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DHS Finalizes Public Charge Rule

The Department of Homeland Security (DHS) finalized its proposal to alter the definition that determines whether an individual seeking to enter the country or become a lawful permanent resident could become a public charge — a heavily weighted negative factor in immigration decisions.

Public charge determinations currently are based on the likelihood that an individual will become primarily dependent on the government for subsistence, defined by use of cash assistance or government-funded, long-term institutional care. If an individual applying for entry or for a green card is deemed likely to become a public charge, they are denied entry or a green card.

DHS finalized updates to the public charge definition, including:

  • an expanded list of programs considered in a public charge determination, including certain nonemergency Medicaid benefits;
  • a single duration-based standard to evaluate the receipt of all benefits;
  • new income requirements for the individual seeking entry or a green card; and
  • new standards for consideration of public charge status, including age, health, income, and education.

In the final rule, DHS defines exemptions for certain health-related public benefits, including:

  • emergency Medicaid;
  • Medicaid received for services provided under the Individuals with Disabilities Education Act and school-based benefits;
  • Medicaid services for noncitizens younger than 21 and pregnant women during pregnancy and 60-day postnatal; and
  • receipt of Medicare Part D low-income subsidies.

The rule also establishes exemptions for specific individuals, including:

  • children who are adopted by U.S. citizens;
  • those enlisted in the U.S. Armed Forces, serving in active duty or in the Ready Reserve, or such an individual’s spouse or children; and
  • those Congress has previously exempted, such as asylum seekers and refugees.

America’s Essential Hospitals released a statement expressing continued concern about the final rule because of anticipated effects on essential hospitals and their patients. The association is analyzing the final rule and will send members a detailed Action Update.

The rule will take effect 60 days after its publication in the Federal Register.

Contact Senior Director of Policy Erin O’Malley at or 202.585.0127 with questions.


About the Author

Zina Gontscharow is a former senior policy analyst for America's Essential Hospitals.

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