Health care administrators and immigrant advocates say they are trying to stem widespread fear and confusion over efforts by the Trump administration to discourage immigrants from using public assistance such as Medicaid or food stamps.

Leaders at Hennepin Healthcare system have objected to the proposal, which was temporarily blocked in federal court last month, along with a companion measure that would make it easier to deport immigrants for improperly using public benefits. Minnesota’s largest safety net hospital, where nearly half the clients are insured by Medicaid, recently submitted testimony to the U.S. Office of Management and Budget saying the plans would threaten the health of patients and the institution’s financial stability.

“While we are relieved that the courts have stopped the implementation … in many ways, the damage has been done,” wrote Susie Emmert, senior director of advocacy and public policy at Hennepin Healthcare.

She added: “It’s quite clear that the [Department of Justice] has not considered a number of factors, including that using deportation to threaten legal immigrants will decrease enrollment in public programs,” and increase costs of uncompensated care.

Last year, the Trump administration issued the proposal that would make certain people ineligible for permanent resident status if they were likely to become dependent on the government for assistance as a “public charge.” The complex proposal broadened existing “public charge” rules to include health care, nutrition and other types of assistance. The White House defended the move by saying that sufficiency has long been a basic principle of American immigration law.

“The benefit to taxpayers is a long-term benefit of seeking to ensure that our immigration system is bringing people to join us as American citizens, as legal permanent residents first, who can stand on their own two feet,” said Ken Cuccinelli, acting director of U.S. Citizenship and Immigration Services, in an August briefing.

The rule is mainly centered on those seeking permanent resident status through family member petitions, and many types of immigrants would be exempt.

The Minnesota Department of Human Services (DHS) has partnered with Legal Aid to make sure immigrants have accurate information about the rule, and posted information online, including in Somali and Spanish, about the potential effects. The agency said that it met with Minnesota congressional staff, the Minnesota Association of County Social Service Administrators, and the Cultural and Ethnic Communities Leadership Council. But so far, it lacks data on people dropping public health care benefits — such information has been anecdotal.

Hennepin Healthcare says it has spent “tremendous resources” to educate patients and staff — and that even then, many still fear that participating in a program will compromise their immigration status.

Dr. Maria Veronica Svetaz recalled an immigrant mother crying in the lobby of Hennepin Healthcare’s Whittier clinic about feeling that she could not apply for public health insurance for herself and her children struggling from depression. She had received inaccurate legal advice.

Staff follow-up with families

As a number of patients at the clinic have been dropping Medicaid or stopped coming, staff members are calling families to follow up. She said they work closely with Legal Aid and that it’s hard to convince people at a time when the fear is “sort of unstoppable.”

Svetaz is worried about the health effects — inflammation, depression, anxiety — of so much fear and also the prospect that people delaying care could end up costing the system more in the long run if they wind up in the emergency room.

“It’s hurting the community, but it’s also hurting the hospital, which has a higher proportion of Medicaid [patients],” said Svetaz, who is medical director of a program for Latino youth at the Whittier clinic called Aqui Para Ti.

The Immigrant Law Center of Minnesota wrote in a legal brief last month that in August alone, its staff had spent “considerable amounts of time away from normal duties” to learn the complexities of the new rule — organizing educational materials, planning training sessions, and working with Legal Aid and community partners. The organization joined the city of Baltimore and other plaintiffs in federal court there to challenge the constitutionality of the changes to the “public charge” rule, as part of a series of legal challenges across the country.

Mid-Minnesota Legal Aid has held outreach events at schools, churches and health care navigation centers over the last year, with more planned for November. It has publicized a toll-free number to answer questions. Lawyers have been trying to educate callers not to worry about the injunctions since the rules did not apply to many of them to begin with. The public charge test does not apply to refugees and people seeking asylum, for instance, and the proposed changes would not consider benefits used before the rule took effect.

“We don’t want to leave people with the impression that the only reason they don’t have to worry is because it’s been [blocked] in court,” said Anne Quincy, supervising attorney of the public benefits unit at Mid-Minnesota Legal Aid.

Hannah Lichtsinn, a Health Partners doctor who co-founded the Minnesota Immigrant Health Alliance, said fear over the policy takes away services from children who have done nothing wrong, as some worried immigrant parents remove their kids from Medicaid.

“It’s very hard to respond to fear rather than to a direct policy, because we’re seeing so much harm from the fear of the policy rather than from the impact of the policy itself,” Lichtsinn said.