A patient picks up a prescription at the QueensCare Health Center in East Los Angeles. (Leslie Berestein Rojas/LAist)

Last fall, the Trump administration unveiled a proposed federal rule that would disqualify immigrants from legal residency if they've used various public benefits.

Ever since a leaked draft of the so-called "public charge" rule first appeared in early 2018, there's been plenty of speculation that it would push immigrant families to drop out of public health, nutrition and other programs out of fear. And there's been plenty of anecdotal evidence that that has been happening.

Does the data bear this out? Perhaps.

Thousands of Los Angeles-area children who were enrolled in the CalFresh food stamp program in Jan. 2018 are no longer on the rolls. They had been signed up in the program's "child only" category, which tends to draw families with parents who lack legal status.

The same goes for adult Southern California Medi-Cal patients identified as "undocumented" in state data; there were roughly 20,000 fewer of them last December than there were at the start of 2018.

Experts say it's hard to draw hard conclusions from the data. There are other variables, like California's strong economy. But medical and other service providers who work with immigrant families say the proposed public charge rule has had a clear chilling effect.

'THERE WAS THAT FEAR'

The administration unveiled the proposed rule last October. It was around that time that the staff at the QueensCare Health Center in East Los Angeles noticed a rash of cancellations.

"Individuals didn't want to come in to the clinic, so they were canceling appointments," said Daisy Salinas, who does patient outreach for the clinic. "And there were lots of inquiries regarding public charge."

Those who were fearful included immigrants who were not using any of the public benefits affected by the proposal, Salinas said. Still, she said, some opted to stay away.

"They were asking over the phone," she said. "There was that fear of actually coming in to the health center, and actually getting those services."

The proposed rule would greatly expand the definition of who is considered a public charge, defined as an individual who is likely to become "primarily dependent on the government for subsistence," according to the U.S. Citizenship and Immigration Services website.

Right now, only the receipt of public cash assistance, or long-term institutionalization at government expense, qualifies an individual as a public charge. The proposed rule would expand these grounds of inadmissibility to include use of health care benefits like Medicaid - known in California as Medi-Cal - food stamps (CalFresh in California), public housing and other assistance.

In truth, unauthorized immigrants generally don't qualify for much in the way of public benefits: They can't accept cash assistance programs like Supplemental Security Income, commonly known as welfare, nor can they sign themselves up for CalFresh. Under current state law, those 19 and over can't use Medi-Cal unless it's for emergencies, pregnancy, or a handful of specific cancers. A new law will expand full-scope Medi-Cal to young immigrants up to age 25 starting next year.

However, families with mixed immigration status - say, with U.S. citizen children - can access food stamps and public housing assistance on a pro-rated basis if other members of their household who are here legally qualify. Pregnant women, new mothers and kids under age five qualify for the Women, Infants and Children (WIC) supplemental nutrition program regardless of immigration status. And children without legal status qualify for nutrition programs, like school lunches.

WHAT THE NUMBERS TELL US — AND WHAT THEY DON'T

Data from state programs like Medi-Cal, CalFresh and WIC show there has been a decline in enrollment since early 2018. But the reasons may vary.

Between January 2018 and December 2018, the most recent month for which data is available, overall Medi-Cal enrollment statewide declined steadily, from 13.3 million to 12.9 million enrollees.

During this time, there was a drop-off of more than 36,000 people on Medi-Cal identified by the state as "undocumented." A large share of these were in Southern California: Medi-Cal enrollment data from Los Angeles, Orange, Riverside and San Bernardino counties shows a drop-off of more than 20,000 adult "undocumented" patients between January 2018 and December 2018 in those four counties alone.

There was also a statewide decline in children and teens under age 19 without legal status, who became eligible for full-scope Medi-Cal in 2016. After their enrollment peaked in early 2017, it flattened out - then last fall, after the administration announced the proposed rule, it began to drop.

Another barometer, as mentioned above, is CalFresh —in particular households in which only children are eligible and enrolled in the program, typically because their parents don't have legal status.

Between January 2018 and January 2019, the most recent month for which data is posted, child-only enrollment in CalFresh declined statewide by more than 40,000 child-only households - and by more than 85,000 children.

The drop was especially pronounced in Southern California: In Los Angeles, Orange, Riverside and San Bernardino counties alone, approximately 45,000 children who were on CalFresh in January 18, were no longer on it a year later.

Then there's WIC, which has also seen a gradual slide in participation, from nearly 75 percent of the families in its funded caseload participating in January 2018 to only 65 percent participating this past June, according to state data provided by the California WIC Association. A similar decline in WIC usage has occurred in Southern California, according to the same data.

State officials say the economy plays a role in the use of public benefits. Anthony Cava, a spokesman for the California Department of Health Care Services, pointed to a declining state unemployment rate in recent years as one reason why fewer Californians may be signing up for Medi-Cal.

"Since the Great Recession ended, California's economy has continued to recover," Cava said in an emailed statement. "With this improved economy come changes in Medi-Cal enrollment, as individuals secure and-or transition to higher paying jobs."

But Sarah Diaz with the California WIC Association, the nonprofit member association for California local WIC agency directors and staff, said she believes some women are dropping WIC benefits out of fear.

"I personally know people who have withdrawn," Diaz said. "I'm the one who usually gets the emails from all the WIC directors when they have people come in and ask to be disenrolled. So I don't have the data points, but I do have the phone calls, and people telling me that they decided it was just safer for them not to participate."

Experts say it's difficult to draw conclusions from the data.

"It is very complex, there are a lot of things that affect benefits receipt," said Hamutal Bernstein, a researcher with the Urban Institute in Washington, D.C. who's been studying the possible effects of a public charge rule on benefits enrollment.

The economy is one, she said. Another is that it's not just public charge - other anti-immigrant rhetoric and policies from the White House may also be discouraging people from public programs.

"It's difficult to draw the direct line between just this ... proposed policy change and all of the other developments in the immigration policy space that might be leading to these chilling effects," Bernstein said.

That said, Bernstein believes fear over the public charge proposal is prompting some immigrants to drop out of programs.

The Urban Institute recently polled nearly 2,000 adults in immigrant families; one in seven reported that they or a family member had declined a public benefit in 2018 because they didn't want to risk losing a potential green card. In lower-income families earning less than 200 percent of the federal poverty level, it was one in five.

"The fact that we are seeing such a large share of families reporting chilling effects, even before a final rule is released ... suggests that even discussion around the rule, public conversation around the rule, is having an impact on people's choices about participating in programs," Bernstein said.

NEEDLESSLY DECLINING MY HEALTH LA

Back at the QueensCare clinic in East L.A., Daisy Salinas said the staff is trying to keep people enrolled in programs like emergency Medi-Cal, or at least in programs that don't fall under the public charge rule — such as My Health LA, a free health program launched in 2014 offered by Los Angeles County.

"We noticed that a lot of individuals were not renewing My Health LA, or declining services for emergency Medi-Cal," Salinas said.

The staff has gone so far as to set up educational appointments for these patients to explain the rules, but even that doesn't always work, she said.

"You know, even after explaining all of these issues, they still don't want to go through with the enrollment process," Salinas said.

Perhaps not surprisingly, countywide enrollment for My Health LA has also dropped: As of last April, the program had close to 6,000 fewer enrollees than it did in January 2018.

A final public charge rule is expected in the near future. The public comment period closed last December. Once a final rule is published, it would not take effect for at least 60 days.

Meanwhile, the Trump administration is also reportedly considering a companion rule that would expand grounds for deportability, also for use of public benefits.

Editor's note: A version of this story was also on the radio. Listen to it on KPCC .

— NORMAL —