Last week the Trump administration published its long-anticipated proposed “public charge” rule, which carries enormous implications for Medicaid and immigrants enrolled in the program. A public charge is an individual considered dependent on the government for subsistence. The proposal would radically expand the extent to which public benefits received by legal immigrants who are not yet citizens are used as evidence of public charge status. This status plays a role in determining admission into the United States, and adjusting legal residency to permanent “green card status.”
Current policy states that medical assistance counts as evidence of public charge only when it is used to pay for long-term institutional care. The rule, now in a 60-day comment period, would sweep away this approach. Enrollment for more than 12 months over a three-year period in virtually any forms of Medicaid could be used as evidence in a public charge determination. Only Medicaid-covered emergency services (available to all immigrants, authorized or otherwise), and Medicaid enrollment and services provided in school settings to children with disabilities and other children would not count.
The administration’s proposed policy shift disincentivizes anything more than short-term enrollment to address immediate emergencies. The government has encouraged Medicaid enrollment by eligible legal immigrants in recent years, and the Migration Policy Institute estimates that more than 4 million legal U.S. residents who are not yet citizens receive Medicaid. Another nearly 9.6 million live in families in which a member (nearly always a U.S.-born child) is enrolled in Medicaid. Millions of these citizen children could be hurt by the “chilling effect” of this rule change that could lead parents to pull their still-eligible children out of Medicaid. The latest estimates put the coverage losses between 2.1 million and 4.9 million legal immigrants.