Legal immigrants using Medicaid penalized under new Trump rule
Skip to main content
MDHC_Logotype_white
Subscribe
  • My Account
  • Login
  • Subscribe
  • News
    • This Week's News
    • COVID-19
    • Providers
    • Insurance
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • People
    • Regional News
    • Digital Edition
    • Feds shouldn't lose sight of drug misuse epidemic, GAO says
      OU Health Physicians, Oklahoma Blues plan fail to reach new contract
      NIH, partners commit $74.9M to new phase of Alzheimer's program
      COVID, one year later: New York hospital execs reflect on lessons learned
    • COVID, one year later: New York hospital execs reflect on lessons learned
      Senate Dems sorting final details of $1.9T virus relief bill
      White House: Merck to help produce rival J&J's vaccine
      Blue Cross NC claims costs rise thanks to COVID
    • Shareholder group calls out HCA for alleged excessive emergency department admissions
      Metrologo 600x400_i.jpg
      MetroHealth forms Center for Cancer Research
      The Check Up: Dr. Marc Boom
      The Check Up: Dr. Marc Boom of Houston Methodist
      Dr. Marc Boom
      Q&A: Houston Methodist CEO praises staff efforts to keep vaccine efforts going during ice storm
    • OU Health Physicians, Oklahoma Blues plan fail to reach new contract
      Blue Cross NC claims costs rise thanks to COVID
      BlueCrossBlueShieldSign-main_i_i_i.jpg
      Michigan Blues post lowest operating profits in four years amid COVID-19 pandemic
      Highmark, HealthNow finalize affiliation, creating fourth-largest Blues plan
    • Feds shouldn't lose sight of drug misuse epidemic, GAO says
      House health panel chair says it's time to make Medicare telehealth permanent
      Pandemic raises questions about impact of Medicare pay restructuring in long-term care
      Proposed overhaul of Arkansas Medicaid expansion unveiled
    • UPMC's patient volumes stabilize, boosting 2020 profits
      Genomics firms taking advantage of SPACs trend to go public faster
      COVID-19 could dent hospital revenue by at least $53 billion in 2021, AHA says
      deloitte GDP image chart graph going up
      Sponsored Content Provided By Deloitte
      Breaking the cost curve
    • Teladoc reports $383.3M in fourth-quarter revenue, up 145%
      man and woman looking at ipad wearing face masks stock image
      Sponsored Content Provided By Surescripts
      Improvements to benefits data can enhance ePrescribing and the patient experience
      Oscar Health's $1B IPO sets the stage for more health tech exits in 2021
      A map of the U.S. with images of the coronavirus.
      The digital divide becomes a new social determinant of health
    • Highmark Health partners with Verily subsidiary on chronic care issues
      Children's mental healthcare needs skyrocket during pandemic
      Tensions over vaccine equity pit rural against urban America
      Utah cancels vaccine appointments after registration error
    • Alicia Wilson
      Q&A: Emerging leader Alicia Wilson on staying close to home
      Michael Jordan, Novant team up to address health equity
      Former Ascension CEO, the first to lead the health system, passes away
      Biden's pick to head CMS would be first Black woman to hold post
    • Midwest
    • Northeast
    • South
    • West
  • Insights
    • ACA 10 Years After
    • Best Practices
    • Special Reports
    • Innovations
    • The Affordable Care Act after 10 years
    • Dr. John Fischer
      Patient-reported outcomes tool for hernia surgery helps physicians improve care
      New care model helps primary-care practices treat obesity
      doctor with patient
      COVID-19 treatment protocol developed in the field helps patients recover
      Rachel Wyatt
      Project to curb pressure injuries in hospitals shows promise
    • What's next for on-demand telehealth companies?
      A CalOptima PACE vaccination clinic.
      Will COVID-19 be the catalyst for creating a more sustainable healthcare system?
