On Friday, June 22, more than 70 HCFANY members from across the state gathered in Albany for our annual spring to learn about the Coalition’s ongoing and upcoming work to strengthen and expand health coverage all for New Yorkers and promote health equity. As you all know, it has been a very challenging year for health care, and we are very grateful to all who attended and engaged with us!

The agenda included an Advocates’ Panel during which we heard updates on HCFANY work on New York’s indigent care pool and safety net hospitals and the Coverage 4 All Campaign for immigrant coverage. We also discussed strategies for improving market stabilization and affordability in the individual market. Slides from the presentation are available here.

We were also honored to present our annual “Consumer Health Champion” Award to the grassroots groups, the “New York Grassroots Defenders of Health Care” who have been so instrumental in the fight to defend the ACA and Medicaid here in New York. Awardees included: ACR Health, “Faso Friday,” Long Island Save Our Health Care Alliance, NY-11 for Health Care, Rochester ADAPT, and Saratoga Progressive Action.

The meeting concluded with discussion and planning groups on federal advocacy, protecting New York State’s individual market, and preserving and expanding immigrant coverage.

Guest 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.

Guest post by Ben Anderson, Director of Health Policy at Children’s Defense Fund – New York.

On February 5, 2018, Children’s Defense Fund – New York (CDFNY) released a new report related to the health needs of and services available to displaced students—namely homeless children and unaccompanied immigration children. The report included survey results from school administrators in high need school districts in New York City. Alarmingly, the report found that many schools continue to call 911 to send students to the emergency room to address disruptive behaviors related to underlying mental health issues. Eighty-four percent of school administrators responding to CDFNY’s survey indicated that they had to refer at least a few students to the emergency room because of mental health or behavioral issues. Students at the schools surveyed are disproportionately students of color.

The survey responses were obtained nearly two years after the New York City Department of Education issued Chancellor’s Regulation A-411, which requires schools to intervene and de-escalate disruptive student behavior prior to calling 911 to send students to the emergency room to address the behavior. Issued in 2015, the regulation requires schools to employ a variety of de-escalation strategies, such as obtaining support from on-campus mental health professionals or mobile crisis teams. The required de-escalation strategies were intended to curtail the practice of calling 911 to address mental health issues.

CDFNY’s concern is that the high percentage of schools sending students to the emergency room suggests that New York City may still be spending millions of dollars on emergency response services and emergency room care, rather than investing more in preventative mental health services that better serve the students and their families. If schools had sufficient resources to address the mental health and behavioral needs of their students, we would expect a lower volume of 911 calls. Without additional investments in mental health services and other behavioral interventions and supports, schools will continue to struggle to achieve the desired results of the regulation.

Other issues addressed in the report are the significant health needs of displaced children, including lack of consistent meals and medical care. In total, the report recommends:

 Expanding school-based health centers (SBHCs) and services—particularly mental health services—in medically underserved areas;
 Allowing SBHCs to serve as health homes in the Medicaid and Child Health Plus programs;
 Increasing support for teachers to implement PBIS in the highest need school districts; and
 Expanding access to after-school and weekend meal services in the highest need school districts.

For more information on this report, contact Ben Anderson at banderson@childrensdefense.org or (212) 697-0942.

Guest 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.