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Napa County wants to clear up confusion prompting some foreign-born residents to forgo health care, nutrition and other public assistance for fear of hurting their chances of receiving permanent resident status.

The county Board of Supervisors on Tuesday informally endorsed a bilingual, frequently-asked-questions sheet on proposed federal “public charge” rule changes. That might only be a start.

“I truly believe this is going to require a joint community campaign,” Supervisor Ryan Gregory said.

The Trump Administration wants expanded criteria to determine if immigrants applying for green cards and visas are likely to depend primarily on public assistance, rather than be self-sufficient. If the answer is “yes,” they may be turned down. The proposed test would not affect lawful, permanent residents seeking citizenship.

Some immigrants aren’t enrolling for aid even when they wouldn’t be affected by the proposed public charge rule changes, local nonprofit leaders told supervisors. That includes failing to enroll children.

“Our immigrant population is strong, however (it’s) one that is vulnerable and susceptible to damaging changes, even if they’re only proposed changes,” said Elba Gonzalez-Mares, executive director of Community Health Initiative.

Nonprofit leaders told supervisors the story of a pregnant mother who would be affected if she enrolled for Medi-Cal under the proposed rule changes, but not if she enrolled in Medi-Cal pregnancy coverage. Still, she chooses not to have pregnancy coverage.

At stake is whether her family will have an expensive hospital bill for the birth. The nonprofits are keeping track of her, since she goes to OLE Health for prenatal care.

She’ll be asked again, because it’s flagged when a person is without coverage, Gonzalez-Mares said.

More than 900 Napa County residents have disenrolled from Med-iCal benefits administered by Partnership Health Plan, nonprofit leaders said. Most of those affected are children. Supervisor Diane Dillon wants to change that.

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“This is going to have a ripple effect,” Dillon said. “Those 900 people may not get immunizations. Just that alone…”

The frequently-asked-question sheet is designed to give immigrants information they can trust as they make public assistance decisions. For example, it says that people receiving assistance for their U.S. citizen children but not for themselves are not considered public charges.

Supervisor Alfredo Pedroza said the nonprofit groups need to lead the way in reaching immigrants who might not know who to believe about the proposed public charge rule changes.

“You’ve earned something by your hard work, connecting with people, looking in their eyes,” Pedroza said. “You’ve earned their trust.”

But nonprofit leaders made it clear that having the Napa County stamp on the frequently-asked-questions sheet makes a difference. They also say more needs to be done.

“This is going to be a multi-year potential fallout we’re going to see,” Alicia Hardy of OLE Health said. “We have to intervene early so we can prevent decline of health and these patients who could come in because they’re eligible for services.”

Michele Grupe of Cope Family Center said the proposed public charge changes will have fiscal and emotional impacts. County Health and Human Services, health care systems and nonprofits must plan how to meet safety net needs.

Presently, only cash assistance and long-term institutional care are used for the public charge test. Under the proposed changes, immigrant parents of citizen children and immigrant individuals who use Medi-Cal health insurance, Medicare Part D low-income subsidies, housing assistance and CalFresh nutrition assistance could have lower chances of receiving a green card, a U.C. Los Angeles study said.

“Misinformation, confusion and fear generated by the proposed changes could drive people to disenroll from public assistance programs, even if they’re not legally subject to the new test,” the study said.

OLE Health officials said they saw a 20 percent rise in Medi-Cal enrollment with the Affordable Care Act. That allowed OLE Health to use the now-reimbursable income for local programs. Every 1 percent shift in the other direction to uninsured means losing about $200,000 for local programs.

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Napa County Reporter

Barry Eberling covers Napa County government, transportation, the environment and general assignments. He has worked for the Napa Valley Register since fall 2014 and previously worked 27 years for the Daily Republic of Fairfield.