Trump administration may limit green cards for immigrants on Medicaid

Legal immigrants in the United States may soon be denied green cards if they utilize Medicaid or other public assistance.

The rule was proposed by the Department of Homeland Security over the weekend. Immigrants are already required to establish they will not be a public charge unless exempted, but these new rules are much broader, requiring immigrants prove they have not received public benefits. Public charge is defined as a person who receives certain public benefits above certain thresholds or for a certain length of time.

DHS can deny residency to applicants looking for green cards or revisions to their immigration statuses if they’ve received public assistance, including Medicaid.

“Under long-standing federal law, those seeking to immigrate to the United States must show they can support themselves financially,” said DHS Secretary Kirstjen Nielsen. “The department takes seriously its responsibility to be transparent in its rulemaking and is welcoming public comment on the proposed rule. This proposed rule will implement a law passed by Congress intended to promote immigrant self-sufficiency and protect finite resources by ensuring that they are not likely to become burdens on American taxpayers.”

The new rule would include past uses of public benefits as a negative factor in determining immigration applications. Service members and their families are excluded from the proposed rule.

Noncitizens are far more likely to be uninsured than American citizens, according to the Kaiser Family Foundation. Opponents of the rule argue it could inadvertently harm children who need medical care—12 million children lived with a noncitizen parent in 2016, KFF found. The rule would not impact U.S. citizen children of immigrants receiving benefits, according to DHS.

The rule intends to support the principle of self-sustainability in the immigration system, according to DHS, and ensure that public benefits are not an incentive for immigration into the U.S.

Hospital associations, including America's Essential Hospitals and the American Hospital Association, have spoken out against the proposal, arguing it will harm those seeking care and increase healthcare costs. 

"By creating a strong disincentive to seek care, this rule would force people to forgo medical visits and medications until they are sicker and costlier to treat," Bruce Siegel, MD, MPH, president and CEO of America’s Essential Hospitals, said in a statement. "It would drive higher levels of uncompensated hospital care and, ultimately, higher costs for insured patients and taxpayers."

"America’s hospitals and health systems have serious concerns that those legally in the country could choose to forgo health care benefits–and therefore delay accessing care–out of fear of repercussions for themselves and their families," Rick Pollack, president and CEO of AHA, said in a statement. "Forgoing care can exacerbate medical conditions leading to sicker patients and a higher reliance on hospital emergency departments. In turn, this could drive up costs for all purchasers of care."

The proposal notes that those seeking green cards will have to submit more forms to prove they are not or are not likely to become a public charge. The additional total cost of the proposed rule is between approximately $45 million and $130 million annually for the population applying for states, according to DHS.

Lawfully present immigrants, which make up about 60 percent of the 23 million noncitizens in the U.S., can currently qualify for Medicaid and the Children’s Health Insurance Program (CHIP), but they must meet certain requirements. For example, green card holders must wait at least five years before they can enroll under a qualified status. Those who are lawfully present as asylees and refugees do not have to wait five years, but those with protected temporary status are not eligible for benefits, according to KFF. Undocumented immigrants are not eligible to enroll for Medicaid and other public assistance programs.