As the Trump administration moves to reinstate a stricter version of the federal public charge rule, immigrant families are pushing away from Medicaid and other health care programs, even when they are legally eligible.
On Nov. 19, the Department of Homeland Security issued its new public charge rule, giving broad latitude to immigration officials to determine inadmissibility for immigrants seeking a green card — or other change of immigration status — based on whether they have availed of any federal public benefits, including Medicaid and the Supplemental Nutrition Assistance program. The proposed rule must undergo a 30-day public comment period, which ends Dec. 19.
KFF predicts between 1.3 million to 4.0 million people could disenroll from Medicaid or CHIP, including nearly 600,000 to about 1.8 million citizen children, if the rule is implemented.
In his first term, President Donald Trump invoked a similar version of the rule, but President Joe Biden narrowed the scope in 2022, limiting immigration inadmissibility only to those who had availed of cash assistance or folks who would need long-term institutionalized care.
Reducing Access
“The administration is seeking to return Medicaid to its perceived initial definitions, the populations that it perceives to have been the intended recipients of Medicaid,” said Tomas Bednar, senior vice president and counsel at Healthsperien, speaking at a Nov. 21 American Community Media news briefing. “The net effect of that is to try to establish policies that limit access to Medicaid, which is the primary safety net source of health insurance for low-income Americans and certain other residents.”
Historically, Medicaid participation could not be used against immigrants applying for green cards. That changed in 2019, when Trump first rolled out his new public charge rule.
Chilling Effect
“There was a perceived chilling effect to the access of Medicaid,” Bednar said. “Even if the changes weren’t applicable to you as an immigrant, you were being dissuaded from accessing the benefit because of the uncertainty of whether or not this was going to apply to you.”
This return to the previous standard comes in a very different Medicaid landscape. In contrast to the 2019 debate, Bednar noted that today’s immigrant families face not only the public charge rule but also sweeping cuts passed under HR 1 — the administration’s omnibus legislation that slashed federal Medicaid funding and narrowed eligibility for some immigrant groups.
Bednar said he expects the rule will take effect unless blocked by court action. “We see no reason that this will not be implemented,” he said.
Fear
Many immigrants remain legally eligible for Medicaid and Affordable Care Act coverage, said Bednar, but the problem is fear.
“It remains true that there are absolutely lawful means of access to coverage via Medicaid and other services for immigrants,” he said. “But this chilling effect likely eliminates or reduces, decreases the willingness of many of those immigrants to access those things.”
Even small policy changes, he cautioned, can have outsized effects. “The real distinction that’s relevant here is the posture of this administration, and the pressure and the scrutiny that is being placed on the immigrant population,” he said.
“This public charge rule is reflective of an intentional limitation of access to Medicaid benefits, as well as being part of the broader immigration policies that this Trump administration has taken on,” said Bednar.
