Pa., N.J. health experts warn new Trump immigration rule will increase uninsured

The change widens the definition of “public charge” to mean people here legally who get public benefits like Medicaid, food stamps, and housing vouchers.

In this Jan. 31, 2019, file photo, hundreds of people overflow onto the sidewalk in a line snaking around the block outside a U.S. immigration office with numerous courtrooms in San Francisco.  (Eric Risberg/AP Photo, File)

In this Jan. 31, 2019, file photo, hundreds of people overflow onto the sidewalk in a line snaking around the block outside a U.S. immigration office with numerous courtrooms in San Francisco. (Eric Risberg/AP Photo, File)

Updated 2:15 p.m. Thursday

The Trump administration is making it more difficult for some immigrants who are in the United States legally and receiving certain public benefits to be granted permanent legal status here.

As it stands, if people are considered likely to become a “public charge” to the state, that will be counted against them in their applications for green cards. The new rule, which was announced Monday and published in the Federal Register Wednesday, will expand the definition of “public charge” to include those on public benefits such as Medicaid, food stamps, and housing vouchers.

In Pennsylvania, more than 9,000 lawful, non-citizen immigrants who were admitted to the United States for any temporary period of time (non-green card holders) were receiving Medicaid benefits in June. Under the new rule, continuing to do so would count against any effort for to apply for legal permanent residency.

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In New Jersey, the Department of Human Services estimated that as many as 20,000 eligible women and children enrolled in Medicaid and CHIP could be affected by the chilling effect of the proposed rule.

“The Murphy administration is committed to ensuring that residents who need assistance have access to nutrition, health care, and other essential support to help them get on the best possible financial footing,” said Human Services Commissioner Carole Johnson. “The public charge rule unfairly forces families to choose between critical services like health care services and food assistance and their green card. That is quite simply wrong. We continue to call on the federal government to withdraw this unfair rule.”

In 2017, there were 22 million non-citizen immigrants living in the United States, 60% of whom were here with some form of documentation. Some were granted temporary protected status, while others were here with work visas or had been granted temporary stays on their deportation or removal proceedings. That year, just over 1 million immigrants were granted legal permanent status in the United States, according to the Department of Homeland Security. About half had already been living here — that’s the group that would be most directly affected by the new rule.

But research has shown that a change like this also would likely have a “chilling effect,” causing those who would not necessarily be affected by the rule to avoid public benefits out of fear that enrolling would worsen their chances of being granted green cards. Many immigrant families live in households with a mix of documentation status. A Kaiser Family Foundation report estimated that Medicaid enrollment would drop between 15% and 35% if the proposed change went into effect, or by between 2.1 million and 4.9 million Medicaid/CHIP enrollees living in families with at least one noncitizen who would disenroll.

Although the new rule does not include enrollment in CHIP, the Children’s Health Insurance Program, as a cause for public charge designation, researchers and advocates are worried that parents will confuse that insurance program with Medicaid, causing their kids — many of whom are U.S.-born citizens — to lose health insurance.

Advocates for health care coverage say that the effects of this policy have already materialized. The Trump administration announced in October 2018 that it was considering the changes to the public charge law, which caused confusion among immigrants about whether taking advantage of certain public benefits would disqualify them from getting green cards.

“For the past year almost, we’ve seen the fear, the anxiety, folks not signing up their kids for coverage,” said Antoinette Kraus, director of the Pennsylvania Health Access Network, which helps signs people up for insurance across the state. “In some cases, families are disenrolling in public benefits just because of the uncertainty and the fear that they have of being associated with these programs.”

Kraus estimated that 20% of the clients her organization serves in Southeastern Pennsylvania are in immigrant communities.

“These are all folks who are here lawfully — they work hard, they play by the rules, they’re paying taxes, they should be eligible for these benefits,” Kraus said.

Ken Cuccinelli, acting director of U.S. Citizen and Immigration Services, announced the planned change Monday. On Tuesday, in an interview with NPR, he invoked the inscription on the Statue of Liberty to illustrate the change the new rule represents.

“Give me your tired and your poor who can stand on their own two feet and who will not become a public charge,” he said in an interview.

The rule will go into effect in October, though immigration advocates have promised to sue. The rule would not apply to people granted asylum or refugee status, or to people who already had green cards. Lawfully present immigrants would still be eligible for benefits from the Affordable Care Act.

In 1999, the Immigration and Naturalization Service (now absorbed into the Department of Homeland Security) issued guidance clarifying what constituted a public charge as someone who would become primarily dependent on public cash assistance programs or long-term institutionalization, but it specified that Medicaid would not be included.

The new rule expands the number of factors to be considered in public charge designations. On top of receiving public benefits like Medicaid, Medicare Part D, and subsidized public housing, the adjusted rule also considers a person’s income and part-time student status.

The designation is still up to the discretion of U.S. Citizen and Immigration Services. None of these factors would disqualify someone automatically on its own, but they are considered heavily weighted factors for or against a person’s designation.

This article was updated to include figures from Pennsylvania.


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