The New Season of In the Solution Podcast

The New Season of In the Solution Podcast

We return this spring with a podcast reboot and begin with our Healthcare Justice Series with episodes that:

  • Focus on the social determinants of health 
  • And highlight the needs of communities and populations experiencing barriers to health care    

We begin the series with an exploration of The Housing First Model.



 The Housing First Model 

Housing First for the chronically homeless is premised on the notion that housing is a basic human right, and should not be denied to anyone, even if they are  abusing alcoholor other substances. 


The approach offers permanent, affordable housing as quickly as possible for individuals and families experiencing homelessness, and then provides the supportive services and connections (such as health care) at the community-level that are needed to sustain housing and avoid repeating cycles of homelessness.   


Housing First is currently endorsed by the U.S. Interagency Council on Homelessnessas a “best practice” for governments and service-agencies to use in their fight to end chronic homelessness in America and has been adapted in many countries across the world.    


Join me in the exploration of this health justice model of care as I talk with leaders in the US and abroad to better understand how existing policies drive system integration to support stable housing for the homeless.  


Stay Tuned!

 For more information on Housing First in the US, Click Here.

 For more information on Eisenhower Fellowships, Click Here.

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05 | Unintended Consequences: Hospital Consolidations and Women’s Health (Part 2 – The Provider Perspective)

05 | Unintended Consequences: Hospital Consolidations and Women’s Health (Part 2 – The Provider Perspective)


As hospitals across the state are consolidating through mergers and acquisitions to gain market share, many Catholic hospital systems have made strong gains based on their financial strength.  As a greater share of Illinois hospitals are operating under the Ethical & Religious Directives for Catholic Health Care Services, a recent University of Chicago report indicates there are unintended consequences for women’s health, and a disproportionate number of low-income women. 

In this episode, we talk with maternal child health researcher and public health lecturer, Janine Hill about the report and the implications for health equity.


In the backdrop, Illinois Governor J.B. Pritzker signed the Reproductive Health Act in July of this year.  The Act eliminates nearly all restrictions on contraception, sterilization and abortion in the state, and ushered in a law that supports reproductive health care as a “fundamental right”.  Yet, as reported in the Crain’s Chicago Business July 2019 article “Why Illinois’ newly recognized ‘fundamental right’ is getting harder to exercise”, the new law, and the acquisition of regional hospitals by Catholic systems are at odds with one another.  Catholic hospitals operate under a set of rules known as Ethical & Religious Directives for Catholic Health Care Services, or ERDs, which were developed by the U.S. Conference of Catholic Bishops.

ERDs largely restrict access to and the provision of care for contraception, fertility treatment, sterilization and abortion. For women covered by Illinois Medicaid managed care plans in Cook County, this creates a significant barrier to comprehensive reproductive health care access, as the County’s plans are heavily dependent on contractual referral relationships with hospitals newly merged with Catholic hospital systems.  

In this episode, I’m talking with Janine Hill, President of Soar Strategies, Inc., former Executive Director of EverThrive Illinois (a statewide coalition for maternal and child health), lecturer in public health at UIC School of Public Health and non-profit management at Northwestern University, and PhD candidate in community health with a focus on maternal health outcomes.

Janine’s expertise in public health policy, health systems and maternal and child health research brings a unique perspective to this new challenge in Illinois, as the health outcomes for women and their children is largely dependent on broad access to comprehensive reproductive health care services. 

Soar Strategies is a consulting and coaching firm committed to helping leaders and groups in the social good and corporate sectors to share their strengths, create goals, and achieve their professional as well as personal goals through a collaborative process.

We are passionate about teams and individuals. We believe that our diversity in experiences, knowledge, and thoughts are our best qualities, and our goal is to help your special gifts shine at work, school, and home by creating brave spaces for coaching interactions, as well as consulting engagements.

We believe that change is a collaborative process that must be guided by goals. We seek to continuously collaborate with organizations, individuals, and teams to facilitate crucial conversations that lead to transformation.


For more on the article “Why Illinois’ newly recognized ‘fundamental right’ is getting harder to exercise”


Reflecting on your research and work, what impact would this have on Maternal and Child health outcomes at the population level?

