One of Mountain Family Health Centers’ central missions is to offer accessible health care to all populations, regardless of socioeconomic background. The eight locations across the Western Slope — including a mobile dental van at the Glenwood Springs Integrated Health Center — staff bilingual caregivers and provide medical services regardless of insurance coverage.
It’s even a recognized Hispanic Advocacy Center of Excellence by the National Association of Community Health Centers.
So when the U.S. Department of Homeland Security on Aug. 14 issued a final ruling that could pose new obstacles for lower-income legal immigrants to change their status or obtain a green card, Mountain Family’s leadership felt a response was needed.
“About 50 percent of our patient population is Latino or Latina,” said Garry Schalla, development director for the nonprofit health care system, adding that about 21,000 people comprise that patient base.
“The fears are already existing and have been for some time. We feel it’s a really important issue, not only for the population that it’s really putting its thumb on, but also for that economic viability.”
The policy update — officially titled Inadmissibility on Public Charge Grounds — puts greater emphasis on what’s called the totality of circumstances when considering an applicant’s eligibility for permanent residence. In addition to weighing factors such as a person’s fluency in English, education level and wealth more heavily than in the past, the latest ruling focuses on the definition of public charge — that is, whether or not someone is likely to use public services such as cash assistance programs and Temporary Assistance for Needy Families.
That standard already existed in U.S. Citizenship and Immigration Services protocol. The new USCIS rule broadly expands the list of programs to include in a public charge test — such as Medicaid, Supplemental Nutrition Assistance Program and Section 8 housing vouchers and related programs.
Mountain Family advocacy coordinator Danyelle Rigli worries that the new rule — which, barring any action from the judicial system to the contrary, takes effect Oct. 15 — may negatively affect immigrants’ health care decisions.
“We are here to provide high quality mental, behavioral and dental health care, no matter your immigration status,” she said in an email. “The public charge evaluation does not apply to sliding fee scales, like we offer here, or any other program not directly addressed in the new rule. We encourage people to remain enrolled in programs that they are eligible for.”
MFHC does not monitor the immigration statuses of its patients, so Rigli was unable to provide a concrete number for how many people may be directly affected by the new policy. She has noticed a downward trend in the number of people utilizing public services such as Medicaid.
“We have been seeing our uninsured rate rise, and we believe this issue is a contributing factor to that,” she said. “Folks need to understand when someone would be evaluated for public charge, and though that may vary, this would usually be done when people are applying to enter the country and when they apply for Legal Permanent Residency.”
That is, the new rule does not penalize anyone currently using public benefits. Further, the new rule only applies to an individual using public programs for that individual’s benefit — it would not apply to a child, for instance, explained Elizabeth Lower-Basch, director of income and work supports of the Center for Law and Social Policy in Washington, D.C.
“It’s primarily family based immigration that will be affected by it. If your child is a citizen, and that child receives benefits, that doesn’t count against you. Children and pregnant women’s receipt of Medicaid don’t count,” she said. “But this totality of circumstances really will make it much harder … for immigrants in the hospitality and tourism industry to get green cards.”
It’s that last point that Schalla thinks is often overlooked, especially in tourism-based economies like those in the Roaring Fork Valley.
“In our communities, [this] was really a benefit to get people to come in, to be a part of the economic base from Basalt to Aspen tourism, as well as Eagle County, from Eagle on up to Vail,” he said.
According to data compiled by the Migration Policy Institute from the U.S. Census Bureau’s pooled 2013-2017 American Community Survey, Garfield County is home to 8,700 immigrants, 7,300 of which hail from Central America. An additional 2,100 immigrants live in Pitkin County, though the demographic breakdown was not available because of insufficient sample size (less than 2,000).
Statewide, there are 317,600 noncitizens, of which 146,400 — or 46.1 percent — receive benefits from either TANF, SSI, SNAP or the Children’s Health Insurance Program known as CHIP. For comparison, more than 1.3 million Coloradans born in the United States — or 27.3 percent — receive benefits from these programs.
“Overall, in the U.S., about a quarter of children have at least one immigrant parent, so this really is America,” Lower-Basch said.
And, she continued, the Oct. 15 deadline for the new rule is not a guaranteed one.
“I know of at least six different lawsuits that have been filed, and today the lawsuit run by the California Attorney General requested … to suspend the implementation while the case is going to the [U.S. District] Court,” she said Tuesday.