Andie Patterson, Director of Government Affairs

Immigration Update

After months and months of speculation, the proposed public charge regulation was officially published in the Federal Register on October 10, 2018. CaliforniaHealth+ Advocates has, for nearly a year, been working in close partnership with our other immigration allies to defend against any changes to the “public charge” definition.

“Public Charge” is a term used in immigration law to describe an individual who is dependent on the government for financial and material support. The proposed rule would amend the existing definition and would expand the public benefit programs currently considered in the public charge determination. We are deeply concerned that the federal administration aims to include public benefit programs, such as Medi-Cal and SNAP, in the public charge determination.

The proposed public charge rule would undoubtedly have a negative impact on health center patients. In California, one out of two children has an immigrant parent and over half of all children are enrolled in the state’s Medicaid program.[1] If this rule is implemented, California health centers could experience a financial loss of $74 to $221 million in Medicaid reimbursements if we see disenrollment rates of 20 to 60 percent from our non-citizen patients in Medi-Cal. This will force health centers to reduce care coordination services, such as providing health nutrition classes and transportation vouchers.

Public Charge Advocacy

The public comment period commenced on October 10, 2018 when the proposed rule was published on the Federal Register and will end on December 10, 2018. CaliforniaHealth+ Advocates has been working closely with the Protecting Immigrant Families (PIF) coalition to amplify the health center voice by creating resources that assist health centers in advocating against changes that would negatively impact immigrant patients and communities.

Our goal is to have the administration drop the proposed rule altogether due to the barrage of critical feedback. With our allies we aim to coordinate a massive number of submitted public comments to the U.S. Citizenship and Immigration Services (USCIS). To be successful in this endeavor, it is CRUCIAL that we not only have individuals and health centers submitting public comments, but that we also encourage state entities and representatives to do the same.  Particularly valuable in comments is explanation of the negative economic impact analysis this rule would have if published.



Need help with your public charge advocacy plan? The California Primary Care Association created the Public Charge Advocacy toolkit that includes community facing materials in 9 different languages (10 if you include English), talking points, FAQs, social media toolkit, template letter guide, and much more. You can access the toolkit here.

If you have any questions, please feel free to contact Liz Oseguera at

[1] California Department of Health Care Services Research and Analytic Studies Division. January 2016. Proportion of California Population Certified Eligible for Medi‐Cal By County and Age Group – September 2015. Medi‐Cal Statistical Brief. (pre-dates eligibility for children regardless of immigration status)
You can access the California Public Charge Comment Portal by going to the California Primary Care Association’s Immigration Resource Page or by clicking HERE.