Health Outcomes of the ‘Public Charge’ Rule for U.S. Latinx Children and Adults: A Systematic Review Open Access

Abstract

Background: The ‘Public Charge’ rule assesses the likelihood of an immigrant becoming dependent on government assistance. This is assessed with an evaluation of cash-benefit programs use or likelihood of use. Being deemed a ‘public charge’ can render an immigrant’s application for legal status inadmissible. 

Methods: This systematic review aims to summarize the health outcomes of the public charge rule for U.S.-residing Latinx children and adults. Following PRISMA guidelines, literature was retrieved from PubMed, SCOPUS, and Web of Science. Articles that examined the public charge rule (exposure) and its association with health-related topics (outcome) among U.S. Latinx children and adults (population) were included. An initial 133 articles were retrieved across the three search engines. Covidence software was used for the screening process of literature. A total of 15 articles satisfied the final inclusion and exclusion criteria. Data were extracted using a table derived from the PICOS framework. 

Results: A total of 11 studies examined the use of public assistance or healthcare programs (n=11, 73%). All of these studies documented the underutilization of services. This observation was made across three program scopes: 1) nutrition assistance, 2) perinatal care, and 3) health care. An overarching theme across studies that explained this behavior was fear of deportation/ legal consequences that stemmed from the public charge rule. Studies also found that misinformation, misperceptions, false rumors, and knowledge gaps surrounding the public charge rule influenced the health behaviors of Latinx individuals. Two studies (n=2, 13%) had results related to adverse birth outcomes including low birth weight and pre-term births. The rest of the literature focused on program utilization and access (n=13, 87%). The underutilization of social safety net programs persisted even among Latinx populations who qualified or were entitled to assistance. 

Discussion: Evidence from this review suggests that the public charge rule has an unintentional impact on the utilization of non-cash benefit programs. Programs like WIC, SNAP, and Medicaid aim to close racial and socio-economic health disparities. However, fear stemming from the public charge rule is discouraging the use of these programs by Latinx individuals, which could be amplifying health inequalities. 

Table of Contents

1. INTRODUCTION ....................................................................................................... 1 

2. METHODS ............................................................................................................... 4 

Introduction....................................................................................................................... 4 

Eligibility Criteria ............................................................................................................... 5 

Information Services .......................................................................................................... 6 

Search Strategy ................................................................................................................. 7 

Selection Process .............................................................................................................. 7 

Data Collection Process ..................................................................................................... 8 

Study Risk of Bias Assessment ........................................................................................... 8 

Quality Assessment ........................................................................................................... 8 

3. RESULTS .................................................................................................................. 9 

Program Utilization and Access ........................................................................................ 10 

Nutrition Assistance ............................................................................................................................. 10 

Healthcare ........................................................................................................................................... 12 

Perceptions About the Public Charge Rule ............................................................................................ 13 

Medicaid .............................................................................................................................................. 15 

Maternal Health ............................................................................................................... 16 

Perinatal Care ...................................................................................................................................... 16 

Adverse Birth Outcomes ....................................................................................................................... 17 

Barriers and Facilitators ................................................................................................... 18 

4. DISCUSSION ......................................................................................................... 19 

Underutilization of social welfare programs and health services ....................................... 20 

Inadequate information on the public charge rule ............................................................. 22 

Recommendations .......................................................................................................... 24 

Limitations ...................................................................................................................... 25 

Conclusion ...................................................................................................................... 26 

5. TABLES AND FIGURES ........................................................................................... 28 

Figure 1: PRISMA Flow Diagram ........................................................................................ 29 

Table 1. Overview of Included Studies............................................................................... 30

Table 2. Recommendations for Future Research on the Public Charge Rule ....................... 37 

6. REFERENCES ........................................................................................................ 39 

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	public charge immigrants health immigration policy Latinx health Latino health children's health Systematic review health policy public charge rule
Committee Chair / Thesis Advisor	Liliana Aguayo-Markes, Emory University

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