By Stacy Collins, MSW, Associate Director, Health Systems Transformation

“In keeping with our nation’s values, this policy treats all those we serve with fairness and respect. Though there is still much to do to overcome confusion and fear, we will continue to work to break down barriers in the immigration system, restore faith and trust with our immigrant communities, and eliminate excessive burdens in the application process.” 

 

Ur Jaddou, Director, U.S. Citizenship and Immigration Services

In September, the Biden Administration took an important step in protecting immigrant families’ access to health, housing, and nutritional programs to which they are entitled, without fear of consequences to their immigration status. The Administration’s release of the revised “Public Charge” rule reduces the chilling effect of the previous rule, which created fear and uncertainty among immigrant families, and a reluctance to access services for their citizen children. As a result, many immigrant families have foregone benefits despite the hardships many have faced throughout the pandemic.

What is the “Public Charge” rule?

The “Public Charge” rule refers to an admissibility test that has been a component of federal immigration law for 140 years. It is designed to identify people who may depend on the government as their main source of support in the future. If an immigration official determines that someone is likely to become a “public charge,” the government can deny that person’s application for admission to the United States or for lawful permanent resident status.  The Public Charge test does not apply to humanitarian immigrants, including refugees, asylum seekers, and survivors of domestic violence and trafficking.

What changes to the Public Charge test were instituted in 2020? 

Historically, a Public Charge determination only considers an immigrant’s use of government income support programs – Supplemental Security Income (SSI), Temporary Assistance for Needy Families (TANF), and state and locally funded cash assistance for income maintenance – as well as long-term, Medicaid-funded institutional care.  In 2020, the scope of benefits in the Public Charge test was broadened to include Medicaid, Children’s Health Insurance Program (CHIP), Supplemental Nutrition Assistance Program (SNAP), and Section 8 housing assistance.  These changes created a climate of fear in immigrant communities and deterred many people, including those with American citizen children, from applying for these essential services, for fear of jeopardizing their immigration status.  Many immigrants also feared their information being shared with immigration enforcement authorities, which could result in deportation of family members.

Research from the Urban Institute found that in 2020, almost one in seven adults in immigrant families reported that they or a family member avoided a non-cash government benefit program, such as Medicaid, CHIP, SNAP, or housing assistance, because of concerns about future green card applications. This “chilling effect” was most significant in families more likely to be directly affected by the rule, such as those in which one or more members do not have a green card.

What does the updated Public Charge rule do?

The new policy restores the original Public Charge admissibility test, which had been in effect since 1999.  Once again, immigrants and their families can safely access non-cash health, nutritional and housing programs they qualify for, such as Medicaid/CHIP, SNAP, WIC, and Section 8 housing assistance. Benefits received from these programs will not count towards the Public Charge test.  Applying for benefits, being approved for benefits, assisting someone else to apply for benefits, or residing in the same household as someone who receives benefits will not be counted towards the applicant’s immigration application.  Immigrants should know it is always safe for their citizen children to receive benefits, including cash assistance.

The chilling effect of the 2020 rule was particularly alarming in the context of the COVID-19 pandemic. Immigrant families, particularly families of color, have disproportionately experienced economic and health hardships resulting from the pandemic.  Avoiding medical care and emergency supports necessitated by the pandemic presented serious risks to adults’ and children’s well-being.  Immigration advocates have noted that even with the new regulations, work must be done to battle the chilling effect the 2020 rule had on people’s willingness to access benefits.

What can MCH advocates do to support immigrant families now that the final Public Charge rule is in place?

The final rule comes at a critical time as the country prepares for Marketplace open enrollment and the unwinding of the COVID-19 Public Health Emergency (PHE).  State MCH programs, Medicaid/CHIP agencies, enrollment assistance personnel, and community-rooted organizations working to help enroll individuals in health insurance have important roles to play in helping immigrants access coverage for which they are eligible, including by informing them that enrolling in health coverage will not hurt their chances of obtaining a green card or becoming a citizen.

Likewise, education and outreach efforts to help families prepare for Medicaid redetermination at the end of the PHE must be specifically tailored to immigrant families, to ensure them that Medicaid renewal will not affect their immigration status. In many immigrant communities, there is understandably deep distrust in government institutions. As such, it is critical for MCH advocates to partner with community-rooted organizations, who are considered trusted messengers in their communities.

Looking forward……….

Immigration and MCH advocates applaud the restoration of a more humane Public Charge rule, which goes into effect on December 23, 2022. But full removal of the racist and classist Public Charge provision in U.S. immigration law will further advance equity and promote access to health care and economic well-being for immigrants and their families.

Resources:

• The final 2022 Public Charge rule.
• Public Charge resources from the U.S. Citizenship and Immigration Services.
• The Protecting Immigrant Families (PIF) Coalition toolkit to help families, advocates, and service providers understand the new Public Charge regulation.
• Issue brief: Reshaping the Narrative on Public Charge to Reach Immigrant Populations that Need Affordable Health Insurance.