The Power of Fear & Trust

– The Department of Health and Human Services (HHS) and partner agencies should routinely publish and amplify informational bulletins, press releases and other official documents that clearly articulate the current public charge policy. Existing guidance, such as the 2021 Center for Medicare and Medicaid Services (CMS) Informational Bulletin, should be routinely updated and distributed via multiple communications channels.

– Government officials, including HHS Secretary Xavier Becerra — the first Latino to hold the office — are being called upon to reinforce that the community is “already eligible for certain benefits and they can feel confident in enrolling themselves and their families in these programs” via statements, video, and more. To further instill trust amongst immigrant communities and attorneys, messages should be reinforced by the Department of Homeland Security (DHS) and messengers like Alejandro Mayorkas, the first Latino and immigrant to lead the agency.

– Government communications should be accessible, ideally in English and Spanish, and distributed widely via social media (paid and owned) and Spanish-language media, and reinforced by state and local health authorities. Community groups and navigators/assisters can then use these media products to build confidence with eligible individuals. Importantly, individuals in the community want to know that information comes from an official government source. Navigators and enrollment assistants are more effective in their role when they can provide information (e.g., printed copies of applications, government documents, and materials, on official letterhead from high ranking elected officials, Administrative leaders and government entities. To be clear–community-based organization and cultural centers continue to be best suited to provide in-person information and support, using the official government products on the public charge policy. Community outreach specialists should continue to be resourced with a wide range of different types of “official” materials and tools that are in-language.

– Explore opportunities to connect needed changes to health equity as they relate to CMS Administrator Chiquita Brooks-LaSure’s key priorities. Consider leveraging her as a spokesperson on basic issues related to the U.S. health care system (e.g., YouTube explainer video or Facebook Live on Medicaid) and if possible, reinforce privacy and security with a specific focus on applicants from mixed-status households.

– Specifically, CMS should develop model language and clear guidance for Medicaid and Marketplace administrators to remove questions on the application that may hinder an applicant from applying either for themselves or a dependent, including requests for a social security number. Applications should also include a clear explanation that the information used by a parent or guardian applying on behalf of a citizen child or family member can not be used for other purposes, including how and when application data can be shared with DHS.

– With additional funding and resources, trusted messengers who come from impacted communities are also most likely to have success capturing stories, including those from within a trusted local referral network (e.g., legal advocates, school administrators, etc.) that can serve as a critical support in motivating other eligible individuals to enroll. Providing accessible tools across community groups — including social media toolkits, translation support, as well as a national platform for storybanking — can free up assisters to focus on what matters most: one-on-one dialogue and relationships.

– Resource groups and coalitions that link advocates and community-based, immigrant-serving organizations, such as Protecting Immigrant Families (PIF) and the Florida Health Justice Project, to connect the dots between immigrant rights and health equity. These multi-sector partners can help influence policy, provide (and encourage) best practices to state agencies, and help get resources and information to the local level.

– Invest in long-term, ongoing partnerships to facilitate applications, enrollment, and access across a variety of public assistance programs (e.g., SNAP, CHIP, Medicaid). These partners are best suited to counter misinformation, including explaining the nuance of confusing government guidance or information. Given cultural and language barriers, a case manager who can serve as an advocate and middle-person across and between different agencies, applications, and the individual, could not only result in higher enrollment but also enhance an individual’s likelihood to seek out care. Similarly, resource trusted community-based organizations to meet people where they are and provide greater support through culturally relevant programming and services, including tax prep, ESL classes, and more. These services can serve as an on-ramp for enrollment for individuals that might not otherwise seek information and services related to health care or insurance, especially when many come from countries that do not have government funded health care.

– In addition to being one of the most impacted by the pandemic, Latinx immigrant communities are the least likely to proactively seek out enrollment services. Therefore, we must continue to encourage community outreach (often in multiple languages) to meet people where they are on weekends and after hours (e.g., schools, soccer tournaments, grocery stores, churches, etc.). In some instances, like with COVID education and outreach, partnerships with employers (farmworkers/factory workers) might be advised, as well as door-to-door activations similar to census work, or on-site partnerships with local health entities, though promotion should come from community/cultural hubs.

– Encourage the development of community-based “trusted referral networks” that can enable support of the whole person as they navigate intersecting issues, from health to housing, to legal advice, and counseling. A list of trusted contacts should be readily available to enrollment assisters to deepen community connections and limit a person’s likelihood of engaging with “bad actors.”

– Establish promising practices to engage immigration lawyers and legal advocates that sit at the intersection of immigrants’ rights and pro-bono services in educating their peers on the appropriate application of public change and the use of public benefits. Many immigration lawyers focus solely on status and apply an overly-cautious interpretation of usage of public benefits, resulting in additional chill and forgoing of health care services.

– Conduct research to identify and test language that will best resonate with immigration attorneys, including messages that emphasize the economic benefits of health insurance, which in the long-run could help with citizenship/ avoid being a so-called “public charge.”

– Develop materials and analysis through national legal organizations, such as the National Bar Association, that decode federal and state benefits’ policies for immigration attorneys. Explain the basics of what public assistance programs are, how they work, and determinants of eligibility for relevant communities. Distribute these materials to immigration attorneys through all available means, including through professional societies, medical-legal partnerships, and paid, targeted digital ad campaigns to educate and persuade these audiences to use the findings from focus groups and any statements made by HHS/DHS officials on public charge.

– Align with the DREAMERS movement to identify and leverage supportive attorney advocates for referrals, pro-bono community-led meetings, FB-Live Q&As, and earned media opportunities both at the national and state-based level.

– Build training and related materials that incentivize attorneys to deepen their understanding around the legal and policy landscape on public benefits through grants, continuing education credits, as well as meetings and conferences.