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"That's My Fear:" How Changes to the Public Charge Rule Affect Immigrants in Tennessee

Chodorow Law Offices

First the Trump Administration separated immigrant families when they crossed the U.S. border illegally. Now, another policy change is likely to make it harder for immigrants to join family here through legal routes, as well.


Immigration officials began using a new interpretation of the existing “public charge” rule February 24. It will expand the criteria for predicting whether an immigrant might become dependent on the government. The rule mostly affects people applying for a green card, which shows they’re legal permanent residents.


“The outcome that this is going to have is to keep families separated,” saidAlessandra Ceccarelli, program leader for the office of immigrant services at Catholic Charities of East Tennessee.


And health providers warn that the law could have broader effects because so many people misunderstand it.


The “public charge” rule isn’t new. For more than a century, permanent residency could be denied to people who needed long-term institutional care or who lacked a sponsor here to support them. But now age, health, English skills, education, and financial status -- even whether they can afford health insurance -- can be taken into account in predicting whether someone might become a public charge in the future.


Applicants and their sponsors will have to provide loads of documents to answer these questions, including credit reports, debt paperwork, translated copies of foreign transcripts, test results to prove language proficiency, and more.


The process will be more expensive, time-consuming and difficult to understand, said Ceccarelli (who is herself a naturalized citizen from Italy). It amounts to a significant new barrier for many, especially those who aren’t proficient in English. Ceccarelli said the end result will be that people who are more vulnerable, older or less educated will find it incredibly difficult, if not impossible, to be approved as residents.


The rule will be most broadly applied when American citizens want a spouse or parent to join them here legally. Ceccarelli’s office provides legal help to people from 36 East Tennessee counties. She said 20 to 30 percent of clients are U.S. citizens attempting to obtain legal residency for a family member. Last year, the office began seeing some green card applications rejected by the U.S. consulate in Juarez, Mexico, based on new public charge guidelines.


Not everyone applies for green cards from abroad. People can also seek residency if they are already in the U.S. on a short-term visa for travel, work or study.


Some apply after a visa has expired. An example, Ceccarelli said, would be a person who came to the U.S. on a student visa, then married a college sweetheart and never left. Despite marrying a citizen, this person would still need a green card to be considered a legal permanent resident.


Under the new public charge approach, if someone like this has used food stamps, housing vouchers, Medicaid or other public benefits, that could be held against them when they apply for a green card. In Tennessee -- unlike in some other states -- almost none of those things are available to undocumented immigrants anyway. Ceccarelli said pregnancy-related health care benefits are the only public supports they can use.


A culture of fear


Unfortunately, misunderstanding about this is scaring people away from legitimately using support services they need.


For example, the public charge rule doesn’t apply to children, refugees, people seeking asylum, or legal residents pursuing citizenship. And of course, it doesn’t apply to U.S. citizens.


But many believe otherwise.


“You wouldn’t believe the amount of individuals who are naturalized citizens who are concerned about applying for benefits right now because they’ve heard about public charge and they think that they might get deported,” Ceccarelli said.


In addition, undocumented immigrants are afraid to get TennCare for their kids who were born here. Those children have full access to all programs available to U.S. citizens.


“The result is that a  lot of those children end up not having coverage, because parents are afraid to complete the forms, even though the children have every right to apply for Tenncare,” Ceccarelli said. “We’re talking about babies 2 years old.”


Ceccarelli said the number of Tenncare applications decreased significantly when the change to the public charge was first proposed last August.Lawsuits held up implementation until the Supreme Court lifted an injunction in January. (Legal challenges continue to make their way through the court system.)


East Tennessee medical providers worry that fears about the public charge will cause immigrants to avoid the doctors’ office.


“Thankfully I haven’t seen that yet, but that’s my fear: That people aren’t going to come, because they’re afraid that coming in for care is going to decrease the likelihood that they’re going to apply for citizenship successfully,” saidEboni Winford, a psychologist with Cherokee Health Systems. She participated in a work group with a primary care association that fought the rule change.


Cherokee Health is a non-profit where most East Tennessee immigrants and almost all refugees and asylees receive their mental and physical care. It has in-house translators who speak Spanish, Arabic, Swahili, Kinyarwanda and Kirundi.


Community costs


Immigrants’ hesitancy to visit a doctor could be more expensive for the whole community, since it costs much more to treat an advanced disease in the emergency room. As an example, Winford said an immigrant recently sought treatment for a huge, visible tumor that will probably require surgery -- if it can be treated at all.


“When we think about what the public charge is really designed to do, it’s screwed up, because now people are going to avoid care and come in worse than before,” Winford said. “And it’s going to cost more to take care of something we could have prevented, had we not treated them like they weren’t humans.”


Drocella Mugorewera, director of Bridge Refugee Services, notes that many Americans overestimate how much immigrants and refugees use publicly-funded programs and health benefits.


“Some people think people who come here from other countries get benefits forever,” Mugorewera said. “It’s not true.”


The extent of benefits available varies. Refugees and people seeking asylum -- who are fleeing persecution in their home countries -- receive a few years of public support. Most other immigrants don’t.


Cherokee tries to serve even immigrants who are undocumented or who can’t pay. Helena Lobo runs its outreach program for Hispanic farm workers in Grainger County, visiting pickers in the fields.


“At the beginning was very hard because in a certain way, we look like immigration! And they used to hide from us!” Lobo said.


But the Spanish-speaking Cherokee team has won their trust. Lobo said she’s hopeful because she’s seen the number of Hispanic patients increasing over the last 13 years.


Mental health needs


Mental health treatment is often vital for this population. Large workplace immigration raids like the one in 2018 in Bean Station have left holes in families, lasting psychological scars on individuals, and an atmosphere of constant vigilance for the Latino community.


Cherokee psychologists continue to treat Hispanic children who were terrified to go to school, where kids taunted them that their parents would be deported by the time they got home. 

Winford said many immigrants and refugees suffer post-traumatic stress from experiences in their home country, and often from the trip itself. Winford treated one man who had been held in detention for six months while he and his mother waited for a response to their asylum application.


“And he said, ‘Sometimes I have bad dreams and nightmares about when they would only let me see my mom once every two weeks for about five minutes through the fence, but you know, I try not to dwell on that.’”


Symptoms of trauma may take the form of anger or anxiety, said Leticia Y. Flores, director of the psychological clinic at the University of Tennessee. The effects spread. For example, if a parent is reluctant to leave the house because of flashbacks and anxiety, it erodes the family’s finances and emotional stability.


When people avoid treatment out of fear, she said, “These kinds of behaviors that are born from mental health issues and pain may end up becoming criminal activities: Somebody loses it in a parking lot, somebody attacks someone for seemingly no reason.” Then the sick end up in the criminal justice system, which has a poor track record for providing mental health, she said.


Flores, a Latina American born in Texas, said the change in the public charge rule is part of a larger policy framework that stigmatizes people with darker skin.


“The implicit assumption is we need to put this public charge law out there because there are lots of people taking advantage,” she said. “It’s an extension of the old-school stereotype about people of color who just want to be on welfare so they can have children and get rich off of welfare. It’s the same trope that’s being used for immigrants.”