NYC Health & Hospitals projects $362M loss from Trump-proposed changes to public charge rule

New York City Health + Hospitals said Wednesday it could see a loss of up to $362 million in the first year alone if proposed changes to the public charge rule are enacted.

The Trump administration this year proposed changing the public charge rule, which determines whether immigrants can enter and stay in the United States based on the public benefits they use. The changes would expand guidelines beyond cash benefits to nutrition, housing and health benefits including Medicaid.

H+H is the city's largest provider of care to Medicaid patients, and about 40% of its patients were born outside the United States.

H+H and its patients are already feeling an impact from the proposed changes, which could ultimately affect 350,000 of the more than 1 million patients it sees each year, a spokesman for the health system said. Whether or not the changes are enacted, the fear exists, he said.

Not only could the changes lead to decreased revenue for H+H, they also could lead to increased costs from more emergency room visits and negative effects on health.

"New Yorkers should not have to choose between the health care services to which they are entitled and a green card," Dr. Mitchell Katz, president and CEO of H+H, said in a statement. Some of the system's patients have already declined to enroll in Medicaid as well as its MetroPlus health plan, he said, while others have opted out of the WIC program, a supplemental nutrition initiative for women, infants and children.

H+H said up to 62,000 of its patients ultimately could abandon Medicaid and other insurance, while many more patient visits and prescriptions—including those to treat and prevent contagious diseases—could fall by the wayside.

The health system developed its forecasts by drawing from outcomes of the Welfare Reform Act of 1996, the American Community Survey and its own patient insurance coverage information.

"We're not talking about something that's just research or projected harm, but something that we've seen historically, which is why the policy is what it is today," said Bitta Mostofi, commissioner of the Mayor's Office of Immigrant Affairs.

Public comments on the proposed public-charge-rule changes are due by Dec. 10.

"NYC Health & Hospitals projects $362M loss from Trump-proposed changes to public charge rule" originally appeared in Crain's New York Business.