      A map of the U.S. with images of the coronavirus.
      The digital divide becomes a new social determinant of health
      Ascension’s St. Mary’s Hospital Surgery Center at Towne Centre and Allegheny Health Network’s Bethel Park surgery center
      Hospitals see opportunity, risk in ambulatory surgery centers
    • Dr. Daniel Hall
      UPMC pilots machine learning, telehealth to inform patient transfers
      A woman being recorded using her inhaler on a smartphone.
      Digital check-ins, connected inhalers help control asthma
      A phone screen showing the question, "Mary we hope this information was helpful and we'd like to keep guiding you. Are you interested in knowing when it's your turn to receive the vaccine?"
      Chatbots, texting campaigns help manage influx of COVID vax questions
      A woman with a wearable sensor talking to her provider.
      Wearable sensors help diagnose heart rhythm problems in West Virginia
  • Transformation
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • What's next for on-demand telehealth companies?
      Rising prescription copays drop adherence, spike mortality, research shows
      Dr. John Fischer
      Patient-reported outcomes tool for hernia surgery helps physicians improve care
      Highmark Health inks six-year cloud, tech deal with Google
    • Hospitals' Medicare billing practices suggest upcoding, OIG says
      California hospitals prepare ethical protocol to prioritize lifesaving care
      Amazon, JPMorgan Chase, Berkshire Hathaway disband Haven
      Digital pathways poised to reshape healthcare continuum in 2021
    • Dr. Daniel Hall
      UPMC pilots machine learning, telehealth to inform patient transfers
      A woman being recorded using her inhaler on a smartphone.
      Digital check-ins, connected inhalers help control asthma
      Humana partners with in-home provider for 24/7 care
      A phone screen showing the question, "Mary we hope this information was helpful and we'd like to keep guiding you. Are you interested in knowing when it's your turn to receive the vaccine?"
      Chatbots, texting campaigns help manage influx of COVID vax questions
    • Bundled payments reduce surgery costs by 10.7%
      Coordinated payment policies could speed transition to value, experts say
      CMMI's geographic direct contracting model needs an overhaul, experts say
      Hospitals fight UnitedHealthcare policies over lab test, specialty drug payments
  • Data/Lists
    • Rankings/Lists
    • Interactive Databases
    • Data Points
    • Health Systems Financials
      Executive Compensation
      Physician Compensation
  • Op-Ed
    • Bold Moves
    • Breaking Bias
    • Commentaries
    • Letters
    • Vital Signs Blog
    • From the Editor
    • Dr. Alan Kaplan
      The risks, rewards of taking organizations 'where they haven’t gone before'
      Wellstar CEO calls adapting for the pandemic her bold move
      Howard P. Kern
      Recognizing the value of telehealth in its infancy
      Dr. Stephen Markovich
      A bold move helped take him from family doctor to OhioHealth CEO
    • Dr. Stephen Markovich
      Making sure we're aligned along the path to achieving inclusion
      Barry Ostrowsky
      Ending racism is a journey taken together; the starting point must be now
      Laura Lee Hall and Gary Puckrein
      Increased flu vaccination has never been more important for communities of color
      John Daniels Jr.
      Health equity: Making the journey from buzzword to reality
    • Vaccinating children could be the key to ending the pandemic
      Mikelle Moore
      The promising future of rural healthcare, even amid the COVID-19 pandemic
      In-person visitation must be part of the national COVID-19 response
      We've lost so much to the pandemic, but we've also made gains that will endure
    • Letters: Eliminating bias in healthcare needs to be ‘deliberate and organic’
      Letters: Maybe dropping out of ACOs is a good thing for patients
      Letters: White House and Congress share blame for lack of national COVID strategy
