A new data note discusses the heightened impact of the public charge rule on community health centers, patients and communities resulting from the COVID-19 pandemic.

The public charge rule represents a serious threat for immigrants who seek permanent U.S. residency status. Of major concern is both the rule’s impact on Medicaid, and whether immigrants would avoid health care itself. Research has documented the rule’s significant chilling effect, both on those directly subject to its terms as well as on their families, including citizen children, with the sanctions expected to have a substantial effect on health center revenue and care capacity. Prior estimates by the authors found that between 165,000 and 495,000 Medicaid patients at community health centers could be expected to lose coverage, translating to a decline in the capacity to serve between 136,000 and 407,000 health center patients nationally, and revenue declines ranging from $164 million to $493 million as a result of the Medicaid coverage drop. Since that time, as a direct result of the COVID-19 pandemic, community health centers have lost an estimated $4.006 billion in cumulative patient revenue over eight months, or 13 percent of all 2019-reported revenue. At the same time, the pandemic has demanded a major increase in care capacity, especially for the worst-hit populations, who tend to reside in impoverished communities and to include large numbers of immigrants. Funding to offset the effect of the pandemic has been inadequate. With no additional federal COVID-19 financial relief yet committed, health centers will be unable to restore operational capacity to pre-pandemic strength. Thus, the public charge rule becomes a matter of even greater concern both because of the direct threat it poses to community health when care is most needed, and because of its spillover financial and operational effects on community health providers struggling to care for their communities.

The data note was produced by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative.
Download the data note.