WHA Opposes Department of Homeland Security “Public Charge” Proposed Rule Change

Could lead to loss of insurance coverage, more uncompensated care for hospitals

December 11, 2018

The Wisconsin Hospital Association (WHA) sent a comment letter Monday in response to the Department of Homeland Security’s proposed rule, “Inadmissibility on Public Charge Grounds.” The proposed rule would add Medicaid to the list of public benefits that would be considered in determining whether an immigrant is eligible to enter the U.S. or make changes to his or her immigration status. In its letter to the Department of Homeland Security, WHA noted that while it does not typically comment on immigration policy, the proposed rule could have adverse consequences for public health and hospital financial stability.

At the heart of the proposed rule is a longstanding immigration policy that immigrants coming to the U.S. should be able to support themselves and should not be dependent on government benefits. However, the new proposal from the Department of Homeland Security diverges from prior policy by expanding the list of benefits considered in determining whether an immigrant would be determined a public charge to include Medicaid, housing assistance, and Supplemental Nutrition Assistance (or FoodShare in Wisconsin). It would also change the definition of what is considered a public charge from someone who is “primarily dependent” on government assistance to someone who “receives one or more” government benefits for 12 months or more in a 36-month period.

Of particular concern, is that the proposal would be applied to immigrants already in the U.S. This means an immigrant could be faced with the decision of forgoing Medicaid benefits he or she is legally entitled to due to concerns it would hurt his or her immigration standing. WHA noted that the Department of Homeland Security itself recognized the consequences of this action could lead to more cases of uncompensated care and worse health outcomes as patients delay care until ultimately seeking it in a hospital emergency room. With 285,000 individuals in Wisconsin who are either immigrants themselves or have family members who are immigrants, the proposed rule could impact a large population. While it is targeted specifically at immigrants entering the U.S. or already in the U.S., confusion over complex state and federal Medicaid and immigration policies could lead to family members forgoing Medicaid as well as subsidized insurance on the ACA exchange for fear that either would jeopardize the ability of their loved ones to stay in the U.S.

In addition to these concerns, WHA also recommended the Department of Homeland Security immigration policy recognize the important contribution new immigrants play in filling our state’s unmet health care workforce needs. With Wisconsin currently having more jobs open than workers, and the demand for health care jobs projected to increase by 30% over the next 12 years, more workers will be needed to fill entry-level jobs. These jobs fill important needs to ensure the higher skilled health care positions can focus more of their time on direct, specialized, patient care. They also often become pipelines into higher skilled positions as workers are exposed to and pursue careers that pay better and are more fulfilling. 

For more information, contact WHA’s Director of Federal and State Relations, Jon Hoelter.

This story originally appeared in the December 11, 2018 edition of WHA Newsletter