Community Health Center Talking Points About Public Charge


In 2019, the public charge rule was revised in a way that deliberately and adversely impacts immigrant communities. As trusted healthcare providers serving these populations, Washington’s Community Health Centers are receiving many questions about the new rule from their patients, colleagues and community members. Here are the most important talking points for Community Health Centers:


Facts About Washington State Community Health Centers
  • Washington’s 27 community health centers treat 1.2 million patients – that’s 1 in 7 Washingtonians.
  • Community Health Centers provide care to everyone, regardless of their ability to pay, their immigration status or their individual circumstances. Our goal is a healthy community, and that requires universal access to primary care services.
  • We want to reassure our patients that community health centers will remain a safe space for everyone to seek services and Washington’s community health centers maintain their commitment to serve everyone – no matter their immigration status.
Changes to Public Charge
  • The final rule changes the definition of “public charge” to a person who uses or receives one or more specified public benefits for at least 12 months in a 36-month period and expands the public benefit programs considered in the public charge determination.
  • While the final rule provides clarification that a person applying to adjust or change their status or seeking to obtain a green card will not be penalized if family members use public benefits, we are deeply concerned that the rule penalizes immigrants for using lifesaving public benefit programs such as Medicaid and SNAP.
  • Moreover, it discourages them from accessing more than one program at a time since receiving two benefits in one month counts as 2 months of benefits.
  • This means that if a person uses both SNAP and Medicaid for 6 months, then they would reach the 12-month limit within half the year.
Public Charge and COVID-19
  • Avoid saying “immigrants” and “disease” or “coronavirus” together.
  • Avoid “othering” immigrants by making a distinction (explicit or tacit) between immigrants and others.
  • Avoid responses focused only on coronavirus or infectious disease.
Sample Talking Points
  • All families deserve access to healthcare coverage to ensure the wellness of our communities.
  • Experts have warned that the public charge regulation weakens America’s response to coronavirus.
  • Critics of the public charge policy warned from the beginning that it will make the nation poorer, hungrier, and sicker. If we want to build a stronger, more resilient, better prepared, and healthier country where all can thrive, we must reverse the dangerous public charge policy.
  • On March 13, 2020 U.S. Citizenship and Immigration Services (USCIS) announced that testing, prevention, or treatment for COVID-19, also called Coronavirus, should not be used against immigrants in a public charge test.
  • This means that immigrant families should seek the care they need during this difficult time. Free COVID-19 testing sites are available throughout Washington state. Find a testing site in your county: Seattle/King County, Tacoma-Pierce County, Spokane County, Yakima County, Whatcom County.
Impact to Washington Health Centers
  • At my health center, providers and staff have seen [INSERT PATIENT IMPACT].
  • We understand from patient activity in our health centers that the chilling effect of these changes has already been driving entire families away from enrolling in programs (or compelling them to unenroll from programs).
  • When immigrant families no longer enroll in public benefits, they will need to rely on state/local public health and other under-resourced systems, at a significant cost to states and localities.
  • Some examples of this would be increased utilization of emergency rooms as a form of primary healthcare or delaying treatment until medical conditions are more severe and more costly to treat.
  • Clearly, the rule is increasing access barriers to healthcare for immigrant. At my health center we’ve seen a decline in use of [INSERT ANY DATA ON LOWER USE OF SERVICES BY PATIENTS].
  • We are also concerned about the financial impact that this rule is likely to have on my health center [INSERT ESTIMATED FISCAL IMPACT IF YOU HAVE ONE]. Already we’ve had to reallocate hours of our staff’s time to learning more about the rule and helping to explain the nuances to patients.
Importance of Immigrants
  • The people impacted by changes to public charge are our colleagues, our neighbors and our friends.
  • These individuals contribute to our society and this administration’s inability to recognize that will hurt all of us in the end.
  • Our immigrant population makes up a large portion of the workforce. As a crucial part of our workforce, we need to ensure that our immigrant and migrant workers continue to have access to public benefit programs, like healthcare, without threatening their ability to become a legal permanent resident.
  • Washington has worked hard to protect our immigrant communities, and changes to the public charge rule will undermine these protections.
  • It is vital that our patients and their families continue to access medical care and other social services without fear of adverse immigration consequences as healthy families are better able to assimilate and contribute to the U.S. economy
  • We are troubled that the final public charge rule will punish low-income individuals who are seeking to adjust their status, thus if they choose to deny themselves public benefits they may still be deemed public charges and unable to adjust their status.
  • We understand from patient activity in our health centers that the chilling effect of these changes will drive entire families away from enrolling in programs (or compel them to dis-enroll from programs) that help them stay healthy and pay for medical care at community health centers, even if they are eligible for programs.
  • Not only will the expansion of public charge deter many immigrants from accessing public programs, but it will deter parents from enrolling their children, including children with legal immigrant status, in services for which their legally eligible, even if the rules do not apply to them.

Special thanks to the California Primary Care Association and Protecting Immigrant Families for these talking points.


Reviewed on 8/27/2020