By Virginia Gaglianone and Yesenia Amaro

The USC Center for Health Journalism Collaborative

More than anything else, Claudia Navarro wanted health insurance for her children when she arrived in the United States.

Navarro’s daughter has spina bifida — a congenital condition her doctors in Mexico said would kill the girl within a year. But Navarro didn't give up on her baby. Instead, she brought her two young children to the U.S. to seek medical help. She obtained limited Medi-Cal benefits for her child, despite her immigration status, and arranged treatments that kept her daughter alive.

Now, 27 years later, Navarro worries that her decision to seek benefits could threaten her chances at becoming a legal U.S. resident.

She’s focused on proposed federal restrictions that would place new limits on who can qualify for a green card. The rule change would broaden who the immigration system defines as a “public charge” — essentially a taxpayer burden — and includes an expanded list of federal taxpayer-funded public benefits that would count against immigrants, including food stamps and Medi-Cal, the state’s health program for low-income individuals and families. Under the new rules, which are still under review, immigrants also could be denied a green card if they are deemed likely to depend on federal benefits in the future, even if they haven’t applied for them yet.

Such rules cannot be implemented retroactively and legal challenges to an expanded rule are all but assured, experts say, but immigrants such as Navarro still fear that the prior use of benefits could increase the chances that federal officials will deny immigration petitions. Some immigrants also are being advised to drop all their benefits by attorneys and notarios, who are under-the-table legal advisors who may not be familiar with the law.

Across the country, worries over the proposed rule have already prompted some undocumented immigrants to drop out of public programs or to stop going to the local clinic when they are sick, say doctors, immigration attorneys and advocates.

In California, such fears could also stop millions from signing up for free health care for low-income families under proposals by Gov. Gavin Newsom and state legislators to expand Medi-Cal eligibility for undocumented individuals. 

“The concerns over public charge are legitimate because the federal immigration policies have been focused on enforcement and sown fear and mistrust among immigrant families, whether they are undocumented, permanent residents or naturalized citizens,” said Jesus Martinez, executive director of the Central Valley Immigrant Integration Collaborative service agency.

Navarro, 51, said the Trump administration’s proposed rule change has introduced new uncertainty into her family's already precarious life here.

“Since we arrived, it’s been an ordeal trying to find doctors and hospitals, a real agony,” said Navarro, whose children are on Medi-Cal.

Although Navarro does not regret asking for coverage for her children, she admits worrying about her immigration status. One source of relief: Her children have won temporary protection from deportation under the Deferred Action for Childhood Arrivals or “Dreamers” program, granted to children who were brought to the U.S. illegally.

“Right now, everything regarding my status is in limbo,” the Los Angeles resident said. “We live in great anguish and uncertainty, praying that Dreamers and their parents are granted residency status.”

Who is a taxpayer burden or ‘public charge?’

It’s established law to deny green cards to immigrants based on whether a person could eventually become a public charge. But until now, that rule was limited to those receiving long-term care provided by institutions, such as mental health centers or nursing homes, or cash-assistance programs for people who have physical or mental disabilities.

In September 2018, the Department of Homeland Security proposed expanding the definition of “public charge” to include social assistance programs such as Medicaid, food stamps offered under the Supplemental Nutrition Assistance Program (SNAP), and Medicare Part D’s Low Income Subsidy for prescription drugs. Use of food stamp and housing programs under Section 8 could also hurt residency applicants.

Expanding the definition of who represents a burden on society makes sense, argues Andrew Arthur, a Washington, D.C.,-based fellow at the Center for Immigration Studies, which supports reducing U.S. immigration. The proposed rule changes are needed because “the law has never really been implemented the way it was written,” he said.

Arthur added that “generous benefits” promised by state lawmakers would raise other questions, such as whether people with pre-existing conditions would enter the country or move to California from other states so they can receive medical coverage.

People in need of medical care could get a visa to come and get that care, he said. But it could also encourage other people to enter California illegally “and put a burden to the taxpayers.”

“It’s a bad public policy,” Arthur said.

The new governor’s health care plan

Newsom's plan would expand Medi-Cal to every Californian under age 26, regardless of immigration status, provided they meet low-income criteria. Assemblymember Joaquin Arambula and state Sen. Maria Elena Durazo have introduced legislation that would expand Medi-Cal even further, to all low-income, undocumented adults. The state currently provides Medi-Cal to undocumented children.

Daniel Zingale, director of the governor's Office of Strategic Communications and Public Engagement, said the state will spend millions of dollars to educate immigrant communities about the Medi-Cal expansion if the governor’s initiative goes through. It’s hard to underestimate the potential chilling effect of the Trump administration’s proposal to redefine who represents a “public charge” and the fears spurred by other federal immigration crackdowns, he said.

"We can’t be timid about it, we can’t hesitate in our outreach to try to … bring people into these appropriate services without putting them at some draconian risk," Zingale said. “The messenger will really matter."

Who would be affected by the new rule?

The public charge proposal was open to comments during a 60-day period, which ended on Dec. 10, 2018. The Department of Homeland Security is now analyzing over 216,000 comments before approving or modifying the proposal.

An estimated 382,264 people — many of them applying for permanent residency — are expected to be targeted annually under the proposed rule change, according to Homeland Security.

In a statement, U.S. Citizenship and Immigration Services spokesman Michael Bars said the agency “looks forward to addressing these public comments in the final rule this year.”

While the policy is debated, many of the 1.5 million uninsured and undocumented immigrants in California are forced to weigh the benefits and potential risks of using public services.

 “Ana” has been waiting for 30 years for the opportunity to become a U.S. resident. But now she’s worried about the services and government aid, such as Supplemental Security Income, that she sought for her older son.

Ana, who asked to keep her real name confidential, arrived in Los Angeles from Durango, Mexico, with her two children in 1989, and raised them as a single mother. Her older son suffers from rheumatoid arthritis and has had to regularly seek medical care since early childhood. Ana has had to sometimes give up work to take care of her son.

“That was when I had to ask for SSI” for the son, explained Ana.

Under existing regulations, her ongoing receipt of cash aid under SSI likely means Ana will be barred from legalizing her status. Her two sons have already won protections from deportation under the Deferred Action for Childhood Arrivals program.

“I’m afraid they will deny me for having asked for care for my children,” said Ana about the application she’s filed to adjust her immigration status. “I sometimes think it would have been better not to have asked for any help.”

This project results from an innovative reporting venture – the USC Center for Health Journalism News Collaborative – which involves print and broadcast outlets across California, all reporting together on the state’s uninsured.

We want to hear your story — please fill out this quick survey if you are willing to talk with a reporter, or call 510-833-7346.