      Letters: VA making strides to improve state veterans home inspections
    • Sponsored Content Provided By Optum
      How blockchain could ease frustration with the payment process
      Sponsored Content Provided By Optum
      Three steps to better data-sharing for payer and provider CIOs
      Sponsored Content Provided By Optum
      Reduce total cost of care: 6 reasons why providers and payers should tackle the challenge together
      Sponsored Content Provided By Optum
      Why CIOs went from back-office operators to mission-critical innovators
  • Awards
    • Award Programs
    • Nominate
    • Previous Award Programs
    • Other Award Programs
    • Best Places to Work in Healthcare Logo for Navigation
      Nominations Open - Best Places to Work in Healthcare
      Nominations Open - 50 Most Influential Clinical Executives
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top 25 Innovators
    • Minorities in Healthcare
      • - Luminaries
      • - Top 25 Minority Leaders
      • - Minorities to Watch
    • Women in Healthcare
      • - Luminaries
      • - Top 25 Women Leaders
      • - Women to Watch
    • Excellence in Nursing Awards
    • Design Awards
    • Top 25 COOs in Healthcare
    • 100 Top Hospitals
    • ACHE Awards
  • Events
    • Conferences
    • Galas
    • Webinars
    • COVID-19 Event Tracker
    • podium march webinar logo lockup
      Sponsored Content Provided By Podium
      Webinar: Critical Touchpoints for Every Patient’s Journey — How Technology Plays an Important Role
      scp health logo lockup march 2021
      Sponsored Content Provided By SCP Health
      Webinar: COVID’s call to action — Reset for success in 2021
    • Women Leaders in Healthcare Conference
    • Social Determinants of Health Symposium
    • Healthcare Transformation Summit
    • Leadership Symposium
    • Virtual Briefings
      • - Hospital of the Future
      • - Mental Health
      • - Patient Safety & Quality
      • - Strategic Marketing
      • - Virtual Health
      • - Workplace of the Future
    • Best Places to Work Awards Gala
    • Health Care Hall of Fame Gala
    • Top 25 Minority Leaders Gala
    • Top 25 Women Leaders Gala
  • Listen
    • Podcast - Next Up
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Video Series - The Check Up
    • Sponsored Video Series - One on One
    • Next Up Podcast: Educating patients on the COVID-19 vaccine with Tanya Andreadis
      Dr. Joseph Cacchione
      Next Up Podcast: Educating patients on the COVID-19 vaccine with Dr. Joseph Cacchione
      Dr. Karen DeSalvo
      Next Up Podcast: What to expect with telehealth and healthcare technology in the next four years
      Carter Dredge
      Next Up Podcast: Ready, set, innovate! Innovation and disruption in healthcare
    • Beyond the Byline: Insurers are betting on virtual-first plans as COVID-19 shifts care pathways
      Beyond the Byline: How residents' stories shape our coverage of the vaccination rollout in nursing homes
      Beyond the Byline: Regulators aim to boost value push with fraud and abuse law updates
      An older man wearing a mask receiving a vaccine.
      Beyond the Byline: Verifying information on the chaotic COVID-19 vaccine rollout
    • Outreach during COVID-19
      Leading intention promote diversity and inclusion
      Introducing Healthcare Insider Podcast
    • The Check Up: Dr. Marc Boom
      The Check Up: Dr. Marc Boom of Houston Methodist
      The Check Up: Dr. Imran Andrabi
      The Check Up: Dr. Imran Andrabi of ThedaCare
      The Check Up: Tanya Blackmon
      The Check Up: Tanya Blackmon of Novant Health
      The Check Up: Dr. Patrick Hwu
      The Check Up: Dr. Patrick Hwu of the Moffitt Cancer Center
    • ivana naeymi-rad one on one intelligent medical objects
      Video: Ivana Naeymi Rad of Intelligent Medical Objects
  • MORE +
    • Advertise
    • Media Kit
    • Newsletters
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Breadcrumb
  1. Home
  2. Medicaid
August 12, 2019 11:19 AM

