Homeland Security Finalizes Proposed Public Charge Rule

Concerns remain over impact to uncompensated care

August 20, 2019

The federal Department of Homeland Security (DHS) finalized a rule proposed in 2018 that would expand the definition of what constitutes a “public charge” as it relates to immigration. Unfortunately, the final rule does little to address concerns from WHA and other groups that the expanded definition could lead to more uncompensated care for hospitals and health systems and could negatively impact Wisconsin’s projected health care workforce shortage.

The final rule adds 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. Historically, U.S. immigration policy has used the “public charge” criteria to determine the likelihood of a prospective immigrant becoming dependent on government benefits. The final rule expands the list of benefits considered in determining whether an immigrant may be determined a public charge to include Medicaid, housing assistance, and Supplemental Nutrition Assistance (called FoodShare in Wisconsin). It also changes 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. In other words, if an individual received both FoodShare and BadgerCare for a cumulative total of more than six months each in a three-year period, they could be considered a public charge under the new rule. However, the full public charge test is based on several different factors that look at the “totality of circumstances,” such as a person’s age, health, family status, financial status, education, and skills.

In its comment letter last December, WHA cautioned DHS that since this policy would be applied to immigrants already residing lawfully in the U.S., it could lead people who are legally entitled to Medicaid benefits or subsidized health insurance to drop their coverage over fears of it negatively impacting their own or a family member’s legal immigration status. Indeed, DHS itself acknowledged in the proposed rule that this policy could lead to more cases of uncompensated care, worse health outcomes, and increased emergency room visits. While it’s impossible to forecast how widespread such negative impacts could be, Wisconsin is currently home to an estimated 285,000 individuals who are either immigrants themselves or have family members who are immigrants. WHA also noted concerns about the rule’s potential impact on Wisconsin’s health care workforce shortage, particularly considering the number of immigrants that could fill open entry-level jobs that support direct patient care. Wisconsin currently has more open jobs than workers, and the demand for health care jobs is projected to increase by 30% over the next 12 years.

The final public charge rule will take effect on October 15, 2019. Since its announcement, several groups have called for its withdrawal and several states are suing to block its implementation. 

Contact WHA Director of Federal and State Relations Jon Hoelter for more information.

This story originally appeared in the August 20, 2019 edition of WHA Newsletter