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Stephanie Pellitt

, National Council for Behavioral Health

New Rule Would Limit Immigrants’ Medicaid Access

October 11, 2018 | Medicaid | Take Action | Comments
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This week, the Trump Administration formally published a rule that would allow legal immigrants to be denied lawful permanent residency if they enroll in Medicaid or other public benefits. The proposed rule would expand the definition of “public charge,” a test that determines if immigrants are likely to become dependent on government for subsistence, to include federal health, housing and nutrition programs. The National Council strongly opposes the rule as it would deter immigrant families from seeking health care coverage, harming the health of millions of adults and children. The proposed rule is subject to a 60-day comment period, meaning comments on the rule will be accepted until December 10.

Historically, immigrants could be classified as a public charge only if they used cash assistance or required institutional, long-term care. Under the Department of Homeland Security’s (DHS) new proposal, a public charge would instead be defined as an immigrant who receives one or more public benefits. Use of public benefits would be weighed heavily against an immigrant’s application for a green card or permanent residency in the U.S., and likely result in the application being denied. Notably, this policy would only impact legal immigrants as undocumented immigrants are prohibited from receiving public benefits.

Other key provisions include:

  • Public Benefit Programs Included: Medicaid (with limited exceptions), Supplemental Nutritional Assistance Program (SNAP or “food stamps”), Medicare Part D’s Low Income Subsidy (LIS), housing assistance (public housing or Section 8 house vouchers and rental assistance).
    • In contrast to earlier leaked drafts of the rule, the Children’s Health Insurance Program (CHIP) was not included, but DHS requests feedback on potentially adding CHIP into the final rule.
  • Public Benefit Programs Excluded: Disaster relief, emergency medical assistance, entirely state or tribal-funded programs (other than cash assistance), benefits received by immigrant’s family members, and any other benefits not specifically listed in the rule.
  • Children’s Use of Benefits: The receipt of public benefits used by U.S. citizen children will not be a direct factor in a parent’s public charge test. While this is a noticeable departure from earlier leaked versions of rule, experts warn that the health of a parent and child cannot be separated. Community providers of health and nutrition services have already seen a “chilling effect” of immigrants disenrolling themselves and their children from public benefits out of fear of jeopardizing their immigration status long before this rule’s release.
    • Additionally, if a child is an immigrant, their use of public benefits counts toward their own public charge determination.
  • When Public Charge Applies: The public charge test applies at green card determinations and when individuals are seeking to enter the U.S. with a visa. The test does not apply in when lawful permanent residents (green card holders) apply for U.S. citizenship.
    • Public charge does not impact refugees, individuals claiming asylum and survivors of domestic violence.
  • Changes Not Retroactive: Public benefits used before the rule’s effective date would not be considered a in a public charge determination.


The National Council is part of a nationwide Protecting Immigrant Families (PIF) coalition effort asking all Americans to take action against the proposed regulation. The National Council encourages member organizations to submit comments opposing this rule before the Dec. 10th comment deadline by filling out the Protecting Immigrant Families health care comment form here or by submitting comments on the comment portal here. Note that the National Council will be submitting comments and will circulate these comments as template for member organizations to use later this month. The full text of the proposed rule can be found here.

Visit the Protecting Immigrant Families website for more resources including fact sheets about public charge, guidance on talking with immigrant families and upcoming webinars. Note that the National Council will be hosting a webinar on public charge specifically for its members in the near future. Stay tuned to the Capitol Connector for an announcement of the webinar’s date, time and registration details.