The California Primary Care Association (CPCA) has been a leader in advocating for the rights of our immigrant patients and employees. CPCA ramped up its involvement on this issue after member health centers reported an increase of fear in immigrant patients and employees after various executive orders were leaked in 2017, including one on public charge. This led us to create various resources, like sample policies and procedures that health centers can adopt to prepare for an immigration raid, FAQs to help health centers better understand their rights against immigration enforcement, Know Your Rights information, talking points for frontline staff to help answer questions from immigrant patients and an immigration resources page where members and the public can access all the resources we’ve created along with other materials created by our immigrant partners.

Given our increased involvement in resource building and collaborating on this issue with our immigrant partners, CPCA was asked to be a sector lead for health centers through the Protecting Immigrant Families (PIF) Coalition. This led us to connect with both the National Association of Community Health Centers (NACHC) and the Association of Asian Pacific Community Health Organizations (AAPCHO) to create the National Health Center Immigration Workgroup, which we now co-lead, to ensure we are aligning the health center voice on immigration issues and helping to encourage advocacy from other state Primary Care Associations (PCAs) and health centers. This put CPCA in the forefront of national immigration issues impacting health centers.

Through our work and collaboration with our immigrant partners, CPCA was asked to be the lead applicant for a state Protecting Immigrant Families (PIF) grant and are now planning two training events to ensure we are helping community-based organizations (CBOs) conduct education and outreach around public charge in the community. CPCA was also approached by the California Health Care Foundation (CHCF), who offered us an additional grant to help with health center advocacy around public charge, which will allow us to create more education materials and partner with the consortia to distribute them.

Public Charge

According to multiple reports, the Trump Administration is unfairly attempting to discourage utilization of public benefits by expanding the definition of what constitutes as a public charge. This would include public benefit programs like SNAP, WIC, Medi-Cal, and much more. Unfortunately, the health center sliding fee scale was not explicitly exempt, meaning that at this point in time we are unsure if the Trump Administration will consider its use as a negative factor in the public charge analysis.

In response, the CPCA and CaliforniaHealth+ Advocates (the advocacy arm of CPCA), have been working closely with our immigrant-focused partners to create resources that assist health centers in advocating against changes that would negatively impact our immigrant patients and communities. To help health centers better understand the harm that could come from the proposed changes to the public charge rule, CPCA has taken a leadership role in helping to provide resources to other state health centers and primary care associations in the hopes of increasing advocacy on the part of health centers on this issue.

Office of Management & Budget (OMB) Meeting Request

The OMB is responsible for reviewing all proposed rules to make sure the administration is abiding by all laws that govern the rule making process, which includes correctly expressing the fiscal impact of these rules. CPCA, along with the AAPCHO, NACHC, Asian Health Services and an Ohio health center met with OMB to discuss the fiscal impact that the proposed changes would have on health centers. 

CPCA predicts that California health centers could see 132,000 to 397,000 patients disenroll from Medicaid, causing a financial loss of $74 million to $221 million in Medicaid funds annually. This analysis solely considers the financial loss in Medicaid reimbursements and does not take into account the loss of other reimbursement from county health insurance programs. The fiscal impact for health centers is likely to be much greater than the Medicaid losses estimated in this document. Overall, the OMB was receptive to the data provided by CPCA and our partners.

National Health Center Immigration Workgroup (NHCIW)

CPCA, in coordination with the AAPCHO and NACHC, has created the National Health Center Immigration Workgroup to help inform other state PCAs and community health centers about immigrant issues, such as public charge. If you are interested in learning more, or joining the National Health Center Immigration Workgroup, please complete the registration form here.

PIF Grantee

Given the leadership role that we have taken in the immigration space, our California immigrant partners elected to have CPCA be the lead applicant for a PIF grant of $20,000 to help support the advocacy work being conducted in California around public charge. We will be holding two free trainings to help provide tools to CBOs and associations (including data and sample template letters) for advocacy efforts.

How can my health center get involved?
If we want our communities to thrive, all of the families in those communities must be able to get the care and services they need. At this time of rising national division, CPCA and its member health centers are proud to stand with our immigrant communities and reaffirm our commitment to valuing and protecting the health care rights of our immigrant patients. We welcome your health center to stand with us in opposing any changes to the public charge rule. For more information on advocacy initiatives, please visit our advocacy affiliate, CaliforniaHealth+ Advocates. (link highlighted portion to the Advocate immigration story)

Please contact Liz Oseguera at for more information.