Note: These focus groups took place in December 2019, when the new public charge rule was not in effect, due to a nationwide preliminary injunction issued in the federal courts. On January 27, 2020, the US Supreme Court struck down the nationwide preliminary injunction, and the new public charge rule went into effect in California on February 24, 2020. The slide deck highlights recommendations that still apply, even though the new rule is now in effect. It also highlights study limitations to put findings in further context.

Historically, the public charge rule allowed immigration officials to deny an application for permanent residence (“green card”) or certain other visas if the applicant was determined likely to depend on the government as their primary source of support. In 2018 the Trump administration proposed changes that redefined public charge, including expanding the list of public benefits that count against applicants to include nonemergency Medicaid (“Medi-Cal” in California) for those 21 and over (unless pregnant), federal housing assistance, and SNAP (“CalFresh” in California).

The changes to the public charge rule, along with other federal immigration policy and rhetoric, have caused many California immigrant families with low incomes, including those who aren’t subject to public charge, to avoid using public benefit programs, such as Medi-Cal and CalFresh. This confusion extends to undocumented young adults with low incomes who are newly eligible for state-funded full-scope Medi-Cal starting in 2020.

In December 2019, Vision, Strategy and Insights (VSI) conducted focus groups in Los Angeles with California immigrants with low incomes who are not subject to public charge but who are at high risk of avoiding benefits. A key objective was to quickly identify legally accurate messages and trusted messengers effective at encouraging this group to keep using the public benefits they are eligible for. One focus group was designed to identify effective messages and messengers to specifically encourage young adult immigrants with low incomes to enroll in Medi-Cal.

Key recommendations when developing public charge outreach materials include:

• Always include the source of outreach and educational materials, ideally a government agency. Participants viewed government agencies as the most credible source of information on the subject of public charge (can depend on municipality; may not be the case outside of California).
• Provide a consistent definition of public charge, including clear lists or groupings of those who are and those who are not affected by public charge. Respondents were just as interested in understanding that they are not subject to public charge as in knowing who is subject. This serves as a double validation tool.
• Be explicit that benefits available to the children of immigrants do not impact the parents’ immigration status. Most participants were not aware of this.
• Feature a website and telephone number(s) to obtain more information and to further verify the source, and thus credibility, of the information.
• Date materials so that readers can assess the timeliness of the publication; date any updates as well.

Key recommendations when developing outreach materials for the Medi-Cal expansion include:

• Materials should always be clear on the following:
  • All Californians with low incomes ages 19–25 qualify “regardless of immigration status.”
  • The requirements to sign up (e.g., “all you need is your ID and a check stub”).
  • Which benefits and services are covered under Medi-Cal.
  • The information shared on applications won’t be shared with immigration.
  • Services through Medi-Cal are provided at little to no cost.
  • Specify that it’s a State of California program.
  • Add a phone number and/or website to indicate available assistance.

A more complete summary of findings and recommendations is available in the slide deck under Document Downloads.