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.”