Trump finalizes rule penalizing legal immigrants for using Medicaid, SNAP

Harris Meyer
  • Tweet
  • Share
  • Share
  • Email
  • More
    Print
    Getty Images

    Legal immigrants will jeopardize their legal status in the U.S. if they use government benefits like Medicaid under a controversial rule finalized by the Trump administration Monday.

    The so-called public charge rule, published in the Federal Register by the Department of Homeland Security, will allow federal immigration officials to consider legal immigrants' use of public health insurance, nutrition, housing and other programs as a strongly negative factor in their applications for permanent legal residency.

    Other negative factors include having a medical condition that will interfere with being able to work or go to school; not having health insurance or being able to afford medical costs; and being younger than 18 or older than 61.

    It takes effect on Oct. 15 and is not retroactive for participation in public benefit programs before the rule takes effect.

    "The benefit to taxpayers is seeking to ensure that legal permanent residents can stand on their own two feet," said Ken Cuccinelli, acting director of the U.S. Citizenship and Immigration Services. "That self-sufficiency is a central part of the American value set."

    But leaders of many healthcare organizations, including the American Hospital Association, America's Essential Hospitals, the American Academy of Family Physicians and the American Academy of Pediatrics, warn that the rule will hurt public health efforts and reduce their ability to serve millions of low-income children and families. They point to evidence that fear created by the proposal already has shrunk participation in health programs.

    "This rule... creates barriers to appropriately caring for the sick and injured, and to keeping people healthy," said Rick Pollack, CEO of the American Hospital Association, in a statement. "Failure to provide such services also has public health implications that could have widespread impact."

    Hundreds of thousands of children and other members of low-income legal immigrant families are likely to drop out of public programs providing healthcare, nutrition and housing assistance due to the 837-page rule, experts said.

    The changes also would apply to citizens' and legal residents' requests to bring family members into the U.S., as well as to young people who have legal status under the Deferred Action for Childhood Arrivals program, known as Dreamers. They would not apply to people granted refugee status or political asylum.

    The public benefits covered by the proposed rule include Medicaid, the Supplemental Nutrition Assistance Program and Section 8 housing vouchers. The agency did not include the Children's Health Insurance Program, after asking for public comment on that issue.

    The final rule also excluded Medicaid received by pregnant women and those under age 21, as well as public benefits received by legal immigrant children of U.S. citizens.

    Immigrants affected by the rule would have to use one of the designated public benefit programs for more than 12 months in total within any 36-month period.

    The Trump administration pushed through the rule despite receiving more than 260,000 public comments last fall, with the overwhelming majority opposing the rule. Many commenters urged the administration to withdraw the entire rule.

    Immigration officials currently are only allowed to consider families' use of public cash benefits and Medicaid long-term care benefits in evaluating applications for legal permanent residency and legal entry into the United States. A 1999 rule clarification said noncash benefits like Medicaid cannot be considered.

    DHS has said the rule is consistent with long-standing U.S. policy requiring immigrants to show they can support themselves financially.

    The agency said the rule will reduce federal and state spending on public benefit programs by $17.3 billion to $21 billion over 10 years. But it acknowledged that might negatively affect state and local economies, resulting in reduced revenues for healthcare providers, medical suppliers and other businesses.

    In addition, DHS said the rule will impose "familiarization" costs on providers and other groups because it will take an estimated 16 to 20 hours per person to study the complex rule.

    Healthcare leaders claim the rule would drive up uncompensated-care costs, increase use of emergency departments, endanger maternal and infant health and heighten the risk of infectious disease epidemics. It also could shift major costs from the federal government to state and local governments.

    The American Hospital Association and other groups warned that legal immigrant families may forgo healthcare benefits and services out of fear of repercussions, such as deportation. That could drive up costs for all patients and payers.

    DHS estimated the regulation will affect about 382,000 people a year. But many experts predicted it will have a far broader impact because families will worry that any member's use of a public benefit programs could jeopardize their legal status.

    Those concerns likely will spill over to families and family members to whom the rule does not apply including citizen children of undocumented immigrants, those applying for political asylum and those who already have green card status or are naturalized citizens.

    The chilling effect is even expected to reduce participation in programs not covered by the rule, such as CHIP; the Women, Infants and Children nutrition program; Head Start; and Affordable Care Act premium subsidies, experts said.

    "Pediatricians across the country have witnessed the chilling effect, with immigrant families disenrolling or avoiding health services," said Dr. Julie Linton, chair of the American Academy of Pediatrics' Council on Immigrant Child and Family Health. "I'm unsure how to guide families when I know enrollment in key health programs could jeopardize their families' unity."

    Cuccinelli sidestepped questions Monday about the chilling effect, saying that people can easily determine from his agency's website whether use of particular public benefit programs would adversely affect their legal permanent residency application.

    In 2016, there were 10.4 million citizen children with at least one parent who isn't a citizen, and 56% had Medicaid or CHIP coverage. An estimated 27 million immigrants and their children are part of families with at least one member receiving public benefits, according to the Migration Policy Institute.

    The Kaiser Family Foundation estimated last year that up to 2 million children who are U.S. citizens with immigrant parents could drop out of Medicaid and CHIP, and most would become uninsured.

