The Biden administration officially proposed a replacement to a controversial Trump-era policy that allowed federal officials to consider immigrants' potential use of public programs like Medicaid when evaluating permanent residency applications.
Benefits including the Children's Health Insurance Program and most Medicaid coverage would not be considered during residency determinations under the proposed rule released Thursday by the Homeland Security Department. Cash assistance, supplemental security income, and long-term institutionalization paid for by the government would still be considered through the new policy.
"Under this proposed rule, we will return to the historical understanding of the term 'public charge' and individuals will not be penalized for choosing to access the health benefits and other supplemental government services available to them," Homeland Security Secretary Alejandro Mayorkas said in a news release.
Research shows the policy significantly chilled Medicaid enrollment among immigrants and their families. More than one in six adults in immigrant families indicated that they or a family member avoided using a government program including Medicaid in 2020 because of concerns about future residency applications or immigration enforcement, according to a 2021 Urban Institute study. The Migration Policy Institute also found Medicaid participation by non-citizens decreased by 20% between 2016 and 2019.
The Trump public charge rule quickly became the subject of multiple lawsuits. The U.S. Supreme Court agreed to hear arguments on the rule last year before the Biden administration decided not to defend the rule. The Supreme Court dismissed the case.
The Biden administration vacated and removed the 2019 policy last March and has been using the 1999 interim guidance on public charge provisions since then. The proposed rule announced Thursday seeks to replace the policy.
But the policies' chilling effects will take time and effort to reverse, experts say. A brief released by the Children's Hospital of Philadelphia's PolicyLab last year emphasized that axing the rule isn't enough to mitigate its impact. Healthcare systems, public health groups and community leaders will need to invest in explaining the change to immigrant communities and support them through applying for benefits, the brief said.
The newly proposed public charge rule is subject to a 60-day public comment period.