Update on Public Charge: What it Means and How to Get Involved

NYIC_Logo-RV_Mar13,2012Guest post by Claudia Calhoon, MPH, Director of Health Policy at the New York Immigration Coalition.

A new proposed rule from the Trump administration promises to undermine the health and well-being of lawfully residing immigrants and their U.S. citizen children by forcing them to choose between benefit programs and getting a green card.  The new rules would penalize lawfully residing immigrants who participate in programs like SNAP (formerly food stamps), the supplemental nutrition program for women, infants, and children (WIC), health insurance, and the Earned Income Tax Credit by radically expanding the definition of who is considered to be dependent on the government or a “public charge”.  The rule would broaden the criteria by which someone is designated as a public charge, moving from describing public charge as being “primarily dependent” to being “likely at any time to use or receive one or more public benefits.”  The rule would increase the benefit categories that trigger public charge consideration to include non-cash benefits and programs.  (Currently just cash assistance and care in a long-term care facility that is paid for by Medicaid prompt public charge scrutiny.)

The rule would also give much greater discretion to immigration officers in assessing whether immigrants applying for a visa or a green card may be likely to use public benefits in the future. People who receive even periodic or one-time support with food, housing, or health insurance could lose their opportunity to become lawful permanent residents, based on one episode of unemployment.  Parents could also be penalized for having applied for benefits for their US citizen children. Given that lawfully residing immigrants are entitled to participate in these programs by law, punishing parents for using these benefits is especially perverse.  Advocates like the National Immigration Law Center believe that the administration is undertaking these changes in order to restrict and discourage family integration through administrative channels.

This rule represents a far-reaching and insidious effort to destabilize immigrant communities in the United States. Damage has already been done. News reports of the rule have already instilled hesitation among lawfully residing immigrant New Yorkers about using health insurance and WIC. If finalized as proposed, the rule could lead to large scale disenrollment from health insurance and other critical social programs, which can cause delays in seeking health care, and increases in economic instability. Delays in health care, food insecurity, and economic instability create long-term challenges for children and families over the course of their lifetimes.  Because New York State has committed to providing needed benefits that are not offered nationwide, New York families stand to lose more, and New York State policy makers will be faced with steeper and more profound public policy challenges than other states.

It is important to note that many individuals and families are not subject to public charge, and that this cannot be changed through the regulatory process.  These include refugees, asylees, survivors of crime and other immigrants and green cards holders with humanitarian protections who are seeking citizenship. When speaking to families, it is also important to note that the rules have not changed yet.  The proposed rule indicates that use of benefits before the rule is approved will NOT be considered, so there is no advantage to terminating benefits at this time for individuals currently receiving public assistance.

What can be done to stop this? Several Health Care for All New York members, including the New York Immigration Coalition, are helping foster efforts to impact the rulemaking process and educate communities.  On Thursday, March 29, the U.S. Citizen and Immigrations Services (USCIS) sent the draft rule to the Office of Management and Budget (OMB).  Advocates believe that it is similar to the version that was leaked most recently and anticipate that the rule will be posted for public comment in the Federal Register shortly, with a comment period of either 30 or 60 days. When the rule is posted, public comment from a wide variety of stakeholders and constituencies will be essential to slowing the rule and mitigating the damage it poses to immigrant communities.  If you would like to contribute a public comment, please email Max Hadler at mhadler@nyic.org to be added to the NYIC’s Health Collaborative listserv, where the NYIC we will share updates on the rule’s progress.  Along with many partners, the NYIC is working on community education materials and trainings for service providers and will share more information about those resources as they are ready. You can also join the Protecting Immigrant Families campaign led by the National Immigration Law Center and the Center for Law and Social Policy (CLASP) to keep up to speed on efforts to fight the rule at the federal level.

C4A LogoGuest post by Claudia Calhoon, MPH, Director of Health Policy at the New York Immigration Coalition.

On Wednesday, December 13, the Assembly Committee on Health, the Assembly Puerto Rican/Hispanic Taskforce, and the Assembly Taskforce on New Americans convened a public hearing on Immigrant access to healthcare.  Coverage 4 All, a campaign of Health Care For All New York led by the New York Immigration Coalition and Make the Road New York was instrumental in advocating for the hearing. The campaign’s goal is to expand insurance eligibility to all New Yorkers to reduce disparities in coverage.   Barriers to coverage are just one of the many current threats to immigrant health access and quality.

Agencies that provided testimony included the New York State Department of Health, the New York City Mayor’s Office for Immigrants Affairs, New York City Department of Health and Mental Hygiene, and New York City Health + Hospitals.  In addition, fifteen individuals from a range of social service, advocacy, health care, and community settings spoke about the impact of the federal administration on immigrant mobility, health utilization, coverage eligibility, and enforcement of language access regulation. Amid a federal landscape hostile to immigrants, New York State programs and protections are increasingly important.

