Rule expanding definition of 'public charge' criteria to Medicaid draws fire from hospitals and advocates for immigrant families

Acting Citizenship and Immigration Director Ken Cuccinelli
announced the final rule at a White House press conference.

Adult immigrants would find it harder to remain in the United States if they signed up for Medicaid benefits, under a rule that the Department of Homeland Security finalized Aug. 12.

The rule brought "outcry from stakeholders across the health-care industry who say the policy will drive up the number of uninsured patients and increase the cost of uncompensated care," reports James Romoser of Inside Health Policy. "Immigration advocates and the California attorney general have already indicated they intend to sue to stop the so-called public-charge rule, which is scheduled to take effect Oct. 15."

The rule "is in some respects not as harsh as the proposed rule released last fall," Romoser writes. "The administration backed off its proposal to penalize immigrants who receive Medicare Part D low-income subsidies, and it also decided not to penalize immigrants who receive Medicaid while they are pregnant or under the age of 21."

Still, six major hospital lobbies said in a joint statement, “This rule could undermine access to care for legal immigrants by discouraging the use of critical public programs like Medicaid. We are concerned that this could lead to delays in care that would negatively impact the health of the communities we serve. We ask the administration to withdraw this harmful rule.” The statement came from the American Hospital Association, America’s Essential Hospitals, the Association of American Medical Colleges, the Catholic Health Association of the United States, the Children’s Hospital Association and the Federation of American Hospitals.

"The Trump administration said the rule will better enforce provisions in immigration law meant to deny permanent legal residency to any immigrant likely to become a 'public charge,' a term used for people who depend on government assistance," Romoser reports. The term has been used as a criterion since Congress passed the first immigration law in 1882.

However, the term has historically "focused on cash welfare programs, Romoser notes. "The new rule broadly expands the definition to include food stamps, housing vouchers and Medicaid. Under the rule, even a short stint on Medicaid could doom an immigrant’s chance to remain in the country legally, immigration advocates say."

Sara Rosenbaum writes for The Commonwealth Fund, "Whereas before only nursing home care counted toward public-charge status, now a host of services, from preventive care to treatment of chronic conditions like diabetes, could render someone a public charge after 12 months."

Kaiser Family Foundation chart; click on it for a larger version

Other critics fear a chilling effect on immigrants with U.S.-born children, who are citizens. "Enrolling their children in Medicaid is not supposed to trigger any penalties," Romoser reports, "but widespread fear about the rule is already causing many immigrant families to avoid seeking Medicaid or any other government assistance even for children who are U.S. citizens, stakeholders say."

"Researchers at the Georgetown University Center for Children and Families said in a May report that fears in the immigrant community contributed to a 2.2% decline in children enrolled in Medicaid and CHIP last year," Romoser notes. "In an analysis of the proposed rule, the Kaiser Family Foundation estimated that between 2.1 million and 4.9 million Medicaid and CHIP enrollees living in a household with a noncitizen would disenroll from the insurance programs."

Ken Cuccinelli, acting director of U.S. Citizenship and Immigration Services, said at a White House announcement, “President Trump’s administration is re-enforcing the ideal of self-sufficiency and personal responsibility, ensuring that immigrants are able to support themselves and become successful in America.”