What Public Payers Can Do To Stop Public Charge Misinformation

March 15, 2022 - With misinformation about the public charge rule still circulating and affecting immigrants’ access to coverage, Medicaid programs, Affordable Care Act marketplace plans, and CHIP programs can take steps to disseminate accurate information about the public charge rule, an issue brief from Manatt Health emphasized.

“Despite the administration’s proactive steps to fund outreach, promote affordable health coverage, and simplify enrollment processes for federally funded health coverage, a key barrier remains: many immigrants and their families are concerned that enrolling in Medicaid/CHIP, Marketplace, and other public health insurance programs will run afoul of public charge rules and jeopardize their immigration status,” the researchers explained.

“State Medicaid/CHIP agencies, Marketplaces, and community-based organizations (CBOs) working to help enroll individuals in health insurance have important roles in helping immigrants access coverage for which they are eligible, including by informing them that enrolling in health coverage will not hurt their chances of obtaining a green card or becoming a citizen.”

There are steps that Medicaid programs can take to combat misconceptions about the public charge rule.

Some strategies revolve around pursuing cultural competency in outreach materials and approaches. 

For example, public payer programs should ensure that their application materials clearly state in multiple languages that public charge does not impact access to coverage through Medicaid, the Children’s Health Insurance Program (CHIP), or the Affordable Care Act marketplace.

Also, materials stating the limitations of the public charge rules are being distributed to sites that might be culturally important to immigrants, such as religious or community centers.

Public payer programs may need to include their partners in efforts to disseminate accurate information about the public charge rule. For instance, leaders might consider offering training for their partners, specifically training about addressing public charge misconceptions. Partnering with community-based organizations to share accurate information could also be effective.

Programs should also leverage existing platforms and strategies to circulate the truth about the public charge rule and its lack of influence on Medicaid, CHIP, and marketplace coverage for immigrants. Social media and established campaigns can be helpful for outreach.

Language is a critical factor in successful outreach, the brief underscored. The materials should be explicit, not complicated. They should be in multiple languages, define “public charge,” and present a consistent explanation across state agencies.

The materials should also be updated regularly and provide links to federal resources. The brief offered specific phrases that Medicaid programs and other public payer programs can use to communicate clearly with beneficiaries or potential beneficiaries.

The researchers pointed to several states that have effectively conducted outreach and education efforts around the public charge rule. 

Some states leveraged websites or social media to explain the changes to the public charge rule. Others included the details about the changes on their frequently asked questions pages. California worked with organizations that serve immigrants to share a public charge guide. 

Illinois took a more targeted approach, centering its efforts on immigrant seniors by building a website with the relevant information. Meanwhile, New Mexico’s Affordable Care Act marketplace used a regularly-scheduled, in-person event to emphasize correct public charge information to its stakeholder partners.

“Because mixed-status families (families that include both citizen and non-citizen household members) may have particularly acute fears about signing up for benefits, states can also take steps to design non-applicant options such as allowing an applicant, such as a parent, to apply on behalf of a citizen dependent,” the brief added. 

“Refraining from asking nonapplicants to disclose their immigration status or to provide their Social Security number as part of an application is another way to allay concerns about accessing benefits.”

Some strategies may overlap with payers’ approaches to combatting misinformation around the coronavirus vaccines.

Studies have shown that the public charge rule still impacts healthcare coverage among immigrants even after the rule ended.

CMS and the Department of Health and Human Services (HHS) have urged states to take an active role in correcting misinformation about the public charge rule.