P3B108: Rescinded Public Charge Ruling: Provider and Patient Perception Towards Addressing Immigration in the Pediatric Health Care Setting

Background: Approximately one in four children in the United States (US) live in immigrant families and are disproportionately impacted by poverty, difficulty accessing resources and health care. Immigration policy, such as public charge inadmissibility, can prevent individuals from obtaining lawful, permanent residency in the US based on an assessment of their reliance on government assistance. The 2019 public charge ruling included important benefits such as Medicaid, nutrition, and housing supports when determining public charge. Despite the ruling being rescinded in 2021, it's "chilling effect" continues to deter families from using eligible benefits. Following the rescinded ruling, the Secretary of Homeland Security called on stakeholders to address the backlash. The feasibility or perception of addressing public charge in pediatric healthcare is unknown despite referrals to public supports commonly made to pediatric patients.

Methods: A convenience sample of providers interacting with pediatric populations at an academic medical center were surveyed to gauge confidence in and experience with addressing patient concerns about public charge. Survey results were collected and tabulated in REDCap. Three focus groups were conducted with Latino parents engaged in services at a community organization. Focus groups were conducted in Spanish and translated and transcribed into English.

Results: Providers (n=56) from ten clinical areas providing care to pediatric patients and their families responded to the survey in late 2021. Majority survey respondents believe accessing public benefits is important; however, very few have discussed public charge concerns with patients and are not confident in their ability to address them (Table 1).

Conclusion: Pediatric providers are key touchpoints for families impacted by immigration policy and public and non-public benefit access. The resources necessary to address immigration-specific concerns in the healthcare setting should be considered along with other social determinants of health.