The specter of a pending “public charge” rule — which could penalize green card applicants who use public benefits like Medicaid — is causing many immigrant patients to decline enrollment, according to a Kaiser Family Foundation survey of community health centers. This month a federal judge temporarily blocked that rule from taking effect.
Texas leads the nation in the number of uninsured children and adults. In Houston, Maricela, a single mother, had carefully filled out the paperwork to re-enroll her younger two children, both citizens, in Medicaid every year since they were born — until now. A permanent resident from El Salvador who earns minimum wage as a hotel maintenance worker, she was so worried about jeopardizing her status that she decided to let their coverage lapse in August. Because of the deportation risk, she agreed to share only her first name.
“My worst fear is that I could end up without my legal status and be separated from my children,” Maricela said this month at Epiphany Community Health Services, a nonprofit group that helps people find health coverage. “That would be fatal for me.”
Her older son, 11, has asthma; at his last doctor’s visit before his coverage ended, she pleaded for extra medicine. His main treatment, a generic version of Singulair, could cost $150 a month without insurance. Listening to him cough at night, she finally decided to take the risk and re-enroll both boys in Medicaid.
“I had to do it,” she said. “But I’m afraid.”
Dr. Sogol Pahlavan, a Houston pediatrician, said the rate of her patients on Medicaid dropped to 70 percent in 2018, from 75 percent a year earlier. The number of uninsured in her practice of 10,000 patients has grown commensurately, with families citing both the impending public charge rule and administrative hurdles.
“It’s definitely going to affect the community, because somebody ultimately has to bear that cost,” she said. “These kids are still here; their chronic disease isn’t going away just because they’re losing health coverage.”