Fearing deportation, immigrants are dropping Medicaid over misinformation about Trump's new policy

Changes to the federal "public charge" rule are set to take effect in October, but fear and confusion are already causing immigrants to drop benefits.

Patients wait to be seen at the People's Community Clinic in Austin, which provides state-subsidized health services to low-income families and individuals.

*Correction appended

When she came to Texas from India in 2015 after marrying a U.S. citizen in her home country, the 41-year-old woman said, she spoke little English and had no knowledge of life in America. Within a week, she said, her new husband began calling her names, beating her, and installing cameras and sensors in their home to monitor her movements.

The woman, who requested anonymity because she fears being found by her husband, said she endured the abuse for two years before she got help from attorney Pooja Sethi and a neighbor and was able to escape with her U.S.-born daughter. She found a job and a place to live in Austin, applied for a permanent green card and went to court to get full custody of her daughter, who she said vomits often and needs regular medical attention.

But after hearing about a new federal immigration policy scheduled to take effect next month, the woman said she considered returning to her husband out of fear that she could be deported if she used Medicaid to get health care for her 2-year-old.

“If I don’t have insurance, how will I take care of my daughter?” the woman said.

The rule, which faces at least six legal challenges nationwide, will allow federal officials to deny visa or permanent residency applications from immigrants who they believe could become “public charge,” or people primarily dependent on government aid, based on their income or prior use of government benefits such as Medicaid and food assistance.

Since 1882, the U.S. government has had a vague public charge rule requiring foreign nationals to be “self sufficient” before they are allowed into the country, but in practice it was only invoked for applicants whose entire income came from government cash assistance or those who needed extensive medical care at the government’s expense.

The new policy, published by U.S. Citizenship and Immigration Services in August and scheduled to take effect Oct. 15, adds health care, food stamps, cash assistance and public housing programs to the list of public benefits that, if used to some extent, could count against immigrants who apply for visas or permanent residency after the changes take effect. It also increases the income requirement for applicants to 250% of the federal poverty level.

Sethi later told the Austin woman that she doesn’t need to worry because the rule won’t be applied retroactively and she already has a green card.

But immigrant advocates say the new policy has spread fear throughout the immigrant community, and many people are reacting by dropping from health care programs or taking their children off of food assistance.

The rule “is creating a climate of fear among the poorest immigrant families,” said Cheasty Anderson, senior policy associate for the Children’s Defense Fund-Texas. Anderson said she recently gave an information session on the public charge rule at Vela, a nonprofit organization for immigrant families with children with special needs, and the atmosphere was tense until she explained that the new rule would not affect most of them and they did not have to drop their children from Medicaid.

“After I had said it five to seven times, you could see the shift in the room. Shoulders came down and people were breathing easier,” Anderson said.

Anne Dunkelberg, associate director of the Center for Public Policy Priorities, a left-leaning policy think tank, said more than 1.6 million Texas children are U.S. citizens living in families with at least one non-U.S. citizen relative, and the misinformation and fear spreading about the rule is resulting in children losing benefits they’re entitled to receive.

Epiphany Community Health Outreach Services, a Houston nonprofit that helps immigrants apply for medical and food benefits, said it has seen a dramatic drop in clients since word began to spread about the public charge rule. Cathy Moore, the group’s executive director, said the number of adult applications and renewals for Medicaid has dropped 44% since last year.

“The parents are too afraid to sign up for the services, and the children are not getting the care they need,” Moore said. “It used to be I would arrive in the morning and there would be 10 people in line. They would line up since 5:30 a.m. I have been there the last few days, and there is nobody in line.”

According to Kelli Weldon, press officer for the Texas Health and Human Services Commission, the state saw a drop in Medicaid and Children's Health Insurance Program applications in 2017 and 2018. But Weldon said the numbers are rising again in 2019. She said the reductions could also be attributed to Texas' record low state unemployment rate, which reached 3.5% in May, according to the National Conference of State Legislatures.

Matthew Tragesser, spokesperson for the Federation for American Immigration Reform, a right-leaning immigration policy organization, said the rule is meant to “promote merit based immigration.” He said it will reduce reliance on public assistance.

“The Trump administration’s public charge rule is a game changer and encourages immigrant self-sufficiency while also protecting the nation’s social safety net,” Tragesser said in an email.

Immigrant advocates say immigrants need to know that the rule — if it survives all the legal challenges — will not affect permanent residents who want to become citizens, nor will it apply to refugees, people granted asylum, survivors of domestic violence and certain other foreign nationals. It also won’t affect an immigrant simply because he or she has a relative or child who uses public benefits. Receiving emergency medical care and care for pregnant women will also not count against applicants.

Zenaida, a Houston resident in her 40s, said it took a lot of deliberation before she went to Epiphany Community Health Outreach Services this month to apply for medical benefits. Zenaida, who asked to be identified only by her first name out of fear of being deported, said she and her husband are undocumented and have lived with their two U.S.-born children in the U.S. for 25 years.

She said she was recently diagnosed with kidney stones and was told she needs surgery, and her husband was diagnosed with severe vision problems.

Moore said ECHOS is helping the family apply for medical benefits for the children, and the parents are eligible for the Harris Health Financial Assistance Program.

Zenaida said she's worried that applying for any benefits could affect the green card application process that her 20-year-old daughter helped her start. She said her fear is that immigration agents will show up at her door.

Now she said she plans to consult a lawyer.

“If we were sent back to Mexico, we would have nothing,” Zenaida said. “We wouldn’t even have a place to stay.”

Correction: An earlier version of this story incorrectly stated the type of medical benefits that Zenaida was applying for. She plans to apply for a program for which undocumented immigrants are eligible.

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