So, I think this is an important topic, and I think that Illinois really is an outlier in the number of hospital beds we have in our state that are Catholic-owned. So 14.5% of US hospitals are Catholic-owned, as you can see from the research from Dr. Stulberg, it’s even more pronounced in our state, and that does have implications for population health outcomes. So, If I’m a woman going to a facility that is now allowed through ERDs to give me a tubal ligation or IUD or even talk about those types of family planning services, then a couple of things can happen.

Let me back up. One of the most important things that we think about when we have reduced access to family planning methods, which is really what we’re talking about is an increase in unintended pregnancies. So about 5% of women of reproductive age in any given year have an unintended pregnancy, and about half of pregnancies are unintended. So we can logically assume that if we have reduced access to family planning and contraception, we’re going to have increased numbers of unintended pregnancies, and many of those will end in either abortion or in births, right? So, let’s follow that flow-chart.

So if the mom is not able to get family planning services, she gets pregnant, she delivers, the research shows that there are adverse implications for both mom and baby. They include mental health challenges for mom, they include challenges in mother/child bonding when the baby is born, they include things like not getting prenatal care in the first trimester, which is recommended, and increased adverse outcomes like low birth weight and preterm birth. We know that the literature shows us very clearly that, when we have access to family planning, we have less unintended pregnancies, and we have a reduced likelihood of those adverse outcomes like low birth weight, preterm births, [difficulty with] mother/child bonding, etc.

Then, let’s follow the other side of that equation, right? Let’s say that, somehow I was able to get an abortion, we know there’s a very clear link to reduced access to family planning, and increased number and incidence of abortions. So moms may wait later to get an abortion, and that’s a more involved medical procedure. They may, unfortunately, try to access unsafe abortion facilities and practices, and then have a number of medical complications due to that.

So I really do think that there are very clear policy recommendations we can make in this instance, and I think we have to think about what these mergers and acquisitions [mean] in our state and the implications of those at the population and individual levels. This article talks about a woman that’s not able to access family planning services. We know that people who are lower-income, who are Medicaid-eligible, who are in more rural surroundings who are not in the Cook County or Chicagoland area; we know that these women are more likely to be challenged by having one catholic hospital in their network.

In your opinion, how are health care systems impacted by this “consolidation effect”? Specifically, what happens to family planning services across systems of care (i.e., Medicaid managed care, hospital-based care, and primary care)?

I think a couple of things, and maybe I’ll start with the research because that’s where I live. We’d not done a lot of research on the impact of training and [practicing medicine] at a Catholic-based institution earlier, but with these mergers and acquisitions, there are some researchers who are starting to ask those types of questions. There was a 2017 study, published in the Journal of General Medical Education. This was a qualitative study that actually interviewed 31 graduates from seven (7) Catholic residencies between June of 2014 and February of 2015.

What the clinicians reported [were] gaps in reproductive health training that they had to access elective training on their own to get that type of information. And after graduation, they were pretty dissatisfied with their training on family planning. They felt they had delayed competencies in this area, and rightfully so, they thought they had a lack of ability to perform various family planning procedures. They all mentioned that they thought that Catholic programs should improve family planning training by providing routine, opt-out, family planning training opportunities.

So you see this thought at the systems-level and at the provider-level, that the impact of being trained at a Catholic institution, that [providers] reported that is was quite negative in terms of their perceptions of their [own] competencies around family planning. So I do think we have to think about collaborations and what is meant by in-network and out-of-network. If I’m a woman in a rural part of our state, and I have one hospital in-network, and it happens to be a Catholic-owned hospital, is there a way that I could have (for example) access to family planning services in another hospital that would be for the auspices my payment and my managed care plan, be considered in-network for those types of services. It feels to me very unfair to have one hospital that has already stated through the ERDs that they are not able or willing to do certain types of procedures. Yet, as we know, we just passed the reproductive health act. We have decided that each person has a fundamental right to make decisions about reproductive health care, and that includes contraception, abortion and maternity care. A fundamental right is classified as one that the government cannot interfere with, except in certain narrow situations.

So it feels like, if I’m on Medicaid or another type of managed care plan, and I don’t have this access in-network, that feels like interference to me, and so I think we need to think about what that means at the systems-level and systems-level changes that we can provide for these women.

