September 24, 2018

Trump admin seeks to deny green cards to immigrants who use Medicaid, food stamps, or other public programs

Daily Briefing

    The Department of Homeland Security (DHS) on Saturday unveiled a proposed rule that would make it more difficult for non-citizens to enter the United States or become permanent U.S. residents if they receive or are likely to receive any of a wide range of public benefits, including Medicaid and Supplemental Nutrition Assistance Program (SNAP) benefits.

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    Proposed rule details

    The Immigration and Nationality Act lays out the factors immigration officials can consider when determining an applicant's inadmissibility on the grounds that he or she is likely to become a "public charge." For example, under current regulations, immigration officials can consider whether a family receives Medicaid long-term-care benefits when evaluating applications for non-citizens to become permanent U.S. residents or legally enter the United States.

    The proposed rule would broaden the criteria immigration officials can take into account when considering someone's immigration status or application for permanent residency to include a much wider range public benefits, including:

    • Medicaid—with a few exceptions for Medicaid benefits covering an "emergency medical condition" and disability services related to education;
    • Medicare Part D Low Income Subsidy; and
    • SNAP or food stamps.

    DHS under the proposed rule would "consider current and past receipt of designated public benefits above certain thresholds as a heavily weighed negative factor," a release stated. Under the rule, DHS "would also make nonimmigrants who receive or are likely to receive designated public benefits above the designated threshold generally ineligible for change of status and extension of stay."

    The proposed rule would apply to non-citizens and legal residents seeking to bring family into the United States, as well as to individuals with legal status under the Deferred Action for Childhood Arrivals program. The proposed rule would not apply to individuals granted political asylum or refugee status or to the parents or family of children with U.S. citizenship.

    DHS estimates the rule would affect about 382,000 individuals annually.

    The proposed rule will be open for public comment for 60 days after it is published in the Federal Register in the coming weeks. The public comment process takes about a year, Politico's "Pulse" reports.

    Implications

     Health care leaders have said the proposed rule could discourage legal immigrant families from enrolling in Medicaid and other federal assistance programs, which could have a substantial effect on health care services for low-income families. For example, they said the proposed rule could increase:

    • Emergency department use;
    • Maternal and infant health risks;
    • The risk of infectious disease epidemics; and
    • Uncompensated care costs.

    The Kaiser Family Foundation (KFF) estimated two million children with U.S. citizenship who have undocumented immigrants parents will drop out of CHIP or Medicaid and become uninsured under the proposed rule. KFF said their parents might think that enrolling them in CHIP or Medicaid would negatively affect their legal status, even though the proposed rule would not apply to them.

    Reaction

    DHS Secretary Kirstjen Nielsen in a statement said, "This proposed rule will implement a law passed by Congress intended to promote immigrant self-sufficiency and protect finite resources by ensuring that they are not likely to become burdens on American taxpayers." She added, "Under long-standing federal law, those seeking to immigrate to the United States must show they can support themselves financially."

    However, Colleen Kraft, president of the American Academy of Pediatrics, said, "The public charge proposal presents immigrant families with an impossible choice: keep yourself or your children healthy but risk being separated, or forgo vital services like preventive care and food assistance so your family can remain together in this country."

    America's Essential Hospitals (AEH) and other health care organizations have urged the administration to abandon or ease restrictions under the proposed rule.

    Bruce Siegel, president of AEH, said, "By creating a strong disincentive to seek care, this rule would force people to forgo medical visits and medications until they are sicker and costlier to treat."

    Olivia Golden, executive director of the Center for Law and Social Policy, said the Trump administration did not provide research to justify the proposed rule, which means the rule could be challenged under the Administrative Procedure Act, which requires federal agencies to provide a reasonable explanation when they change longstanding policies. 

    Some Democratic-led states already have indicated they are prepared to fight the proposed rule. California Attorney General Xavier Becerra (D) in said, "This is an assault on our families and our communities. California doesn't intend to backslide; we will do what we must to challenge this reckless proposal" (Armour/Caldwell, Wall Street Journal, 9/23; Meyer, Modern Healthcare, 9/23; Miroff, Washington Post, 9/22; AP/New York Times, 9/23; Reuters/New York Times, 9/22; DHS release, 9/22, Diamond, "Pulse," Politico, 9/24).

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