Eighteen percent of adults in California immigrant families said they or a family member avoided public benefit programs such as Medi-Cal in 2019 for fear of hurting their future immigration status, up from 12% the previous year, according to research released today by the Urban Institute. This is a dangerous trend given the COVID-19 crisis.

In February 2020 the Trump administration implemented revisions to the federal public charge immigration rule. Among other changes, the new public charge rule makes the use of nonemergency Medi-Cal for those 21 and older (unless pregnant), CalFresh, and federal housing assistance count as negative factors when an immigrant’s application for a green card is evaluated by immigration officials. Multiple lawsuits challenging the validity of the changes are moving through the federal courts.

Before the new rule took effect, there already was evidence of a widespread chilling effect on eligible immigrant families — including those not subject to the rule — who avoided enrolling in public benefit programs for fear of hurting their immigration status.

The Urban Institute’s study, which was commissioned by CHCF, was based on California participants’ answers to a nationally representative, online survey conducted in December 2019 in English and Spanish. The researchers sought to quantify the public charge rule’s chilling effect among immigrant families and to explore where and how these families get information about the rule.

Widespread Confusion, Lack of Trusted Information

The study revealed several other key findings:

• Although a high percentage of respondents said they understood the rule, researchers found widespread confusion about many important provisions, especially as they relate to children’s enrollment in Medi-Cal. Most California immigrant adults (65%) said they were aware of the rule, and 70% said they were confident that they understood the rule. However, only 23% knew it does not apply to applications for citizenship, and only 18% knew that children’s enrollment in Medi-Cal is not considered in their parents’ public charge determinations.
• Legal professionals were considered the most trusted source of information about the effect of using public benefits on immigration status (68%), followed by US Citizenship and Immigration Services (63%), state agencies (55%), and local agencies (50%). However, most survey participants said they got information on the rule from sources they trust far less, such as TV news and social media.

In Their Own Words

As part of the project, the Urban Institute conducted in-depth interviews with a group of survey respondents. These conversations bring to life many of the survey findings and allow us to hear from California immigrant families in their own words.

One interviewee spoke about choosing not to apply for CalFresh or the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), even when she was sick and needed the support:

“El año pasado yo estuve enferma . . . y estuve a punto de aplicar para CalFresh pero me dio miedo. Me dio miedo porque yo dije, no, no quiero ser una carga pública, no quiero que me afecte. El WIC incluso. Están diciendo, pues, que sería mejor no continuar en el WIC porque [toda] esa comida, leche y los vales que le dan para jugo esto y lo otro, pues, el gobierno es el que lo está pagando.”

“Last year I was sick. I was about to apply for CalFresh, but I got scared. I got scared because I thought, No, I don’t want to be a public charge, I don’t want this to affect me. WIC even. They were saying that it’s best not to continue with WIC because everything — food, milk, and vouchers that they give you for this and that — well, it’s the government that’s paying for it.”

It’s important to note that WIC is not included in the public charge rule.

Another interviewee spoke of her strong desire to hear about the public charge rule directly from government officials:

“Me gustaría que viniera directamente del estado, del que impone las leyes. Del gobierno, o del county o del estatal. Yo no quiero escuchar de la bodeguita o de fulanita de tal. Yo quiero escucharlo de una institución confiable.”

“I’d like it to come directly from the state, from those in charge of the law. From the government, whether county or state. I don’t want to hear from the bodeguita or from so-and-so. I want to hear it from a reputable institution.”

New Urgency Created by COVID-19

The increased chilling effect and the confusion about the public charge rule take on new urgency in light of the COVID-19 pandemic and the resulting economic fallout. If California is going to overcome COVID-19, all Californians must be able to get the health care and social supports they need to keep themselves and their families healthy and stable.

This research points to an opportunity and a need for state and local leaders to redouble their efforts to communicate clearly to immigrant Californians about their rights. It underscores how we must continue to put in place policies that promote equity, including health care coverage for all, and raise our voices against policies that exclude and scapegoat rather than include and support.

Amy Adams

Amy Adams is a senior program officer for CHCF’s Improving Access team, which works to improve access to coverage and care for Californians with low incomes. Read More

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