Many Community Health Centers Report That Immigrant Patients Are Declining to Enroll in Medicaid or Renew Their Coverage Amid Concerns About Changes to Public Charge Rules

Nearly half (47%) of community health centers report that many or some immigrant patients declined to enroll themselves in Medicaid in the past year, according to a new KFF survey, and nearly a third (32%) of centers say that some patients dropped or decided not to renew such coverage.

Interviews with health center staff report similar findings and indicate that fear and confusion surrounding recent immigration policy contribute to these changes. The findings come at a time when the Trump administration is tightening “public charge” rules under which immigrants can be denied entry to the U.S. or legal permanent resident status if federal officials determine they are likely to rely on public programs such as Medicaid and certain housing and nutrition programs.  The final rule change to “public charge” inadmissibility policies was scheduled to take effect October 15, but a federal judge in New York issued a temporary injunction blocking it

The survey and interviews — which are based on the perceptions of health center staff about the patients they serve who are immigrants — also find some changes in health care utilization. According to survey data, nearly three in ten (28%) health centers report declines among many or some adult immigrant patients in seeking health care in the past year. More than one in five (22%) centers reported reductions in health care use among some or many children in immigrant families. Interviews with health centers reveal that these changes include pregnant women and people with chronic conditions.

Nationally, 1,362 health centers provide care to 28 million patients in medically underserved rural and urban areas each year, often serving patients with low incomes and who lack health insurance. The survey of community health centers, which covered a broad range of topics, was conducted from May to July 2019 and designed and analyzed by researchers at KFF and the Geiger Gibson Program in Community Health Policy at the George Washington University.

The findings in the new issue brief, Impact of Shifting Immigration Policy on Medicaid Enrollment and Utilization of Care among Health Center Patients, also are based on structured phone interviews with health center directors and senior staff conducted by KFF researchers in California, Massachusetts, Missouri and New York.

Health center officials report that they are training staff to answer questions about the public charge rule and are working to ensure access to care for their patients, for instance by providing home visits and free medication delivery to some patients.

Other recent work by KFF on immigrants and health care includes an issue brief on estimated impacts of the final public charge rule on immigrations and Medicaid coverage, and a fact sheet on President Trump’s proclamation suspending entry for immigrants without health coverage.