Barriers to Health Care for Immigrant Families: Fears of Public Charge May 2005

Kern County Demographics 33,000 children between the ages of 0-18 are uninsured. Two-thirds, or approximately 27,000 uninsured children qualify for Medi-Cal or Healthy Families, but are not enrolled. Application assisters have identified fear of public charge by parents as a deterrent in applying for health insurance.

Access Barriers In the United States, each state has a children's health insurance program to make health care more affordable for working families (Healthy Families). Each state also has a Medi-Cal program that provides free health coverage to children from low-income families. These programs typically cover the cost of many health services for children, including vaccinations, regular doctor visits and prescriptions.

Access Barriers (continued) Sometimes parents are afraid to get health care benefits from the government for their children. They may be applying for lawful permanent residence (“green card”), citizenship, or work authorization, and think their immigration status will be affected if they apply for health insurance for their children.

Access Barriers (continued) Confusing eligibility rules Not aware of programs Fear of being required to pay for services Burdensome application process Concerns that using public benefits will harm immigration status or ability to sponsor relatives Staff are uninformed or unhelpful Lack of language assistance Don’t know how to appeal wrongful denial Fear of harming sponsor Fear of being reported

About Public Charge “Public Charge” is a term used in immigration law. The term describes persons who cannot support themselves and who depend on cash benefits like CalWORKS or Supplemental Social Security Income (SSI).

About Public Charge (continued) The Bureau of Citizenship and Immigration Services (BCIS, formerly known as the INS) can refuse to grant permission to enter the United States to an immigrant who is likely to become a “public charge” in the future. The BCIS issued rules in 1999 that stated that immigrants who use health care benefits, including Medi-Cal (except long-term institutional care), Healthy Families and county health care programs will NOT be considered public charge.

Community Education Strategies The OEC has coordinated 3 trainings in Kern County Immigration Attorneys from the National Immigration Law Center and the National Health Law Program were the presenters. Trainings participants included Application Assisters, Family Advocates, Public Health Professionals and other staff from Community Based Organizations.

Future Strategies Identified by the Outreach and Enrolment Committee Community Forums Continued Trainings Developing and distributing flyer/brochure Media Campaign

Resources Policy briefs and community education: California Immigrant Welfare Collaborative Individual help for health consumers: Kern Health Consumer Center Legal services: Greater Bakersfield Legal Assistance

Additional Information Fact Sheet Summary Good News! New INS Guidance On “Public Charge”INS Guidance This presentation is also available at