Avoiding Medicaid enrollment after the reversal of the changes in the public charge rule among Latino and Asian immigrants

Abstract

Objective To estimate the avoidance of Medicaid enrollment among Latino and Asian immigrants due to fears about immigration status. In 2019, changes to the “public charge” rule made it difficult for immigrants to receive a green card or permanent residence visa, particularly for those who used health and nutrition benefits. Despite the Biden administration's reversal of these changes, fear and misinformation persist among immigrants. Data Sources Pooled data from the 2017 to 2020 California Health Interview Survey. Study Design We used adjusted predicted probability models to estimate differences in access to and use of health care and health insurance coverage among Latino and Asian immigrant adults with and without green cards, using US citizens as the reference. We estimated the avoidance of Medicaid enrollment among immigrants without a green card, the immigrant population subject to the public charge rule. Data Collection/Extraction Methods Population stratified by race/ethnicity and green card status. Principal Findings Latino immigrants without a green card were −23.1% (CI: −27.8, −18.4) less likely to be insured, −9.2% (CI: −12.8, −5.5) less likely to have Medicaid coverage, −9.3% (CI: −14.5, −4.1) less likely to have a usual source of care, and −8.4% (CI: −13.2, −0.3) less likely to have a physician visit relative to citizens. Asian immigrants without a green card were −11.7% (CI: −19.7, −3.72) less likely to be insured, −8.8% (CI: −11.6, −6.1) less likely to have Medicaid coverage, −11.6% (CI: −19.3, −3.9) less likely to have a usual source of care, and −11.0% (CI: −19.2, −2.3) less likely to have a physician visit. Between 107,956 and 192,905 Latino immigrants and 1294 and 4702 Asian immigrants in California likely avoided Medicaid enrollment due to fears about their immigration status. Conclusion While our estimates are lower than those of previous studies, our findings highlight barriers to health care for immigrants despite the reversal of the changes in the public charge rule. Since the public charge rule was not abolished, immigrants with low incomes might choose not to seek health care, despite recent efforts in California to expand Medicaid coverage to all eligible immigrants regardless of documentation statuses.

Citizenship status and cost‐related nonadherence in the United States, 2017–2021

“…Until 2019, the government considered cash‐based public assistance to determine if an applicant was a “public charge”, but the expansion allowed the government to consider most federal, state, and local assistance programs, including Medicaid, subsidized health insurance purchased through the ACA Marketplace, and SNAP 53 . While the Biden administration rescinded this expansion in 2022, 53 it is thought that 1000s of immigrants still forgo safety‐net health care and food assistance programs due to lingering fears 8,50,54 . Therefore, policies that explicitly or implicitly exclude or discourage noncitizens from publicly funded safety‐net programs, even temporarily, may worsen existing inequities in prescription medication access.…”

Household Social Needs, Emotional Functioning, and Stress in Low-Income Latinx Children and their Mothers

“…While we did not have information about participants' immigration status, it is plausible that immigration influenced the study's urban, predominantly Spanishpreferring population. Threats of impending changes to policies affecting or affected by immigration status that occurred during the HASII study's enrollment period, such as those expected to the "public charge rule," negatively impacted enrollment in public assistance programs, including immigrant communities' enrollment in Medicaid (Bustamante et al, 2022;Miller et al, 2022;Wang et al, 2022). It is possible that fear associated with the public charge rule or other programse.g.…”

“…programs that require documentation of immigration status or that depend on English fluencymay partially explain the Model 2 included level of need as the social need variable c This item added after original study began; analyses for this item includes participants with complete data only high rates of social needs in our sample. Despite the recent reversal of the public charge rule, evidence suggests that its impact on immigrant communities' trust in public programs will persist (Bustamante et al, 2022), further underscoring the lasting harm of discriminatory policymaking.…”

Post-COVID19 strategies to support the health care interactions of U.S. Mexican immigrants and return migrants with the Mexican health system

“…Most cross-border patients, however, have a legal status in the U.S. since they can cross the border frequently to purchase prescription drugs, meet their primary care providers, get dental care, or receive specialized treatments. Undocumented immigrants are largely excluded from the cross-border use of health care due to the difficulties of returning to the U.S. (Bustamante et al, 2022). Over time, undocumented immigrants become less familiar with the Mexican health system, making it more challenging to access health care for those who get deported to Mexico.…”

“…Undocumented immigrants from Mexico are particularly vulnerable since 56 percent lack a usual source of care (Bustamante et al, 2021). Restrictive immigration policies, health care navigation challenges and fear of deportation are associated with the suboptimal use of health care among U.S. undocumented immigrants (Bustamante et al, 2022).…”