How the COVID-19 Pandemic Has Intensified the Impact of the Public Charge Rule on Community Health Centers, their Patients, and their Communities

Community health centers operate in the poorest urban and rural communities that experience elevated health risks as well as a serious shortage of primary health care. Immigrants are disproportionately likely to be poor, and therefore experience a greater need for publicly supported health services. Community health centers serve large numbers of immigrants, not only because of their location but also because of the extent to which health centers have adapted their care and services to meet immigrants’ unique language, cultural, and health needs.The Trump administration’s public charge rule represents a serious threat for immigrants who seek permanent U.S. residency status. Under its terms, immigrants who use public benefits for which they are eligible (including most forms of Medicaid) can be considered dependent on government assistance and therefore ineligible for permanent legal residency. Moreover, in measuring eligibility for permanent residency, the rule establishes both a health and wealth test. Extensive news coverage as well as systematic research have documented the rule’s significant chilling effect, not only on those immigrants directly subject to its terms but also their families, including their citizen children.The rule’s impact on immigrants’ use of Medicaid is of major concern, because its sanctions apply to many forms of Medicaid coverage. Furthermore, because of the rule’s health test, an equally significant concern has been whether immigrants would avoid health care itself. In March 2020, the U.S. Citizenship and Immigration Services (USCIS) issued a limited COVID-19-related public benefit exception. However, in its July 2020 ruling blocking the rule from taking effect during the pandemic, a federal court explicitly found that the COVID exception was poorly designed and unable to mitigate the rule’s impact. Since this ruling, there has been no evidence that the exception has in any way lessened the rule’s chilling effect.The data note is available here.