As an advocate for health-equity in a community where more than a third of residents are foreign-born the Primary Care Coalition (PCC) recognizes how decisions related to current and future immigration status are critical decisions for many households. Immigration status is a social determinant of health. Achieving an immigration status that brings residents closer to legal permanent residence or citizenship is often a gateway to greater socio-economic stability and long-term wellbeing. For those people affected, this ruling forces an impossible choice between accessing services and supports they may need today and the future stability that comes with permanent residence or citizenship.
 
As problematic as the new regulations will be for those groups affected, there are many exemptions: refugees, asylum applicants, immigrants from certain countries who have been granted relief and certain visa statuses are all exempt. Sadly, leaked versions of the rule and the overall technical complexity of the regulation have created a sense of fear and confusion among community members, effectively deterring people from accessing needed and available services, even if their U.S. residency applications would not be impacted.
 
Since the first versions of the revised regulation were leaked over a year ago, PCC has monitored changes in patient behavior. We've seen numerous cases of people being fearful to interact with the health care system; not wanting to apply for benefits for their U.S. born children; and, not wanting to remain engaged with locally funded programs even though these local programs are not included in public charge determinations. These fears are not about the text of the ruling itself but the overall environment of fear and confusion that has been created around the Public Charge rule.
 
As a community, we must respond to this issue by equipping residents with information and support in interpreting the ruling so they can make informed decisions based on their specific circumstances. We must also work to mitigate the mistrust and fear of interacting with government offices which is making it hard for people to access not only the federal benefits for which they are legally eligible, but also locally funded programs.
 
Local governments often develop programs to fill the gaps where federal programs fall short. Montgomery County has been a leader in providing access to health services for people ineligible for any other programs through the Montgomery Cares and Care for Kids program, which PCC proudly administers. These programs have been, and continue to be, an option for people who are not eligible for Medicaid. Yet in this climate of fear and uncertainty residents may understandably avoid interacting with government agencies to access benefits. Local governments, nonprofit organizations, faith communities, and other community organizations must work as partners to reach, educate, and sustain trust with foreign born residents.
 
The Primary Care Coalition (PCC) upholds the principles of diversity, inclusion, and respect for people from all cultures and backgrounds and recognizes that these values are directly related to the health of every individual and the health of the community as a whole. We look forward to collaborating with the local government, other community-based organizations, and the residents we serve to reclaim a sense of trust between our immigrant neighbors and the public and private institutions that serve them.

Making health happen takes a concerted effort by people at all points in the health care safety-net system. Without their work, our neighbors experiencing vulnerability wouldn't be able to receive the care they need. On April 18, 2019, the PCC partnered with Story District to bring to the stage the real life stories of the people who weave our health safety net. This event was about celebrating their achievements and hearing who their work has touched the lives of the people who provide services and those who receive them. Event proceeds went to support PCC's Project Access program, which provides specialty care for low-income, uninsured patients.

Fiscal year 2018 marks the eleventh year that the Primary Care Coalition has published selected annual measures of clinical performance among clinics participating in Montgomery Cares. Emphasis on quality, guided by a robust clinical measure set, has resulted in consistent and sustained improvement in clinical quality over the past decade. Nationally endorsed measures and technical specifications are used, and Montgomery Cares performance is benchmarked against HEDIS results (Healthcare Effectiveness and Data Information Set).

The reports from two community roundtable meetings that informed the New Vision for Nonprofit and Government Collaboration can be downloaded at the links below.

Consistent with and in furtherance of the mission and objectives of the Primary Care Coalition (PCC), we make this statement upholding PCC’s core values of diversity and inclusion.The PCC envisions a community in which all residents have the opportunity to live healthy lives. The PCC upholds the principles of diversity, inclusion, and respect for people from all cultures and backgrounds and recognizes that these values are directly related to the health of every individual and the health of the community as a whole.