What are the implications for health care equity? Specifically, who is most impacted by this change in the health care delivery system in Illinois?

So, I think we have a lot of different types of data converging here. If I told you the groups that were more likely to have unintended pregnancies, you could overlay the same demographics with the groups that have less access to health care or [within] some of these Catholic-owned institutions. What do I mean by that? We talked about the rural piece, which I think is really important. Really,really important. The other pieces which we have talked about a little bit are, women that are low-income, right? We’ve talked about Medicaid-eligible women a lot in this segment. I would also put women who also have plans that would be considered catastrophic coverage, and don’t have a lot of health care coverage. I would put them in a similar bucket here, because the in-network and out-of-network are pretty tight and there are very clear, large financial implications for selecting a provider that’s out of network. So I would say low-income women, either in Medicaid or other, private, managed care plan. I would say rural women; definitely there are implications for health care equity.

What we haven’t mentioned, but I want to mention here, is that one of the groups that also have high rates of unintended pregnancies are women of color, and in particular, Black women. I know in the article we’re discussing, that was a Black woman. So I think it’s important to think about the converging of those types of demographics on health care equity. It’s going to be the same crew that would have challenges getting family planning anyway. It would be the same crew that would have increased, unintended pregnancies anyway. If we know that from the get-go, and we know that from the research and the data, shouldn’t we be most focused on that population if we really want to see an impact on the reduction of unintended pregnancies? Shouldn’t we be thinking about what can we do for women who may be inside one Catholic-owned, in-network hospital or provider, and what we can do to expand the delivery system and expand their options?

What might be policy-level options to reduce or eliminate the resulting disparity?

That’s a great question, and I have been thinking about this. If I’m the head of the Department of Healthcare and Family Services, or head of the Medicaid Division, what can I do to think about how to address this issue? In some ways, again, I think the wind is in our sails with the passage of the Reproductive Health Act. We have a great opportunity here. The state has said that we have a fundamental right to make decisions about when and where to have children, and when to choose to not have a child.

If we’ve said that, if we’ve passed this public act, then I do think we have a responsibility. I think I should say that first. Some of that might be around the guidance that the Medicaid Division gives to managed care organizations, and this is where I think advocacy could be useful, too – to think about what in-network and out-of-network mean, particularly for family planning and contraceptive services. I honestly think that there should be a statute that says that, if my network is a Catholic-owned institution or hospital, then I should have another option that is a non-Catholic-owned institution to be classified as in-network for me to get my family planning and reproductive health care services. Period.

We could talk about other, less impactful efforts, but I really think we need to think about the classification of in-network and out-of-network, and I should have another option. Because what the ERDs say is that, obviously there should be timely referrals if I’ve decided that I cannot, by virtue of my employer, provide a tubal ligation, or insert an IUD, then I’m supposed to [receive] a timely referral someplace else, right? But timely referral [is something] I almost want to put in quotes, right? If I’m in a rural situation or if it just gets lost in the shuffle, timely ends up not being so timely, and when you’re pregnant, every week matters. And so I don’t think we need to be doing that in the midst of it; like I go and I can’t get an IUD, that plan needs to be set from the very get go. I think there needs to be educated on this also for consumers to understand that, you are enrolled in a plan that actually has as its in-network hospital, a Catholic-based institution. Here’s what they can do, here’s what they can’t do. We actually will give you another period of time if family planning and contraceptive services are important so you can choose another plan, and to choose another in-network hospital.

I bet that if we had a focus group of reproductive aged women in Catholic-based institutions and we asked them: “do you understand that, in your plan, [which is] under an ERD, you cannot get x,y and z at your hospital”. I bet most of them would not know that right now, and they won’t know that until they get into a situation, which I think is unfortunate. So, one – I think we need to do a better job of education on the front-end about health plans and, two – I think we really need to reevaluate what in-network means, and having an in-network option that’s non-Catholic owned for women of reproductive age.

Learn More about Janine Hill and Soar Strategies, Inc.: 

Soar Strategies, Inc.

