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Stephanie Pellitt

, National Council for Behavioral Health

National Council Files Comments Against Public Charge Rule

December 13, 2018 | Medicaid | Comments
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Last week, the National Council for Behavioral Health submitted comments to the Department of Homeland Security (DHS) regarding the Trump Administration’s proposed 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 expressed strong opposition to the rule as it would deter legal immigrant families from seeking health care coverage, harming the health of millions of adults and children.

Since the formal announcement of the rule in September 2018, the National Council has opposed changes to the federal public charge policy and provided members with an educational webinar and template comments to weigh in against the proposal. The National Council has also been an active member of the nationwide Protecting Immigrant Families (PIF) coalition effort asking all Americans to take action against the proposed regulation. As of this writing, DHS has received more than 216,000 comments in response to the rule.

Specifically, the rule states that receiving health care through Medicaid would weigh heavily against legal immigrant adults and children applying for admission into the U.S. with a visa or for lawful permanent residency with a green card. In official comments, the National Council explained that this move would deter immigrant families that are lawfully residing in the U.S. from seeking health care coverage, negatively impacting the health of millions of adults and children. For this reason, the National Council strongly urged DHS to rescind this rule.

The National Council comments also highlighted the following concerns:

  • Chilling Effect: Months of speculation about the proposed rule have resulted in a “chilling effect” of legal immigrants disenrolling themselves and their children from health care and other public programs. With much confusion and misinformation surrounding the public charge rule, the chilling effect has extended to programs and populations that are not directly impacted by the rule.
  • Increases in Uncompensated Care: Including Medicaid in public charge determinations will not decrease health care costs. Legal immigrants will continue to have health care needs, but without Medicaid they will be more likely to seek care at emergency departments (EDs) and hospitals, resulting in uncompensated care.
  • Decreased Access to Housing and Nutrition: The rule would further harm the health of legal immigrants by including public nutrition programs like the Supplemental Nutrition Assistance Program (SNAP) and federal housing assistance in public charge determinations. Although these are not health care programs specifically, they play a vital role in ensuring a person’s overall health and wellness.
  • Damages Children’s Health: The proposed rule would cause major harm to the children of legal immigrant parents, whether they are U.S. citizens or legal immigrants themselves. Although the proposed rule exempts children who are U.S. citizens, the health of legal immigrant parents and their U.S. citizen children cannot be separated. Children thrive when their parents can access needed health care (including mental health and addiction treatment), when their families have enough to eat, and a roof over their heads.
  • Increased Exposure to Toxic Stress: More families will be exposed to toxic stress, which has been shown to negatively impact individuals’ long-term physical and mental health. This exposure will be especially hard on children, who are particularly vulnerable to toxic stress.
  • Increased Health Disparities: The rule will widen existing health disparities, as the immigrant populations that will be most affected by the rule are largely communities of color.

You can read the National Council’s Comments in full here.


It is important to note that this proposed rule has not been finalized. DHS must now review and respond to issues presented in the public comments. Stay tuned to the Capitol Connector for more news on public charge.

For more information on how the rule would work if it was enacted, please watch our Public Charge webinar or see our earlier Capitol Connector coverage.