Nutrition assistance program participation, healthcare access, and perinatal health among U.S. Latinos in the context of the “public charge” rule: a systematic review

The “public charge” rule assesses whether an immigrant to the U.S. is likely to become dependent on government assistance, particularly for potential use of cash-benefit programs or long-term institutionalization at government expense. Being deemed a public charge can make an applicant for legal status inadmissible. Although the rule applies to specific immigration determinations, its effects may impact health outcomes. This systematic review synthesized evidence on public charge policy and health-related outcomes among U.S. Latino populations. Following PRISMA guidelines and a PROSPERO-registered protocol (CRD42024507861), we searched PubMed, Web of Science, and Scopus for peer-reviewed studies published in English or Spanish from January 1996 through February 20, 2026. Eligible studies included U.S.-based Latino populations, examined the public charge rule as exposure, and reported health-related outcomes, health behaviors, healthcare access, or use of health or social programs. Two reviewers independently screened titles and abstracts, with disagreements resolved by consensus and, when needed, a third reviewer. Data were extracted using a standardized PECO-based form and narratively synthesized. Of 157 citations identified, 19 studies met inclusion criteria. Studies examined program utilization and access ( n = 13, 68%), maternal health ( n = 4, 21%), or both domains ( n = 2, 10%). Nearly all used cross-sectional designs ( n = 18, 95%); 9 used qualitative and 10 quantitative data. Across studies, fear, misinformation, and concerns about immigration and legal consequences were the most consistent barriers to nutrition assistance programs, healthcare, Medicaid, and government-funded perinatal services. During the policy changes briefly implemented in 2018, Latino children with medical needs had the highest estimated risk of losing Medicaid, CHIP, or nutrition assistance benefits (79.8%; 95% CI, 74.4%-85.1%). Among likely undocumented Latino patients, self-pay emergency department visits increased after the 2018 proposed rule expansion. Maternal health studies documented delayed perinatal care, reduced Medicaid-funded prenatal care initiation, higher odds of preterm birth, and lower birth weights. The public charge policy may function as a structural determinant of health for Latino families by discouraging the use of safety-net programs, including among eligible individuals. Additional research is needed to assess downstream health consequences, reduce misinformation, strengthen trusted communication, and protect access to healthcare and social welfare programs.