Janine Hill, PhD(c) MPH

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04 | Unintended Consequences: Hospital Consolidations and Women’s Health (Part 1 – What the Research Says)

04 | Unintended Consequences: Hospital Consolidations and Women’s Health (Part 1 – What the Research Says)

The rapid consolidation of hospital systems across Illinois has been dominated by Catholic hospitals, making strong gains based on their financial strength.  With a growing share of hospitals now operating under the Ethical & Religious Directives for Catholic Health Care Services, providers in these systems of care face limitations on the provision of family planning services for their patients and limited options for OB-GYN training as well. 

In this episode, I’m talking with Kai Tao, ND, APN, MPH.

For more nearly two decades, Kai has been in practice as a certified nurse-midwife, Deputy Commissioner with the Chicago Department of Public Health, Senior Policy Advisor for the Director of the Illinois Department of Health and Family Services, and Vice President of Clinical Operations with Planned Parenthood of Illinois. 



As hospitals across the state are consolidating through mergers and acquisitions to gain market share, many Catholic hospital systems have made strong gains based on their financial strength.  With secular and faith-based systems now under their purview, Catholic hospital rules regarding reproductive health care will apply to a greater number of women in Illinois; especially low-income, Medicaid eligible women.

In the backdrop, Illinois Governor J.B. Pritzker signed the Reproductive Health Act in July of this year.  The Act eliminates nearly all restrictions on contraception, sterilization, and abortion in the state, and ushered in a law that supports reproductive health care as a “fundamental right”.  Yet, as reported in the Crain’s Chicago Business July 2019 article “Why Illinois’ newly recognized ‘fundamental right’ is getting harder to exercise”, the new law and the acquisition of regional hospitals by Catholic systems are at odds with one another.  Catholic hospitals operate under a set of rules known as Ethical & Religious Directives for Catholic Health Care Services, or ERDs, which were developed by the U.S. Conference of Catholic Bishops.

ERDs largely restrict access to care and the provision of care for contraception, fertility treatment, sterilization, and abortion. For women covered by Illinois, Medicaid managed care plans in Cook County, this creates a significant barrier to comprehensive reproductive health care access, as the County’s plans are heavily dependent on contractual referral relationships with hospitals newly merged with Catholic hospital systems. 

A recent University of Chicago report indicates there are a disproportionate number of low-income women in health plans served by these hospital systems and that health disparities are likely to increase.  In this episode, we talk with a women’s health provider and women’s health advocate about the rapid consolidations, the report and the implications for patients and providers across Illinois. 

In 2018, Kai launched Juno4Me, a non-profit that provides free IUDs and implants to people in Chicago. Kai’s extensive experience in women’s health, program development, public health policy advocacy, and clinical operations brings a multi-sectoral approach to the challenges of access and equity these recent hospital merges pose to women across Illinois. 

 Juno4Me believes that everyone should be educated and have access to every type of birth control, especially the modern ones such as the new and improved IUDs and Implant. IUDs and the Implant work super well at preventing pregnancy, are considered safer than the typical pill since they don’t contain estrogen, and more importantly, you can forget about it and it’s still doing its a primary job. 


How might this phenomenon impact the number of providers who are willing and able to deliver family planning services across Illinois? 

Dr. Stulberg and I have talked about the data, and for the last few years, the data has been saying that about 1 in 3 hospital networks are either religiously affiliated (often Catholic-affiliated, but could also be non-Catholic, Christian-affiliated) systems, so this data didn’t totally surprise me. I think what was very salient about this data was that, we actually looked at the users of Medicaid from 2015 – 2018, and women from the 15-44 age range, who actually use Medicaid and we saw that women of color were more likely to be enrolled in these programs in Medicaid and thus have the limitations of truly having providers who can provide full access to contraception and reproductive health services.

How might family planning training for providers be different in Catholic hospital settings?

When we think about workforce and pipeline, it is so critical. Not only are we providing evidence, but you want skilled providers who are well trained, and unfortunately for many of these systems that may have some kind of residency, and that could range from family medicine, internal medicine, OBGYN of course, and also for nurses, nurse practitioners, physicians and physician assistants, so it’s not just OBGYN doctors. Their training is really going to be missing a big part of comprehensive care for women.

Will providers have options for patients in need of family planning services that aren’t provided in hospitals newly operating under ERDs?

