Modern Healthcare – August 19, 2019

August 19, 2019 | Modern Healthcare 11

LAST WEEK’S RELEASE of the Trump
administration’s public charge inad-
missibility rule has healthcare providers
across the country scrambling to assess
how the more than 800-page document
might disrupt their ability to provide
care for immigrant patient populations.
The controversial new policy will
make it more difficult for immigrants
who use public health insurance, nu-
trition or housing assistance to obtain
legal permanent residency status. The
rule goes into effect Oct. 15. At deadline,
13 states had filed suit to block it from
taking hold.
“We’re already hearing stories of pa-
tients coming to the door and saying this
is their last visit,” said Berenice Constant,
vice president of government relations
at AltaMed Health Services Corp., a fed-
erally qualified health network serving
300,000 patients in Southern California.
Constant said such stories have made
giving patients factual, timely informa-
tion regarding the rule a top priority.
The system developed a script for front
office staff to help answer patient ques-
tions and inform them of local resources
for legal assistance. AltaMed’s commu-
nications department plans to release a
fact sheet and a frequently-asked-ques-
tions document to further help staff ad-
dress patient inquiries.
Perhaps the most significant action
AltaMed is taking involves working with
community partners. The
system is exploring op-
portunities to hold infor-
mational meetings and
is planning to eventually
partner with local legal
experts to help connect
them with patients.
“We’re going to be lean-
ing on relationships that
we have built over the
years with organizations

By Steven Ross Johnson

that already serve our patients,” Con-

stant said. “A lot of the social services

and supports, advocacy groups, and le-

gal and healthcare partners are serving

the same population, so we will be lever-

aging those long-standing relationships.”

At NYC Health & Hospitals, the sys-

tem’s response began the day the rule

came out with a statement from CEO

Dr. Mitchell Katz, who assured patients

they would not be identified as a pub-

lic charge if they accessed care at one

of the system’s sites.

Chris Keeley, senior director of the

acute-care service line at the pub-

lic health system, acknowledged that

sending the right message was a chal-

lenge. It required striking a balance of

providing patients important informa-

tion while giving them assurances they

can rely on the system to be a safe place

they can visit for care regardless of their

immigration status.

Keeley said Katz’s statement was ini-

tially emailed to staff and highlighted

plans to distribute educational materi-

als in the coming days. Em-

ployees were asked to share

any anecdotes they might

hear from patients about

concerns over the rule so

the system can refine its

messaging.

The system plans to dis-

tribute informational flyers

to patients and staff that

will have more details about

what’s included in the pub-

lic charge rule. Outreach workers who

are already being used to promote

the city’s recently launched universal

healthcare access program for the un-

insured, NYC Care, will also share infor-

mation about the rule and who might

be affected.

An analysis of a draft of the rule re-

leased last December indicated approx-

imately 350,000 NYC Health & Hospitals

patients could be affected, with the sys-

tem taking a loss of up to $362 million the

first year after the rule went into effect.

“The differences between the pro-

posed rule and the final rule made a ter-

rible policy slightly less terrible,” Keeley

said of the final rule’s impact. “But we

still expect to be seeing thousands of

people dis-enrolling and many millions

of dollars of impact to the system.”

Nationwide, the rule could impact

more than 13 million Medicaid and

CHIP enrollees who live in a household

with a noncitizen or are noncitizens

themselves, according to a recent analy-

sis by the Kaiser Family Foundation.

Both Keeley and AltaMed’s Constant

worried the rule’s biggest impact could

be that it will lead to thousands drop-

ping out or opting out of applying for

healthcare coverage—those who are not

affected by the rule but are fearful of how

it might affect their legal status.

“It feels like that is so much the intent

of this rule,” Keeley said. “It is to instill

fear and to build an invisible wall so that

immigrants across the country aren’t

able to live comfortably here.” l

Providers

Hospitals work to inform immigrant

groups of ‘public charge’ rule’s impact

THE TAKEAWAY

Healthcare providers

say they will rely on

their relationships

with community

stakeholders now

more than ever to

talk with immigrant

populations about

access to care.

At NYC Health & Hospitals, the

system’s response began the

day the rule came out with a

statement from CEO Dr. Mitchell

Katz, who assured patients they

would not be identified as a

public charge if they accessed

Dr. Mitchell Katz care at one of the system’s sites.