Supreme Court Paves Way for Public Charge Regulation

The revised public charge regulation that will make it more difficult for some immigrants to come to the U.S. will be implemented after the Supreme Court lifted preliminary injunctions issued by lower courts that delayed the regulation’s implementation.

Under revisions of the public charge regulation introduced last year, individuals seeking entry into the U.S. and green cards who do not appear to be financially independent or have employment commitments can be denied entry if they will be dependent on means-tested public aid programs such as Medicaid or food stamps or even if they, or members of their family, appear likely to become dependent on such aid in the near future.

A number of judges throughout the country blocked the administration’s implementation of revisions of the public charge rule.  The Supreme Court’s action only lifts those injunction; it does not address the constitutionality of the regulation, leaving that matter to continue to be addressed by lower courts for now.

The challenge posed to health care providers by the updated public charge regulation is as much a matter of perception as reality:  individuals already legally in the U.S. who are not subject to the regulation have withdrawn from Medicaid out of fear of deportation while others who also are in the country legally and qualify for Medicaid are choosing not to apply for benefits for the same reason.  This, in turn, may leave some providers with more uncompensated care instead of Medicaid reimbursement for the care they provide to some of their patients.

The National Alliance of Safety-Net Hospitals has conveyed its opposition to the public charge regulation to both Congress and the administration.  In a message to Congress, NASH wrote that “The new public charge regulation threatens the health of families and communities and threatens the ability of private safety-net hospitals to serve those families and those communities.”  In response to the proposed changes in the regulation, NASH wrote in a formal comment letter on behalf of private safety-net hospitals that it

…believes the proposed regulation could have a chilling effect on the willingness of many legal citizens and legal non-citizens to seek out government health care programs for which they legally qualify. This could lead to millions of low-income legal citizens and legal non-citizens choosing not to seek the care to which they are entitled by law and ignoring serious illnesses and injuries until they become a crisis. When such individuals have no choice but to turn to hospital emergency departments in search of care – something hospital emergency departments are required by law to provide regardless of a patient’s ability to pay – this could overwhelm those facilities and would do so to the detriment of other patients while also producing a surge of uncompensated care, especially for private safety-net hospitals. That, in turn, could jeopardize the jobs of thousands who work in those hospitals and the economies of the communities in which those hospitals are located. It could also jeopardize access to care for residents of these same communities – including ordinary people who receive their health care coverage from private insurers and Medicare.

See NASH’s entire comment letter here.

Learn more about the Supreme Court’s decision and how it affects implementation of the public charge regulation in the New York Times article “Supreme Court Allows Trump’s Wealth Test for Green Cards.”

 

Proposed Immigration Rule Discouraging Medicaid Enrollment

A proposal by the U.S. Department of Homeland Security is discouraging participation in Medicaid and other government safety-net programs.

A proposed Homeland Security regulation would establish new criteria for determining whether individuals seeking admission into the U.S. might eventually become “public charges”:  people who would depend on public resources to meet their needs rather than the resources of friends, family, sponsors, or private organizations or be able to provide for themselves or their families.  Among those criteria are past use of government aid programs and current income and health status.

Since the regulation was proposed last October, many legal immigrants, including those who already have green cards, have grown fearful of its implications and have shied away from seeking assistance from public aid programs and have even chosen to withdraw from programs in which they were already participating.  Among the survey’s findings:

  • 13.7 percent of adults in immigrant families reported family members dropping out of non-cash aid programs.
  • 17.4 percent of adults in immigrant families with children under the age of 19 were more likely to avoid public benefit programs.
  • Among those who reported avoiding public aid programs, 46 percent reported choosing not to participate in the federal Supplemental Nutrition Assistance Program (formerly food stamps), 42 percent reported someone in their household not participating in Medicaid even though they were eligible for the program, and 33.4 percent did not participate in housing subsidies.

Any withdrawal of legal residents from Medicaid or unwillingness to enroll in the program when eligible could leave hospitals with increased uncompensated care when serving low-income patients who otherwise lack the means to pay for their care.  This could pose a particular challenge for private safety-net hospitals because they serve communities with especially large numbers of low-income residents.

Learn more about the proposed public charge regulation and its apparent impact on participation in government safety-net programs among legal immigrants in the Urban Institute report “With Public Charge Rule Looming, One in Seven Adults in Immigrant Families Reported Avoiding Public Benefit Programs in 2018.”