Full disclosure, I think there’s variation across the system of hospitals that practice under ERDs, in terms of what can or actually cannot happen, as I say, behind the exam doors. We know, within a hospital system, like if you actually practice within an in-patient hospital setting, we believe (and I’ve seen, because I’ve been working in labor and delivery here in Chicago for about 15 years, so we talk a lot to our peers) you really cannot get something like a tubal ligation if a woman says “I’m done with childbearing, I really want to have a tubal ligation”. A pretty simple procedure, especially if you’re already inpatient in the hospital – that cannot happen, right? What happens through ambulatory, so outpatient, affiliated with the hospital? I have to be candid that I think there’s variation. But again, that’s not how good health care delivery should happen; based on if you have a provider who happens to be savvy. We see a lot of people who are going to these religious [affiliated] clinics, and they all have really bad menstrual cramps or they may have severe other issues associated with needing birth control for non-pregnancy reasons.

And can’t access it?
Well, no. That’s how we’re able to access it, because really – under the directive – it’s saying that you cannot use birth control for pregnancy prevention. If you have some real medical indications that has nothing to do with preventing pregnancy, we can most likely help you. Especially in the outpatient setting, and that’s what I’m saying. A lot of young people are saying “I got birth control pills because it’s being prescribed for a medical reason, and not necessarily for pregnancy prevention”.

I also often wonder how often women who are part of these Medicaid managed care plans that now have hospitals in their networks that are operating under ERDs are even aware that, when they signed on to these plans, that there are these restrictions. My guess is, they show up for what they need, only then to discover what the barriers are. Like the woman in the Crain’s article.

Yeah, and the woman in the article found out what the reason is. Most people are just assuming that they’re getting good care, they have coverage, and this is what their provider offered. End of story. My provider doesn’t do this, so I don’t think that’s a procedure I’m going to get, so that’s fine. Most people are not going to question it, and there’s definitely nothing at this point that tells the user when their picking a plan; oh – if you pick this plan, these are the hospitals, and you may not get the full reproductive health services that are based on evidence and science.

That might be necessary for you based on your age and gender.


There are several key objectives in the CDC’s Healthy People 2020 Family Planning Goals, including increasing the proportion of health insurance plans that cover contraceptive supplies and services. These are national goals that set the standard for public health planning at the state and local levels. Reflecting on your extensive work and practice in women’s health, and as an administrator in Illinois and Chicago’s health departments, what impact would these recent hospital mergers have on family planning outcomes at the population level?

I mean, the reality is, there’s a real disconnect when we think about what actually happens from a payor source (the insurance plan) to the experience that an end user may have. Unfortunately, they are often very misaligned. I think, overall, in the United States we’ve seen trends where unplanned, untimed pregnancies are decreasing.

I believe they’re decreasing here in Illinois.

Correct. Nation-wide, consistent with Illinois and even in Chicago, we’ve seen a decrease, which is great. However, like many health outcomes, we see significant disparities. In the city of Chicago specifically, when we look at teen births [from] 15 – 19 years old, we see Black and Latinas having birth rates five times higher than White teens. I always like to say, it’s not because the White teens are having less sex. Right? It’s all about education and access. And so, you know, these goals that the CDC has, they’re nice targets to have, and we’re seeing progressively downward trends. But [at] the end of the day, these disparities are something that are very real, and very evident here in the city of Chicago.

And they are particularly relevant as the majority of the women who are on the 5 to 7 Medicaid managed care plans, for which the dominant hospital systems are now Catholic hospital systems are African American and Latinx women.

Correct, and when we look at national data, who’s most at risk for unplanned, mis-timed pregnancies? We see it in the younger age; 24 and under is the highest. Even though I say 45% of pregnancies are unplanned or mis-timed, in the under age 24, its 80-90% unplanned and mis-timed. What are the other characteristics of women who self-report having an unplanned or mis-timed pregnancy? They are usually cohabitating with someone, and single. They are usually at or below the federal poverty level. They usually don’t have a high school degree, or are still in high school – so never even got out of high school. Those are the main characteristics, and of course, they are women of color. The people who need the services are the ones that, under the ERDs, are being hurt the most.

What might be policy-level options to reduce or eliminate the resulting disparity?

