For Immediate Release: Nov. 27, 2018

Media Contacts: Kathy Fackelmann,, 202-994-8354

                          Mina Radman,, 202-486-2529

Public Charge Rule Likely to Have a Significant Spillover Effect on Community Health Centers’ Ability to Serve Their Communities

 New Analysis Estimates that 295,000 to 538,000 Patients
Could Lose Health Care Services

WASHINGTON, DC and NEW YORK, NY (Nov. 27, 2018) – 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 today 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). 

Previous studies suggest that changes in federal policies about the use of Medicaid by legal immigrants, a benefit that they are eligible for, can produce a chilling effect on enrollment. Applying prior research into the chilling effect and its spillover impact to the proposed new public charge rule, Collaborative researchers determined that:

  • The rule’s chilling effect could cause between 354,000 and 646,000 community health center patients to forgo Medicaid coverage.
  • Total Medicaid revenue losses associated with this loss of coverage would range between $346 million and $624 million.
  • Revenue losses of this range would result in staffing reductions of between 3,400 and 6,100 clinical staff.
  • As health centers’ capacity for patient care declines, between 295,000 and 538,000 patients could lose access to primary care. 

“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,” said Leighton Ku, PhD, a Professor of Health Policy and Management at GW Milken Institute SPH and lead author of the study. “Our analysis suggests that as Medicaid revenues decline, so does health center capacity, not only for patients losing coverage, but for all patients in the surrounding community.”

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?” also contains state-by state estimates.  The analysis can be accessed here.


The Geiger Gibson Program in Community Health Policy, established in 2003 and named after human rights and health center pioneers Drs. H. Jack Geiger and Count Gibson, is part of the Milken Institute School of Public Health at The George Washington University.

The RCHN Community Health Foundation is the only foundation in the U.S. dedicated solely to community health centers. The Foundation’s gift to the Geiger Gibson program supports health center research and scholarship.

The Milken Institute School of Public Health at the George Washington University is the only school of public health in the nation’s capital.