DHS replaces 'public charge' rule for noncitizen healthcare
The agency's rule reverses a Trump-era policy that affected noncitizens' legal status if they received health benefits, including Medicaid.
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The Department of Homeland Security has finalized a rule ensuring that noncitizens won't have their legal status affected if they receive health benefits including Medicaid, reversing a previous Trump-era "public charge" regulation.
First announced in August 2019, the Trump administration's final rule expanded the programs considered in the federal government's public charge determination. Programs like Medicaid, the Supplemental Nutrition Assistance Program and the Children's Health Insurance Program, which were previously excluded, could be used to bar entry into the country because of the rule.
In effectively nixing that rule, DHS said it was codifying in regulation the "totality of the circumstances" approach that is authorized by statute and which the agency has used for a long time – meaning individual factors, such as a person's disability or use of benefits alone, will not lead to a public charge determination.
WHAT'S THE IMPACT?
The final rule applies to non-citizens requesting admission to the U.S. or applying for a green card from within the country. When assessing whether a non-citizen is "likely to become primarily dependent on the government for subsistence," DHS said it will not penalize those who choose to access most health-related benefits and other supplemental government services. That includes most Medicaid benefits (except for long-term institutionalization, such as residing in a nursing home, at government expense) and CHIP.
DHS will also not consider non-cash benefits provided by other government agencies, including food and nutrition assistance, such as the Supplemental Nutrition Assistance Program (SNAP); disaster assistance received under the Stafford Act; pandemic assistance; benefits received via a tax credit or deduction; and government pensions or other earned benefits.
Receiving cash-based benefits, such as Supplemental Security Income and Temporary Assistance for Needy Families, will not automatically exclude someone from admission or green card eligibility, and will instead be considered in a "totality of the circumstances" analysis.
Reversing the Trump-era public charge rule has long been a stated goal of the Biden Administration. DHS said Thursday that the Trump rule "had the harmful effect of discouraging many immigrants from seeking benefits, such as CHIP and other government services for which they, their children, or their families were eligible, out of fear of jeopardizing their immigration status."
THE LARGER TREND
President Biden first began a push to reverse the public charge rule in February 2021, when he issued an executive order directing federal agencies to review Trump-era immigration policies that affect immigrants' access to healthcare.
This action drew praise at the time from groups such as America's Essential Hospitals and the American Hospital Association.
"The damaging change that applied the public charge determination to non-emergency Medicaid created a chilling effect on immigrants' access to healthcare services, causing many to forgo needed treatment for fear of losing their status as legal residents," Dr. Beth Feldpush, senior vice president of policy and advocacy at America's Essential Hospitals, said at the time. "The policy created an unacceptable risk of people seeking care only as a last resort when they are sicker and more costly to treat."
DHS under the Trump Administration had said the public charge rule was meant to ensure immigrants "are self-sufficient, i.e., do not depend on public resources to meet their needs, but rather rely on their own capabilities, as well as the resources of family members, sponsors and private organizations."
Decreased rates of participation in safety net programs increase uninsured rates among immigrant families, ultimately reducing their access to care and contributing to worse health outcomes, the Kaiser Family Foundation said in a report about the public charge rule.
Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com