First thing is we have to do more public education, so people know what are their options. What you had in 1980 and what your maternal grandmother told you is not what’s available in 2019. I think more people need to have that education, and with the advent of social media, anything goes. So there’s a lot of misconceptions and myths happening in the world, and in health care in general, and we see it predominantly in birth control and reproductive health. Things that are simply not true, and the evidence has shown us otherwise.

So we need education in the first place, which we can say would be a different podcast. Talking about comprehensive, medically-accurate, age approrpriate K-12 education. But more importantly, people who are on these Medicaid plans; do they know, and do providers know that, nationally, under the Centers for Medicaid and Medicare, there is a freedom of choice provision. Which means that, it doesn’t matter who your primary care physician is, or what network you’re in, or what medical home, you have the right to seek contraceptive healthcare outside and still get coverage. Unfortunately, that is one of those things that most people who know about this say, great, but the end user has no idea. And, of course, many providers have no idea. They would just say, “Well, this is all we offer here, and this is your coverage”.

So I think some policies would be, first, let’s let more people know about this. Let the end user know that she has options. Once she knows what all of her options are, where to go to get these options. That’s the other big piece. And that was just one prong of Juno4me, when we’re talking specifically about IUDs and implants. To help identify some places you can go, and you will get coverage no matter what.

And you will get transportation to get there, which is yet another barrier to care when you are low-income.

Exactly. And then the other piece I often think of, when you asked about policy, Kuliva, is I find it fascinating that in 2019, a public program like Medicaid – which is very big and robust (we have expanded Medicaid in Illinois) – to me it’s almost akin to saying; “By the way, you have no vaccine coverage. Are you ok with that?”. Because we know the data shows 99% of American women between the ages of 14 and 45 have used something other than natural family planning for birth control. This affects a big swath of the population.

More than half.

Right. Exactly. And to know that there’s no coverage for that – that could just never happen. I use the analogy of vaccines, because we wouldn’t make that a health plan. We wouldn’t say that’s ok, but somehow, our long history has allowed this to happen [for birth control].

Learn More about Juno4Me and the Alliance for Health :


Alliance Health

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05 | Unintended Consequences: Hospital Consolidations and Women’s Health (Part 2 – The Provider Perspective)

03 | Public Charge: The Chilling Effect on Health Care Access

On August 14, 2019, the Department of Homeland Security published a final rule related to public charge in the Federal Register.  Known as Public Charge, this rule would make it harder for legal immigrants to get green cards (allowing immigrants to live and work permanently in the United States) if they have received certain kinds of public assistance, including Medicaid.  What are the implications to health care access?

In this episode, we talk with the Health Policy Director at the Illinois Coalition for Immigrant and Refugee Rights about the impact Public Charge will have on health care access, and what Illinois is doing to educate and support health care organizations and providers. 

The U.S. Department of Homeland Security’s proposed rule, known as Public Charge, would make it harder for legal immigrants to get green cards (allowing immigrants to live and work permanently in the United States) if they have received certain kinds of public assistance – including Medicaid, food stamps and housing subsidies. 


According to the Commonwealth Fund, the proposed rule puts the administration’s immigration policy in direct conflict with sound health policy and has the potential to disrupt preventive and ongoing care for millions of people. 

Additionally, the rule will have a significant impact on the delivery system, reducing Medicaid support for health care providers and driving up uncompensated care. Safety-net providers and health care providers in communities with large immigrant populations will be particularly hard-hit, affecting not only their fiscal health but their ability to serve the broader community.  

While the implications aren’t all immediately clear, our conversation with a public health sector leader will breakdown some of the key elements and outline ongoing advocacy and education campaigns that seek to support affected immigrant families and the organizations and institutions that provide direct services to those communities. 

In this episode, I’m talking with Luvia Quinones, Health Policy Director with the Illinois Coalition for Immigrant and Refugee Rights, or ICIRR, located in Chicago, IL.

The ICIRR is dedicated to promoting the rights of immigrants and refugees to full and equal participation in the civic, cultural, social and political life of our diverse society, and works with many member organizations on various programs and campaigns to empower the immigrant community in Illinois.

In her role as Health Policy Director, Luvia oversees the In-Person Counselor Program, Immigrant Health Care Access Initiative, and in collaboration with ICIRR’s members, develops ICIRR’s health policy agenda with a special focus on access to health care and on health care reform.


Can you tell us what is Public Charge and when does it apply? 

