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Public Charge Adds to Coronavirus Confusion Among Undocumented Immigrants

Misinformation spread through informal chats is leading to fears undocumented immigrants may not get tested for the virus.

On Tuesday evening, Mon Yuck Yu, a 29-year-old nonprofit executive in New York, received a frantic text message on WeChat from one of her students in English class. The student wondered where his Chinese relatives could get a free COVID-19 test, and without disclosing their immigration status.  

Yu advised the student’s relatives to seek out medical attention or call 311 if they were feeling sick, explaining that the city has ensured anyone without insurance they can get tested for free. Although the student didn’t think his relatives were infected with the virus, he wanted to take precautionary measures since unlike him, they don’t have green cards.

“They are asking because of documentation status,” said Yu regarding the identity question. She is the executive vice president and chief of staff at the Academy of Medical and Public Health Services, which helps direct low-income individuals to health care services.

As New York declared a state of emergency for the coronavirus outbreak, fear, confusion and misinformation has kept many immigrants from seeking health care in light of the new public charge rule which went into effect on Feb. 24. The rule allows immigration officers to determine whether someone is a public charge based on their usage of government benefits such as federal Medicaid.

In the light of the outbreak however, U.S. Citizenship and Immigration Services announced this past Friday that tests and treatment related to COVID-19 will not negatively impact any immigrants in future Public Charge analysis. It said this was to address the possibility that some immigrants “may be hesitant to seek necessary medical treatment or preventive services.”

Amid the mounting uncertainty – of Coronavirus on top of public charge – healthcare providers, the mayor’s office and immigration organizations are working to set the record straight.

Last week, a male undocumented patient, 18, visited Dr. Rubayat Qadeer at Terra Firma, an immigrant health clinic associated with the Montefiore Health System in the South Bronx. The patient said everyone in his family was concerned about treatment for coronavirus as he’s had discussions with Qadeer in the past about U.S. Immigration and Customs Enforcement making arrests at clinics. The patient and his family have been receiving mixed messaging surrounding the outbreak from social media, TV and their friends and family.

Qadeer added that he expects to have more conversations with immigrant patients about health care during the coronavirus outbreak as the crisis unfolds.  

“We’re right in the middle of the community,” Qadeer said. “We’re right next to the bodega, or right next to the pharmacy. We’re right next to where people are living and so we’re really on the front lines.”

State Medicare and Medicaid said undocumented immigrants in New York cannot be considered under the new public charge rule. But in 2018, the city reported that an estimated 304,000 low and middle-income citizens and green card holders in New York would be discouraged from participating in public benefits because of the rule.

While people are searching for answers for themselves or family who may be undocumented, troubling rumors spreading through these chats are at risk of deterring people from seeking out care. One rumor circulating on non-traditional social media outlets like WeChat, Weibo and WhatsApp said a coronavirus test would cost $3,000 and the city would not be paying for it.

“Why this feels so different is because in the social media era there’s so much information out there and people are seeing this change on a day-to-day basis,” Qadeer said. “It makes it really difficult to come up with really cohesive guidance.”

Most of the immigrant families who visit Terra Firma are seeking asylum and are, therefore, exempt from being considered a public charge. A significant number of patients at Terra Firma who have mixed status are left wondering what the public charge rule will mean for them in the middle of the coronavirus epidemic, Qadeer added. For example, patients have also come to Qadeer with false concerns about billing for a coronavirus test.

U.S. Rep. Pramila Jayapal confirmed in a tweet that Ken Cuccinelli, acting deputy secretary of Homeland Security, said in a briefing that the public charge rule will not apply during the coronavirus outbreak.

Immigrant health clinics and organizations are combating the spread of misinformation through workshops and social media campaigns as coronavirus spreads. Gov. Andrew Cuomo confirmed 613 statewide cases Saturday.

According to Yu, the Academy of Medical and Public Health Services prioritized stopping the spread of rumors in non-traditional social media outlets because most immigrants rely on these channels for information.

Qadeer is also advising people who might be sick to call before visiting the clinic, in compliance with Montefiore’s current protocol has changed significantly.

The Mayor’s Office of Immigrant Affairs had previously set up programs, such as NYC Care, to offer healthcare to those who are uninsured regardless of immigration status or ability to pay but have been ramping up efforts in light of both the new public charge law and the outbreak.

“This is a perfect example of why the ability for all New Yorkers to access healthcare, all the time, is a way to ensure that everybody is more protected,” said Bitta Mostofi, commissioner of Mayor Bill de Blasio’s Office of Immigrant Affairs.

To mitigate the fears of those who are uninsured, Mostofi says the Office of Immigrant Affairs has developed guidance plans with the Department of Health that they’ve shared with over 1,000 community organizations and partners throughout the city. They plan to disseminate this information in 20 languages by the end of the week.

The city of New York urged anyone who may be affected by coronavirus to seek care regardless of immigration status in a tweet from March 11. The Department of Health also regularly posts guidance and updates on their website in different languages.

The need to go digital has increased as the city is discouraging large, in-person gatherings. Both the Academy of Medical and Public Services and Terra Firma had to cancel informational workshops this week.

“We’re also hoping to bring workshops like this online or through telephonic systems,” said Yu. “but we have to work with the possibility that there would be a population of individuals that don’t have that [digital] literacy.”

Undoing the damage of public charge’s chilling effect is top priority for the city’s immigrant advocacy organizations and healthcare providers, according to Seongeun Chun, the senior manager of health policy at New York Immigration Coalition.

“With public charge, with ICE’s questionable activity in a Brooklyn hospital, and then the threats of closing borders, we see Trump and his enablers doing exactly the wrong thing,” Chun said

During an open comment period for the public charge rule in August, where members of the public could provide feedback on the rule, one commenter highlighted that the standards could reverse great public health strides relating to communicable diseases.

Several other commenters pointed out that the public charge rule would make immigrant families “afraid to seek health-care, including vaccinations against communicable diseases, and therefore, endanger the U.S. population.” They added that mass disenrollment from Medicaid would restrict access and create harmful effects for the immigrant and general population.

The Mayor’s Office of Immigrant Affairs is advising people to call their Action NYC hotline before disenrolling from state health benefits and foregoing medical attention. Mostofi noted a spike in calls since the public charge rule was passed.

“Factors like immigration status or a lack of English proficiency are not barriers to us giving that care,” said Mostofi. “Our doors remain open.”

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