Proposed Public Charge Rule Likely to Have a Significant Impact on Community Health Centers

Hundreds of thousands of patients could lose access to comprehensive primary and preventive care at community health centers if a proposed rule by the U.S. Department of Homeland Security is adopted, according to an analysis released by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative at the George Washington University’s Milken Institute School of Public Health (GW Milken Institute SPH).

Under the proposal, many legal immigrants would be designated as “public charges,” which federal authorities would use to prohibit them from becoming permanent residents, adjusting their immigration status or even from re-entering the United States. “The proposed rule would sanction many lawful immigrants if they use public benefits, such as Medicaid, SNAP, or public housing benefits, even though they are legally eligible for these benefits,” explains Leighton Ku, PhD, a professor of Health Policy and Management at GW Milken Institute SPH and lead author of the study.

Previous studies suggest that changes in federal policies about the use of Medicaid by legal immigrants can produce a chilling effect on enrollment. Applying prior research into the effect and its spillover impact to the proposed new public charge rule, the researchers determined that it could cause between 354,000 and 646,000 community health center patients to forgo Medicaid coverage.

This would lead health centers to lose between $346 million and $624 million in Medicaid revenue. Revenue losses of this range would result in staffing reductions of between 3,400 and 6,100 clinical staff, the analysis predicts. As health centers’ capacity for patient care declines, between 295,000 and 538,000 patients could lose access to primary care, the researchers found. 

“Understanding the broader, community-wide consequences of major changes in public policy is a vital aspect of measuring the impact of the policies proposed by the Department of Homeland Security,” Ku says. “Our analysis suggests that as Medicaid revenues decline, so does health center capacity, affecting not just immigrants on Medicaid, but many others in their communities.”

The report provides both national and state-level estimates of impacts.  California, New York, Texas, and Massachusetts are likely to be hit particularly hard because health centers are a major source of care and immigrants make up a large part of the low-income population.

Feygele Jacobs, DrPH, president and CEO of the RCHN Community Health Foundation, whose ongoing gift supports the Geiger Gibson Program, noted that, “the type of community-wide impact shown here is a predictable side effect of U.S. policy changes regarding lawful immigrants, which threaten the use of vital Medicaid benefits by large numbers of health center patients.”

The analysis, “How Could the Public Charge Proposed Rule Affect Community Health Centers?” can be accessed here.