Last week’s release of the Trump administration’s public charge inadmissibility rule has healthcare providers across the country scrambling to assess how the more than 800-page document might disrupt their ability to provide care for immigrant patient populations.
The controversial new policy will make it more difficult for immigrants who use public health insurance, nutrition or housing assistance to obtain legal permanent residency status. The rule goes into effect Oct. 15. At deadline, 13 states had filed suit to block it from taking hold.
“We’re already hearing stories of patients coming to the door and saying this is their last visit,” said Berenice Constant, vice president of government relations at AltaMed Health Services Corp., a federally qualified health network serving 300,000 patients in Southern California.
Constant said such stories have made giving patients factual, timely information regarding the rule a top priority. The system developed a script for front office staff to help answer patient questions and inform them of local resources for legal assistance. AltaMed’s communications department plans to release a fact sheet and a frequently-asked-questions document to further help staff address patient inquiries.
Perhaps the most significant action AltaMed is taking involves working with community partners. The system is exploring opportunities to hold informational meetings and is planning to eventually partner with local legal experts to help connect them with patients.
“We’re going to be leaning on relationships that we have built over the years with organizations that already serve our patients,” Constant said. “A lot of the social services and supports, advocacy groups, and legal and healthcare partners are serving the same population, so we will be leveraging those long-standing relationships.”
At NYC Health & Hospitals, the system’s response began the day the rule came out with a statement from CEO Dr. Mitchell Katz, who assured patients they would not be identified as a public charge if they accessed care at one of the system’s sites.
Chris Keeley, senior director of the acute-care service line at the public health system, acknowledged that sending the right message was a challenge. It required striking a balance of providing patients important information while giving them assurances they can rely on the system to be a safe place they can visit for care regardless of their immigration status.
Keeley said Katz’s statement was initially emailed to staff and highlighted plans to distribute educational materials in the coming days. Employees were asked to share any anecdotes they might hear from patients about concerns over the rule so the system can refine its messaging.
The system plans to distribute informational flyers to patients and staff that will have more details about what’s included in the public charge rule. Outreach workers who are already being used to promote the city’s recently launched universal healthcare access program for the uninsured, NYC Care, will also share information about the rule and who might be affected.
An analysis of a draft of the rule released last December indicated approximately 350,000 NYC Health & Hospitals patients could be affected, with the system taking a loss of up to $362 million the first year after the rule went into effect.
“The differences between the proposed rule and the final rule made a terrible policy slightly less terrible,” Keeley said of the final rule’s impact. “But we still expect to be seeing thousands of people dis-enrolling and many millions of dollars of impact to the system.”
Nationwide, the rule could impact more than 13 million Medicaid and CHIP enrollees who live in a household with a noncitizen or are noncitizens themselves, according to a recent analysis by the Kaiser Family Foundation.
Both Keeley and AltaMed’s Constant worried the rule’s biggest impact could be that it will lead to thousands dropping out or opting out of applying for healthcare coverage—those who are not affected by the rule but are fearful of how it might affect their legal status.
“It feels like that is so much the intent of this rule,” Keeley said. “It is to instill fear and to build an invisible wall so that immigrants across the country aren’t able to live comfortably here.”
