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October 12, 2018

House Dems seek to block proposal to tighten immigration rules for potential Medicaid beneficiaries

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    A coalition of 50 House Democrats on Tuesday introduced a bill (HR 7052) that would prevent federal funding from being used to implement a proposed rule that would make it more difficult for non-citizens who are receiving or are likely to receive Medicaid or other public benefits to legally enter the United States or become permanent U.S. residents.

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    Proposed rule details

    The proposed rule, which the Department of Homeland Security (DHS) unveiled last month, seeks to tighten regulations under the Immigration and Nationality Act that 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 of 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
    • Supplemental Nutrition Assistance Program benefits 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," according to a release. The release stated that, 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."

    DHS estimated the rule would affect about 382,000 individuals annually. It 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 families of children with U.S. citizenship.

    Health care groups, Democrats push back

    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 American Hospital Association in a statement said, "[H]ospitals and health systems have serious concerns that those legally in the country could choose to forgo healthcare benefits—and therefore delay accessing care—out of fear of repercussions for themselves and their families. Forgoing care can exacerbate medical conditions leading to sicker patients and a higher reliance on hospital emergency departments. In turn, this could drive up costs for all purchasers of care."

    According to Modern Healthcare, more than 1,500 advocacy organizations, including the American Public Health Association, have signed on a joint statement opposing the proposed rule.

    House Democrats on Tuesday added their voice to the opposition by introducing HR 7052.

    Rep. Judy Chu (D-Calif.), who sponsored the bill, called the proposed rule "an attack on immigrants" (DeChalus, CQ News, 10/10 [subscription required]; Meyer, Modern Healthcare, 10/10; DHS release, 9/22).

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