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Policy Report COVID-19

Forgoing Healthcare in a Global Pandemic: The Chilling Effects of the Public Charge Rule on Health Access Among Children in California

This policy brief estimates the potential chilling effects of the approved changes to the public charge rule on children’s access to healthcare across 7 California regions.




The Trump administration’s expansion of the “public charge” rule — a move that sought to disqualify immigrants who used social programs like Medicaid from obtaining legal residency in the U.S. — may have left thousands of children in California without access to health care in the midst of the devastating COVID-19 pandemic.

Confusion about the criteria that disqualify people from more permanent immigration status, on the grounds of becoming a “public charge,” can lead immigrants and their families to disenroll from public assistance programs or refrain from using public services such as healthcare. Disenrollment from, and reduced utilization of, public benefits due to immigration concerns is known as the “chilling effect.”

In this policy brief, we estimate the potential chilling effects of the approved changes to the public charge rule on children in the state of California who are living with at least one parent without a green card. In particular, we estimate the following potential impacts of public-charge-related concerns on:

  1. The number of children who would lose access to a usual source of care other than the emergency room (ER),
  2. The number of children who would stop receiving a yearly doctor visit, and
  3. The number of children forgoing care.

Main Findings:

  1. Los Angeles County would be the most affected of the seven regions we studied, as between 42,911 and 65,458 children in that county could lose access to public programs due to chilling effects.
  2. Up to 132,062 Latino children in California could lose access to a usual source of care if someone in their household refrains from participating in public health programs out of immigration concerns.
  3. There are currently 98,840 children living with a non-green card-holding parent who did not visit a doctor in the past year, and this number could more than double (as it could increase by at least 107,359 children) due to the chilling effect of changes to the public charge rule.

Considering how little information exists about the implications of new public charge regulations on vulnerable children, our study provides useful and timely evidence for the ongoing debate on the impact of public charge rules on immigrant households and its implications on children’s access to and use of health care.