‘Public charge’ proposal frightened some immigrants into keeping kids off Medicaid

A man talks to a crowd of people in the cafeteria.
Greenvale Park Elementary School principal Sam Richardson talks with first graders and family members Thursday, Sept. 26, 2019 during a community dinner at Greenvale Park Elementary School. The elementary school hosts the dinners as a way to build up their community.
Christine T. Nguyen | MPR News

On a recent school night, Northfield Superintendent Matt Hillmann donned a hair net and began passing out cups of water to first graders and their families in the Greenvale Park Elementary cafeteria.

He was joined by a team of teachers and school administrators, including Greenvale’s principal, Sam Richardson. They served up pizza boats and apple slices.

“It’s a huge community builder for us,” Richardson said. “Connecting the families, I really think, makes the biggest difference in how students and their families feel about school.”

Greenvale has worked hard to build up its community in different ways. It runs on a community school model, partnering with local organizations to support students and families.

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But close to a year ago, it began to be concerned about how a possible Trump administration change to immigration rules might affect the school’s student body and funding.

Those changes, which have been called a “public charge” rule, were officially announced by the Trump administration over the summer. The rule would have made it more difficult for immigrants to get permanent U.S. residency if they used or seemed as if they might use public benefits like Medicaid, food stamps, housing subsidies and cash assistance.

A man wearing an apron and hairnet passes out cups to people in line.
Superintendent Matt Hillmann (center) passes out cups of water and milk to families on Thursday, Sept. 26, 2019 during a community dinner at Greenvale Park Elementary School. The elementary school hosts the dinners as a way to build up their community.
Christine T. Nguyen | MPR News

The rule is now blocked and did not take effect this month as planned. But fear and confusion about the rule’s potential impact on immigration status has already prompted some in Minnesota to take themselves or their children off certain benefits.

At the start of the school year, Minnesota officials said they were concerned the public charge rule might mean fewer families would enroll in free and reduced meal programs at schools.

Superintendent Hillmann said this was a concern for Greenvale Park and the rest of his district.

"There was initially some concern about not seeing the same pattern of (free and reduced meal) applications being made,” Hillmann said.

“My understanding of the confusion was that they hear the (free and reduced school) food program could be interrupted or the food program could be compromised. And so I think there was some confusion about, 'Oh, if I apply for this, I could potentially have my pathway to citizenship impacted,’" Hillman said.

But Hillmann and community workers in Northfield said immigrants in that community didn't really appear concerned about signing up for free and reduced lunch. What they seemed to be worried about instead was signing up for health insurance.

Veronica Gamino, a client specialist at the Community Action Center in Northfield, said a lot of immigrants in her community struggled with whether to sign themselves up for Medicaid since the public charge rule was announced.

"Where I see it most is health insurance. I've seen more people who in the past have been very punctual about renewing (health insurance policies) let it lapse,” she said. Immigrant parents were struggling over the best choice for their children, she said, and worrying about whether their decision is “going to affect them later in life.”

Health workers in Faribault, approximately 20 miles south of Northfield, said immigrants in their community have been going through similar dilemmas.

Daisey Sanchez, director of operations for Health Finders Collaborative, said people walk into her center to get medical treatment or to get help filling out medical and insurance applications.

About six of every 10 people who walk through the center's doors are Latino, Sanchez said, and some of them are working their way through the U.S. immigration system or hoping to change their immigration status. Many of them have raised questions about the public charge rule.

"We would all have a story to say, 'Yeah, there's this one family, here's another family who've chosen to drop … their children (off health insurance),” Sanchez said.

“You know, they're always living in that fear and so they'd rather just not enroll their kids out of fear of being asked their immigration status," she added.

It's not just Minnesota immigrants who have considered dropping Medicaid. The Kaiser Family Foundation recently released the results of a survey that looked at the impact of immigration policy changes on Medicaid enrollment.

It found that almost half of health centers surveyed reported that many or some immigrant patients had decided not to enroll in Medicaid in the past year. Some of those immigrants included people who were excluded from this part of the public charge rule, like pregnant women.

Sanchez and her co-workers have spent time over the past several months trying to educate themselves on who, exactly, would have been affected by the rule.

“Because of the uncertainty out there or families who are misinformed — these are families who are going without health care insurance for their children. These are families that are not applying for their children to receive benefits who lawfully qualify for them,” Sanchez said. “If I had a message for families to say, it’s really, ‘Get informed. Get the right information.’”

Families sit at tables in a cafeteria
Greenvale Park Elementary School first graders and their families take part in a community dinner Thursday, Sept. 26, 2019 at the school. The elementary school hosts the dinners as a way to build up their community.
Christine T. Nguyen | MPR News

Sanchez said she’s hoping now that confusion and fear about the rule will begin to dissipate and that people in her community will sign up for the benefits they qualify for.

"Of course (our) staff will do their best to inform patients and to refer patients to an immigration attorney if they still have doubts and fears to make sure that they can be at ease and apply without having that fear," she said.

In Northfield, Gamino is also doing her best to educate people about what they’re entitled to.

“We want people to feel dignified. We don’t want them to shy away from asking for what they need,” she said. “They should be able to …. not have that thought, that it’s a negative thing to need help.”