Last week, the Trump Administration released a final rule pertaining to immigration that will ultimately make it more difficult for many immigrants to access healthcare. MHA, along with healthcare providers and other advocates across the country, has strongly opposed the revised rule from the outset, and remains opposed despite several modifications to the initial proposed rule in the final version. Thirteen states, including Massachusetts, have already filed suit in US District Court to challenge the changes.
At issue is how the rule re-defines who could be determined a “public charge” of the government and therefore potentially ruled inadmissible for immigration into the United States. A public charge is an individual who is likely to become “primarily dependent on the government for subsistence.” For the past 20 years, this definition has been limited to individuals who receive cash assistance and/or use long-term care at the government’s expense.
When making immigration determinations under the new rules, the federal government will now consider past use of numerous new programs – including non-emergency Medicaid benefits – in determining whether a person seeking to change their immigration status can support themselves financially or if they are at risk of becoming a public charge. While the determination is prospective, use of certain public benefits within the past 36 months will be factored into the “totality of circumstances” including age, health, family status, resources, education, etc. The final rule exempts children up to age 21 and pregnant women (including 60 days after pregnancy) from the provision that negatively considers use of non-emergency Medicaid. Medicare Part D benefits are also exempt in the final version. Use of other public benefits, however, including Supplemental Nutrition Assistance Program (SNAP) and many federal housing programs, will still be considered under the final rule.
These expanded considerations remain very concerning and are expected to have a detrimental effect on healthcare access for immigrants and severely hamper the providers that care for them.
In December, MHA President and CEO Steve Walsh wrote to the Department of Homeland Security opposing the proposed rule, stating “an expansion of [the public charge] definition to include healthcare benefits such as Medicaid will likely mean many immigrants will withdraw or forgo applying for health coverage programs. Worse, many may also forgo even seeking medical care if they believe it will be a potential negative factor in their future immigration status.” MHA further noted that the new rule will create a “chilling effect” that will extend beyond those directly affected by the rule. Given the complexity of immigration rules and healthcare programs, many immigrants will fear participating in federal and state programs.
The rule is currently set to become effective October 15, 2019, and will apply prospectively to those seeking a change in their immigration status. MHA will be working with its members, the commonwealth, the Congressional delegation, and other healthcare stakeholders during the coming months to address implications for Massachusetts healthcare programs.