health care organizations, anti-poverty activists and immigrants rights activists. According to the Department of Homeland Security, the proposed rule could result in an increased use of emergency rooms, worse health outcomes, increased prevalence of communicable diseases, and increased rates of poverty among other concerns.
How Clinics Are Responding
It has been reported that some immigrant patients are already skipping their medical appointments due to the fear of the proposed rule. This leaves doctors and clinics struggling with how keep patients informed about the risks that may be coming, while encouraging them to not drop health benefits or avoid medical care. At an even greater risk to suffer repercussions of this legislation are the children of immigrants. When parents opt-out of public assistance, children are less likely to be enrolled in Children’s Health Insurance Program (CHIP).
Clinics are dealing with this proposed policy in different ways. Some clinics have instructed their staff members to be ready to answer questions if immigrants ask whether Medicaid might affect their legal status down the road. Other providers take a more proactive approach to prepare their patients in the event that the proposal is adopted. Asian Health Services in Alameda County, California, has staff members pass out fact sheets about the proposed changes, provide updates via newsletters directed at patients, and host workshops featuring legal experts who can answer any questions the patients might have in several different languages.
The threat of proposal has resulted in fear and misunderstanding. Clinics need to be cognizant on how and when to engage patients on the issue since nothing has passed into law. L.A. Care Health Plan hosted a webinar last month on the topic for about 180 providers. The webinar was designed to urge doctors to tell concerned patients that nothing has changed yet and that most immigrants would not be affected. John Baackes, CEO of L.A. Care says “I think we’ve got to let people know what could come, and try to give them more accurate information so that they don’t act imprudently. We have to stay current.”
Luthra, Shefali. "5 Things To Know About Trump's New 'Public Charge' Immigration Proposal." Kaiser Health News. September 27, 2018. Accessed February 20, 2019. https://khn.org/news/5-things-to-know-about-trumps-new-public-charge-immigration-proposal/.
Ibarra, Ana B. "Clinics Struggle To Resolve Fears Over Medicaid Sign-Ups And Green Cards." NPR. January 15, 2019. Accessed February 20, 2019.