    A study published in May by the Urban Institute found that 13.7% of adults in immigrant families reported they did not participate in public benefit programs because they feared losing their legal status under the then-proposed rule. The percentage rose to 20.7% among adults in low-income immigrant families.

    Of the families that reported not participating in a public benefit program due to concerns about the rule, 14.7% were in families where all the members who weren't citizens already had green cards, and 9.3% were in families where all members were naturalized citizens.

    Adults in immigrant families with children were more than twice as likely to report chilling effects as adults in families without children—17.4% versus 8.9%.

    SNAP, Medicaid and CHIP were the three most common programs that immigrants reported dropping out of or not signing up for.

    The public charge rule is part of the administration's broader campaign to limit both legal and illegal immigration.

    Marielena Hincapié, executive director of the National Immigration Law Center, said her organization and other groups will sue the agency to block the rule.

    A group of 17 state attorneys general recently sent a letter to the Office of Management and Budget warning that DHS had failed to estimate the true costs of the public charge rule, including injury to states' economies.

    House Democrats have filed a bill to block funding for the rule's implementation.

    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    Proposed overhaul of Arkansas Medicaid expansion unveiled
    Proposed overhaul of Arkansas Medicaid expansion unveiled
    Aetna challenges exclusion from Oklahoma's new Medicaid managed-care program
    Aetna challenges exclusion from Oklahoma's new Medicaid managed-care program
    Sponsored Content
    Get Free Newsletters

    Sign up for free enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today

    The weekly magazine, websites, research and databases provide a powerful and all-encompassing industry presence. We help you make informed business decisions and lead your organizations to success.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS
    • Instagram

    Stay Connected

    Join the conversation with Modern Healthcare through our social media pages

    MDHC_Logotype_white
    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Advertise with Us
    • Ad Choices Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    • Privacy Request
    Modern Healthcare
    Copyright © 1996-2021. Crain Communications, Inc. All Rights Reserved.
    • News
      • This Week's News
      • COVID-19
      • Providers
      • Insurance
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition
    • Insights
      • ACA 10 Years After
      • Best Practices
      • Special Reports
      • Innovations
    • Transformation
      • Patients
      • Operations
      • Care Delivery
      • Payment
    • Data/Lists
      • Rankings/Lists
      • Interactive Databases
      • Data Points
    • Op-Ed
      • Bold Moves
      • Breaking Bias
      • Commentaries
      • Letters
      • Vital Signs Blog
      • From the Editor
    • Awards
      • Award Programs
        • 100 Most Influential People
        • 50 Most Influential Clinical Executives
        • Best Places to Work in Healthcare
        • Health Care Hall of Fame
        • Healthcare Marketing Impact Awards
        • Top 25 Emerging Leaders
        • Top 25 Innovators
        • Minorities in Healthcare
          • - Luminaries
          • - Top 25 Minority Leaders
          • - Minorities to Watch
        • Women in Healthcare
          • - Luminaries
          • - Top 25 Women Leaders
          • - Women to Watch
      • Nominate
      • Previous Award Programs
        • Excellence in Nursing Awards
        • Design Awards
        • Top 25 COOs in Healthcare
      • Other Award Programs
        • 100 Top Hospitals
        • ACHE Awards
    • Events
      • Conferences
        • Women Leaders in Healthcare Conference
        • Social Determinants of Health Symposium
        • Healthcare Transformation Summit
        • Leadership Symposium
        • Virtual Briefings
          • - Hospital of the Future
          • - Mental Health
          • - Patient Safety & Quality
          • - Strategic Marketing
          • - Virtual Health
          • - Workplace of the Future
      • Galas
        • Best Places to Work Awards Gala
        • Health Care Hall of Fame Gala
        • Top 25 Minority Leaders Gala
        • Top 25 Women Leaders Gala
      • Webinars
      • COVID-19 Event Tracker
    • Listen
      • Podcast - Next Up
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Video Series - The Check Up
      • Sponsored Video Series - One on One
    • MORE +
      • Advertise
      • Media Kit
      • Newsletters
      • Jobs
      • People on the Move
      • Reprints & Licensing