Fear, Confusion About Immigration Change Leads Some To Forego Medical Benefits

Feb 22, 2019

Prince Ramirez’s baby is due in a week. She and her husband have a name picked out.

“Oyuki Selene”

Ramirez, originally from Mexico, now lives in Charlotte with her husband and children who are U.S. citizens. Since she’s pregnant and a permanent resident with a green card, she’s eligible for Medicaid. But she’s nervous about signing up.

“There are various cases of people that are residents and don’t dare to ask for much help [from the government] for the same reason, that it will affect them,” she said. “It [getting government assistance] can affect you a lot.”

Ramirez is scared and confused about whether it’s safe to continue getting some benefits like Medicaid or food stamps. The Trump Administration wants to change a long-standing rule known as public charge that would make reliance on those programs count against people at certain stages of the immigration process. Even though the proposal would only impact some, many immigrants are opting out of benefit programs because they fear it could hurt them in the future.   

[Lea Este Artículo En Español Aquí: El Temor Y La Confusión Sobre El Cambio De Inmigración Llevan A Algunos A Renunciar A Los Beneficios

Ramirez said she needs the coverage, and can’t afford to pay for care out of pocket like she did with her last child. She says she spent eight years paying those bills off. But Ramirez was concerned that if she signs up for Medicaid she could face serious consequences when she applies for citizenship.

“Yes, possibly because there are a lot of changes with the law,” Ramirez said. “Instead of me being able to apply for citizenship, [they] tell me, no, you are a public burden.”

One of the factors the government weighs when immigrants are trying to come to the U.S. or get a green card is how much they rely on or might rely on some public benefits in the future. If immigrants rely too much on those programs they could be deemed a public burden. Currently, cash assistance and long term mental health or nursing home aid are considered in that calculation. But the Trump Administration wants to add other things to the list. Namely Medicaid and the Supplemental Nutrition Assistance Program commonly referred to as food stamps. That’s causing some panic in immigrant communities. Louise Pocock is an attorney with the Charlotte Center for Legal Advocacy.

“This we see as a slow, insidious threat and one you can’t even quantify,” Pocock said. “We don’t know how many people have disenrolled from Medicaid or SNAP because of this.”

She said she's been getting calls from concerned immigrants weekly since the rule came out in October 2018. The public comment period has ended, but there is no timeline on when the rule may be finalized. Pocock explains if this public charge rule is enacted it won’t affect many types of immigrants like refugees and asylum seekers. Pocock said that message hasn’t been clear and many clients still fear that getting benefits could hurt them down the line. 

“Unfortunately there is a knowledge gap. Immigration attorneys don’t need to learn public charge,” she said. “So somebody with those questions and who’s in that situation needs advice unless steered to our organization they are not going to know.”

The North Carolina Department of Health and Human Services estimates 250,000 children in the state could be impacted by the rule if their families withdraw from programs. In a letter to the federal government state Secretary of Health Mandy Cohen wrote she’s concerned that families may not get the medical care they need.

Pediatrician Julie Linton said she’s already seeing this with her patients in Greenville, South Carolina. She remembers one of her patients, a one-year-old who wasn’t getting the healthy food she needed. Linton said she asked the mother if she could sign up for food stamps.

“She said she was not able to participate and it got kind of quiet,” Linton said to the mother. “Help me understand that. Your little girl has Medicaid, she was born in the United States. Help me understand why you are not able to participate? And she said ‘I could get sent away.’”

Linton said this mom’s immigration status wouldn’t put her at risk even if this rule was enacted. But Linton said it was clear she was still afraid.

As a doctor, Linton feels trapped between encouraging families to sign up for medical and food programs they need and putting their immigration status at risk.

“I took an oath to do no harm,” she said. “It places pediatricians in a position where we are not able to promote the kind of programs that we absolutely know from decades of science that keep children healthy. What am I supposed to tell families?”   

Linton also serves on the American Academy for Pediatrics Immigrant Health Special Interest Group. In that role, she’s been hearing similar concerns from doctors across the country.

“I have pediatricians form Iowa, pediatricians from Kansas, pediatricians from California, New York, Massachusetts and Texas sharing the same stories of families who are afraid to participate in programs to keep their children healthy because they're stuck in an impossible trap staying together and participating in programs,” said Linton.

The chilling effect could go further and impact hospitals treating patients that now are without insurance. The North Carolina health department wrote that hospitals in the state could lose as much as $200 million in payments from Medicaid when those who dropped insurance end up in the emergency room.

Attorney Louise Pocock ended up convincing Ramirez it was alright for her to apply for Medicaid. But Pocock fears there are many others who she won’t be able to reach who will opt out of these programs. That would not only put their health at risk but also the health of their children.

[To read this article in Spanish, click here]

Correction: A previous version of this story had listed people with university visas as exempt from the public charge test under the proposed rule. Immigrants on university visas would in fact face the public charge test when entering the country and applying for a green card.