Critical areas of particular attention included making sure that new mothers know they can safely continue to enroll in Medicaid and get prenatal care regardless of their immigration status, and continue to use the Women’s Infants, and Children (WIC) Food and Nutrition services. Another area of common interest among advocates was the opportunity that the state has to expand the Child Health Plus insurance program to cover young adults up to age 29 at a cost of $81 million.  Dr. Alan Shapiro, co-founder of Terra Firma, which works with unaccompanied minors, noted that health needs don’t end when young people turn 19.  These individuals “still have comprehensive primary care needs. They need access to immunizations, urgent care, sexual and reproductive health services.” The Child Health Plus Expansion is part of Health Care for All New York’s policy agenda, and the key priority of the Coverage 4 All campaign.

Hearing testimony from multiple stakeholders also highlighted the critical nature of improving enforcement of language access regulations, addressing mental health needs of immigrant communities subject to heightened stress under enhanced federal immigration enforcement, and ensuring that safety net hospitals have the revenue they need to care for all New York State residents.

NYIC_Logo-RV_Mar13,2012Guest post by Max Hadler, Senior Health Policy Manager at the New York Immigration Coalition.

Immigrant New Yorkers are under relentless attack from the anti-immigrant forces that wield the levers of control in Washington, DC. In this environment, it falls on New York State to devise solutions to the crisis. Access to health care represents a key element of immigrant inclusion and protection that state and local governments must address. In acknowledgment of the ongoing health access disadvantages that immigrants face and the acute needs related to the current sociopolitical dynamic, the New York State Assembly has called a public hearing on immigrant health for 10am on December 13. Public testimony is strongly encouraged from anyone with a stake in immigrant health access. The hearing will be held at 250 Broadway, New York, NY. This is the official Hearing Notice.

The hearing has been called by Assembly Health Committee Chair Richard Gottfried and cosponsored by New Americans Task Force Chair Michaelle Solages and Puerto Rican/Hispanic Task Force Chair Marcos Crespo. Coverage 4 All, a campaign of Health Care For All New York led by the New York Immigration Coalition and Make the Road New York, has been instrumental in advocating for the hearing. The campaign’s goal is to expand insurance eligibility to all New Yorkers to reduce disparities in coverage (noncitizens are five times more likely than citizens to be uninsured), but coverage is just one of the many current threats to immigrant health access:

  • Persistent restrictions on health coverage based on immigration status, exacerbated by the Trump administration’s cancellation of many forms of immigration relief
  • Pervasive fear of using health care services because of the dramatic increase in immigration enforcement and threats against immigrant communities
  • Acute behavioral health care needs layered on a system that already cannot meet the demand for culturally and linguistically responsive behavioral health services
  • Major cuts to uncompensated care funding that threaten the financial sustainability of safety-net health care systems
  • Language access laws that lack sufficient monitoring and enforcement mechanisms

We strongly encourage testimony from anyone with a stake in immigrant health access – directly affected community members, concerned citizens, immigrant rights advocates, health care consumer advocates, health care providers, social services providers, legal services providers, local and state health officials, and faith communities, to name a few. This hearing is an unprecedented chance to voice concerns to the New York State Assembly, and to propose solutions the state can undertake to improve immigrant health access. Do not miss this opportunity!

NOTE: You must receive an invitation to testify. If you would like an invitation, please e-mail Claudia Calhoon of the New York Immigration Coalition at ccalhoon@nyic.org. If you are unable to attend the hearing in person, you are strongly encouraged to submit written testimony (the email for written submissions is included in the official Hearing Notice).

PreschoolersGuest post by Ben Anderson, Director of Health Policy at Children’s Defense Fund-NY. Here we are 39 days and counting since the September 30th deadline for Congress to fund the Children’s Health Insurance Program (CHIP), and yet families of the 350,000 New York children who depend on CHIP for coverage are still waiting for Congress to act. Sadly, once again children are being held hostage to political debates.

Created specifically for children, CHIP’s benefits and provider networks are designed to ensure children in working families who are not eligible for Medicaid have access to child-appropriate services, providers, specialists, and facilities. Despite bipartisan support for a strong, five-year extension of CHIP in both the House of Representatives and the Senate, debate continues about how to pay for CHIP and the extension of other important health programs.

Last week, the House of Representatives passed the Championing Healthy Kids Act, a bill that includes the same strong, bipartisan five-year extension of CHIP that the House Energy and Commerce and Senate Finance Committees approved and that most child health advocates strongly support. However, the bill passed by the House pays for the extension of CHIP and other critical health programs for vulnerable populations with offsets that would cause undue harm to children and families. These provisions passed over the objections of many in the House and are jeopardizing the bill’s passage in the Senate.

The sad irony is that Congress is bickering over how to fund CHIP and other programs in the bill, when the total cost for these programs is merely 1% of the amount Congress will add to the deficit to provide tax cuts to the wealthiest individuals in America. The senselessness must end. We’re so close to the finish line. There is bipartisan support for CHIP. Senate and House members, Republicans and Democrats alike, agree on what we need to do for children’s health. Congress needs to finish its homework and reach a bipartisan consensus on funding CHIP.