​Summary: The Donald Trump administration’s public charge rule took effect in February 2020, significantly expanding the criteria for determining whether applicants for permanent residency, or green cards, may be denied based on past or potential use of government benefit programs. Even before the rule took effect, evidence shows the proposed rule produced widespread chilling effects nationally, meaning eligible immigrant families — including those who would not be subject to the rule — avoided enrolling in public benefit programs for fear of immigration consequences.

This phenomenon has become even more alarming during the COVID-19 pandemic, in which many immigrant families are vulnerable to acute medical and economic hardship. Families may avoid medical care and public supports for fear of being deemed a public charge, despite formal clarification by the federal government that COVID-19 testing and treatment will not be considered. Given the economic and public health crisis, it is critical to understand how the rule is affecting immigrant families, where these families are getting their information about the rule, and which sources they trust to communicate accurate messages about the rule and its impacts.  

Findings: Authors found the following:

• The public charge rule’s chilling effects on receipt of public benefits in 2018 persisted at similar levels into 2019. More than one in seven adults in immigrant families (15.6 percent) reported that they or a family member avoided a noncash government benefit program, such as Medicaid, the Children’s Health Insurance Program (CHIP), the Supplemental Nutrition Assistance Program (SNAP), or housing subsidies, in 2019 for fear of risking future green card status. More than one in four adults in low-income immigrant families (26.2 percent) reported chilling effects during that period.
• Between 2018 and 2019, there was a statistically significant increase (from 21.8 percent to 31.0 percent) in chilling effects among adults in immigrant families where at least one member was not a permanent resident, the group most likely to be directly affected by the rule through future green card applications.
• Among adults reportedly avoiding noncash government benefit programs because of green card concerns, nearly half said their families avoided Medicaid/CHIP or SNAP and one-third avoided housing subsidies. Smaller but substantial shares of adults also reported spillover effects to public programs excluded from the public charge rule, including free or low-cost medical care programs for the uninsured (20.8 percent); the Special Supplemental Nutrition Program for Women, Infants, and Children (16.3 percent); Marketplace health insurance coverage (14.1 percent); and free or reduced-price school lunches (13.0 percent).
• Two-thirds of adults in immigrant families (66.6 percent) were aware of the public charge rule, and 65.5 percent were confident in their understanding about the rule. Yet, only 22.7 percent knew it does not apply to citizenship applications, and only 19.1 percent knew children’s enrollment in Medicaid will not be considered in their parents’ public charge determinations.
• Adults in immigrant families were most likely to trust government agencies and legal professionals for information about how using public benefits would affect their or a family member’s immigration status. US Citizenship and Immigration Services was the most trusted source (66.1 percent), followed by legal professionals (63.0 percent), state government agencies (55.6 percent), and local government agencies (50.7 percent). However, very small shares reported getting information on the public charge rule from these sources; most reported getting information on the rule from the media or personal networks, which they trust less.

This study references data from the 2019 California Health Interview Survey.