WASHINGTON -- Healthcare organizations expressed concern Monday about a proposed federal regulation that would deny permanent residency status ("green cards") to certain legal immigrants who rely too heavily on public programs such as Medicaid and food stamps.
"This policy will deter immigrant families from seeking healthcare coverage, negatively impacting the health of millions of adults and children," Linda Rosenberg, president and CEO of the National Council for Behavioral Health, a group of mental health treatment providers, . "Under this rule, receiving healthcare through Medicaid would weigh heavily against legal immigrants applying for permanent status in the U.S. In some cases, the rule would also penalize immigrant parents if their children enroll in Medicaid and/or public nutrition programs. The impact of this is huge, as one in four children in the U.S. -- approximately 20 million -- live in an immigrant family."
The American Medical Association (AMA) and the American Academy of Pediatrics (AAP) also weighed in against the policy, calling on the Trump administration to withdraw it.
The , which was announced on Saturday by the Department of Homeland Security (DHS), would change the the way an immigrant is defined as a "public charge" -- someone who uses a lot of government services. "The proposed regulation defines a public charge to be a person who receives certain public benefits above certain defined threshold amounts or for longer than certain periods of time," the department .
"In making this determination, DHS is proposing to consider current and past receipt of designated public benefits above certain thresholds as a heavily weighed negative factor. The rule would also make nonimmigrants who receive or are likely to receive designated public benefits above the designated threshold generally ineligible for change of status and extension of stay."
The proposed regulation defines a public charge to be “a person who receives certain public benefits above certain defined threshold amounts or for longer than certain periods of time,†DHS said.
The public benefits that the DHS would look at under the proposed rule include "federal, state, local, or tribal cash assistance for income maintenance, Temporary Assistance for Needy Families (TANF), Supplemental Security Income (SSI), Medicaid (with limited exceptions for Medicaid benefits paid for an 'emergency medical condition,' and for certain disability services related to education), Medicare Part D Low Income Subsidy, the Supplemental Nutrition Assistance Program (SNAP, a.k.a. food stamps), institutionalization for long-term care at government expense, Section 8 Housing Choice Voucher Program, Section 8 Project-Based Rental Assistance, and Public Housing," the release said. Use of the Children's Health Insurance Program (CHIP) was not included in the proposal at this time, but the rule document said it remains under consideration.
Under current law, only the first three categories of aid -- cash assistance, TANF, and SSI -- are considered for "public charge" purposes, the release noted.
"Under long-standing federal law, those seeking to immigrate to the United States must show they can support themselves financially," said Homeland Secretary Kirstjen Nielsen in the release. "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 Department takes seriously its responsibility to be transparent in its rulemaking and is welcoming public comment on the proposed rule," Nielsen added.
Physician Groups Cry Foul
"The public charge proposal presents immigrant families with an impossible choice: keep yourself or your children healthy but risk being separated, or forgo vital services like preventive care and food assistance so your family can remain together in this country," AAP president Colleen Kraft, MD, MBA, . "This disruption of family unity comes mere months after the same government agency pursued a policy of forcibly separating immigrant parents and children at the border, many of whom remain separated today."
The proposal will have a big impact, since one in every four U.S. children lives in a family in which the child or at least one parent is foreign-born, the AAP noted. "Children covered by Medicaid ... miss fewer school days due to illness or injury, perform better in school, are more likely to graduate and attend college, and be healthier adults that earn higher wages and pay more in taxes than their uninsured peers. The fear families face as a result of this proposed regulation will lead to fewer children enrolling in these programs."
"Research also shows that when parents have health insurance, children are more likely to get the care they need; when parents do not have healthcare coverage, their child's health can suffer," the statement continued. "Taken together, this proposal will not only have a negative impact on the economy, but also children's health and well-being."
AMA President Barbara McAneny, MD, warned in a statement that the proposal would "likely reverse the public health gains we have made in the last several decades" and that discouraging access to healthcare "forces [immigrants] to make choices ... that may harm their families and worsen public health."
A DHS official acknowledged in an email that the rule could "result in some individuals choosing to disenroll from or forego [sic] enrollment in public benefits programs." However, the official added, "this proposed rule is intended to implement the law, clarify the meaning of public charge, and promote immigrant self-sufficiency."
"With respect to aliens outside the United States who would be affected by this rule, such aliens are generally not eligible for the benefits covered by this rule," the official continued. "With respect to aliens within the United States who would be affected by the rule, the rule would not directly eliminate their access to any of the designated public benefits, but would create negative immigration consequences for receipt of certain benefits above a designated threshold."
The proposed rule will have a 60-day comment period once it is published in the Federal Register, which is expected in the coming weeks.