Agenda Item: Caring for Immigrant Patients and Families in our Community
- San Diego County is currently home to 3.1 million residents with approximately 21.5% of the county's population being immigrants, including refugees, who come from other countries (1).
- The relationship between immigration and mental health has significant implications for both psychiatric symptomatology and public health outcomes.
- Recent policy changes have led to decreased accessing of medical and mental healthcare services by legal residents of San Diego and Imperial Counties.
- The San Diego Psychiatric Society has joined with the American Psychiatric Association to issue statements opposing the widespread separation of children and families, and calling for humane care for asylum seekers at the U.S. border
- Multiple medical societies have issued statements against changes to “Public Charge” criteria on the grounds that it worsens the health and safety of patients, families, and communities (3).
- A 2019 JAMA study found that the “public charge rule would likely cause millions of children to lose health and nutrition benefits, including many children with specific medical needs that, if left untreated, may contribute to child deaths and future disability (4).”
Inadmissibility on “Public Charge” Grounds:
- Introduced by Trump Administration on Aug 14, 2019, in effect Feb 24, 2020
- Under the new rule, federally-funded Medicaid, the Supplemental Nutrition Assistance Program (SNAP, formerly known as food stamps), Section 8 housing assistance and federally subsidized housing will be used as evidence that a green card or visa applicant is inadmissible under the public charge ground. All use of cash aid, including not just TANF (Temporary Assistance for Needy Families) and SSI but also any state or local cash assistance program, could make an individual inadmissible under the public charge ground. The rule allows immigration officers to consider English proficiency (positive) or lack of English proficiency (negative), a person’s credit score, medical conditions and whether the person has access to private health insurance (5).
Here are some messages that physicians may consider when communicating with patients and families:
- I do not care about your immigration status, will not ask about it, and am here to help you.
- You do have rights and resources. It's important to know them.
- I am here to support you in keeping your family together.
- I care about the health and well-being of you and your family.
The Impact of Changes to the Public Charge Rule on Immigrants Living in the U.S.
UCSD US Immigration Policy Center
News Release: San Diego Unified Addresses Concerns Regarding New Public Charge Rule, Encourages Families to Continue With Free and Reduced Lunch
Immigrants Afraid of Trump’s ‘Public Charge’ Rule Drop Food Stamps, MediCal
- Zallman et al. Implications of Changing Public Charge Immigration Rules for Children Who Need Medical Care. JAMA Pediatrics. April 2019.
- Department of Homeland Security. Proposed rule: Inadmissibility on Public Charge Grounds. CIS No. 2499–10; DHS Docket No. USCIS–2010–0012. Federal Register. https://www.federalregister.gov/documents/2018/10/10/2018-21106/inadmissibility-on-public-charge-grounds.