CHA News Article

Proposed Rule Expands List of Programs to Be Considered Under ‘Public Charge’ Test
Certain health care, nutrition and housing programs would now be considered

On Sept. 22, the U.S. Department of Homeland Security (DHS) announced a proposed rule that would change “public charge” policies. Under long-standing policy, the federal government can deny individuals U.S. entry or any adjustment to their legal permanent resident status (e.g., green card) if they are determined likely to become public charges. The proposed rule — which is narrower than the drafts that were leaked to the media this spring — expands the list of programs that may be considered to include not only cash assistance and long-term care but also certain health care, nutrition and housing programs.

If the rule is fi­nalized in its proposed form, the benefits considered would be greatly expanded to include:

  • Non-emergency Medicaid — Medi-Cal, in California — with limited exceptions for Medicaid benefits for treating an “emergency medical condition,” certain disability services related to education and benefits received by children of U.S. citizens who will be automatically eligible to become citizens
  • Supplemental Nutrition Assistance Program,  referred to as CalFresh in California
  • Low-income subsidies for prescription drug costs under Medicare Part D
  • Section 8 Housing Choice Voucher Program, Section 8 Project-Based Rental Assistance and public housing

Under the current policy, the only bene­fits considered in determining who is likely to become a “public charge” are:

  • Cash assistance such as Supplemental Security Income; Temporary Assistance for Needy Families, which is referred to as the California Work Opportunity and Responsibility to Kids program in California; and comparable state or local programs
  • Government-funded institutional long-term care

In its determination, DHS would not consider:

  • Disaster relief
  • Emergency medical assistance
  • Benefits received by an immigrant’s family members
  • Entirely state, local or tribal programs other than those specifically listed
  • Benefits that are not listed, such as education, child development, employment and job training programs
  • Bene­fits received by active duty service members as well as their spouses and children
  • Pell grants
  • Special Supplemental Nutrition Program for Women, Infants, and Children

DHS asks for input on inclusion of the Children’s Health Insurance Program, but this program is not included in the current regulatory text. Some immigrants — such as refugees, asylum seekers, survivors of domestic violence and other protected groups — are not subject to “public charge” determinations and would not be affected by this proposed rule. Public charge is also not a consideration when lawful permanent residents apply to become U.S. citizens. Additionally, the use of benefi­ts by eligible children who are not applying for status themselves would not be considered under this proposal. The rule would not be retroactive, meaning that benefits — other than cash or government-funded institutional long-term care — that are used before the rule is final and effective would not be considered in the public charge determination.

The proposed rule will be officially published in the Federal Register in the coming weeks. The comment period will last 60 days following the date of publication. CHA is currently reviewing the proposed rule and will submit comments outlining how it will impact Californians’ health care. In addition to the impact on those directly affected by the changes, it is likely that participation in Medi-Cal and other programs among legal immigrant families and their primarily U.S. born children would decrease. This could negatively affect the families’ health and financial stability, as well as their children’s growth and healthy development. Also, the number of uninsured individuals would likely increase.