Soon after news broke last week of the Trump administration’s finalized “public charge” rule, benefit enrollers at the Eisner Health community clinic in downtown Los Angeles started getting phone calls.

Patients enrolled in Medi-Cal, the state’s health insurance program for low-income people, and CalFresh, California’s food stamp program, asked to end their family’s coverage. Those with pending applications pleaded to pull out.

Many of these patients were non-permanent residents who, under the new federal immigration rule, could have difficulty obtaining a green card if they’ve received certain government-funded aid, or if immigration officials determine they might need that aid in the future. But they were also cancelling coverage for family members unaffected by the rule, including their U.S.-citizen children, said Eisner Health enrollment specialist Gilbert Soto.

“Our patients are confused and fearful,” he said. “We’re letting them know and we’re reassuring them that the children are not impacted by the new public charge rule,” but they’re still pulling out, Soto said.

This exodus from health and food benefit programs—even of people who should have nothing to worry about under the new regulation—is expected to amplify across California and the nation as fear and misinformation about the rule spreads. Even before the “public charge” rule was finalized Aug. 12, organizations working with immigrants reported an uptick in clients dropping out of benefits and forgoing medical care, including for their children.

Many people are reportedly withdrawing from programs that aren’t even under the scope of the regulation, such as emergency medical assistance, Medi-Cal for pregnant women and children, and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). At the Venice Family Clinic in Los Angeles last week, a young, pregnant student told the doctor she didn’t want to enroll in Medi-Cal for her prenatal care, recounted Anita Zamora, deputy director and chief operations officer.

“Obviously that’s incredibly concerning to have somebody who’s pregnant and potentially have that baby not getting the care that they need,” Zamora said. “What if she develops a high-risk condition and she doesn’t have the coverage to access those services?”

Researchers say the rule is having a “chilling effect.” While the regulation affects about 500,000 people already living in the United States who apply for green cards each year, about 13.5 million people—including 7.6 million children—could be at risk of un-enrolling in Medicaid (the federal name for the MediCal program), according to the Kaiser Family Foundation.

A study by UCLA and UC Berkeley last year estimated that, in California alone, up to 765,000 immigrants could drop nutrition assistance and health insurance because of fear, confusion and misinformation about the rule. Almost 70 percent of those losing benefits would be children, said Riti Shimkhada, an analyst with UCLA’s Center for Health Policy Research. Many of these children live in mixed-status families where some members are legal residents or U.S. citizens, and others are undocumented.

“It has huge ripple effects,” said Shimkhada. “Disruption in health and wellbeing coverage really impacts communities and public health as a whole, especially if kids and families aren’t getting needed preventive care (or) immunizations.”

Not having adequate health coverage can also affect children’s educations, Shimkhada said. “If you don’t have enough food you’re not able to perform well in school.”

California will need to launch informational campaigns to counter misinformation about the rule and prevent families from needlessly un-enrolling from benefits, said Shimkhada. Otherwise, the state could potentially lose millions of dollars in federal funding for safety-net programs, which could in turn negatively impact California’s economy as a whole, the researchers predicted.

The state is suing the federal government over the rule, and two of California’s most populous counties—San Francisco and Santa Clara—have filed a separate lawsuit.

Meanwhile, health clinics are scrambling to reassure immigrant community members that it’s still safe to go to the doctor and to get health insurance for their kids.  

Venice Family Clinic is drafting talking points for medical employees and creating patient pamphlets to help answer questions about “public charge,” Zamora said. At Eisner Health, officials are planning to hold workshops to inform patients and address the stress they’re feeling because of the new rule, Director of Development Emily Bush said.

“We just want to be able to provide our patients with as much accurate information as possible to make sure they can still get the care they need,” she said. “We want everybody to be able to access health care, and this (rule) really prohibits that.”