It’s a test, something that has been in immigration books for almost 100 years. A test that anyone who wants to come to the US with some kind of VISA or trying to adjust your status within the US needs to go through. 

What is being proposed, they want to change the definition of Public Charge. So, they want to go from saying if you’re using any of these benefits, either TANF or long-term nursing assisting as the expense of the government, to adding several programs including SNAP Medicaid housing.  

They want to change the definition to say how likely is it that any of these individuals will ever use any of these programs. Not only do they want to change the definition and give more authority to Immigration officers, but they also want to penalize individuals for being poor, sick or having several children. 

The more negative factors you have the less likely you are to get a green card. 

In regards to who it impacts, its mainly 2 groups of individuals who are trying to come into the US with a VISA or those trying to adjust their status, either one VISA to another or going from a VISA or from being undocumented to getting a green card. 

It does not affect people who already have a green card or those in the process of getting their citizenship. 

Which benefits are included in public charge in-admissibility? 

Of those benefits that were included in the proposed rule are SNAP, Medicaid housing and the 2 that are already included is long term nursing, assisting at the government’s expense and TANF. Not only is this proposed rule including these new programs but also adding this whole other piece of the negative vs positive factors, including income, health, and social status. 

Describe the effect this proposed rule has created for immigrant families seeking public benefits, and health care services and those sectors that serve them? 

We have already been seeing the chilling effect. There have been different iterations of it over the past 2 years. Unfortunately, because one of the versions that were previously leaked included penalizing the undocumented individual for having a child use these benefits, one of the things that are still continuing to happen to this day is families disenrolling their US citizen children from programs that not only do they meet the services but the children are eligible for. 

The chilling effect is larger than the numbers of people that is an impact. The last time this kind of thing happened at this level, was huge. Not only of a huge number of individuals disenrolling from programs but also a high numbers of individuals disenrolling that it did not affect. Refugee’s and Asylees disenrolling even though they were exempt from the rule. 

As a result of various proposed rules as well as other related executive orders that this administration has been introducing and implementing, all this together has been increasing fear in the community. We have seen several things of individuals refusing to go to the hospital unless it is a definite type of health emergency, for example, for fear that immigration eyes would be at the hospital or clinic. 

We see that as part of the chilling effect and also an ongoing attack of increasing fear and anxiety. 

What can you tell us about the advocacy and education work underway on this issue in Illinois? 

In the Illinois Coalition for Immigrant Refugee Rights, we have been developing an infrastructure to make sure that everyone within our staff is not only educated on the issue but is also integrating anything related to Public Charge into their day to day work. We have been working on several rapid response plans. One of community education, which includes ethic media and social media informing what actually is happening and what are myths and lies. Providing training and education and accurate information in as many languages as possible.  

Spanish, Polish, Korean, Arabic, and Cantonese being the top five. 

The other pieces also advocacy and organizing. As we are preparing to make sure that everyone knows this effect and who it does not affect, also making sure that our community is prepared to fight back.  

We believe in creating immigrant power, so making sure every organization knows the potential advocacy opportunist and litigation opportunities. Trying to educate our elective officials so we have passed both city and county resolutions to make sure our elective officials stand against the proposed public charge. 

In Protect Immigrant Families Illinois, a statewide coalition that was replicated from the national model of protecting immigrant families. There are close to 25 organizations working on this and representing the various sections affected by this, whether that be housing, health providers as well as those working around food and security and the disability community.  

Some of the work we have been doing there is preparing the framework as well as infrastructure to get everyone involved. We have organizations making sure the people working against poverty are up toi speed with everything that they know what to tell their clients and patients, what to health care providers tell their patients coming to the hospital and when the opportunity to get involved also creating spaces for that. 

How is advocacy and education work in IL unique among other states across the country? 

There’s a lot of great work happening in several states, whether it be Maryland, California as well as Washington State. They have been doing great work in getting the community involved. One of the things that Illinois as well as a handful of states, is the infrastructure we have created in the last year and a half and how fast we have been able to react and organize various stakeholders. 

Within a day of the rule being published in October, we organized a press conference, a Facebook LIVE, several pieces of training as well as holding a conference call with over 50 organizations to make sure that everybody was educated and informed. 

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