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DHS Proposal Would Consider Health Benefits in Immigration Decisions

The Department of Homeland Security (DHS) released a draft proposed rule that, if finalized, will alter the definition used to determine whether individuals seeking to enter the country or become lawful permanent residents (green card holders) could become a public charge — a heavily weighted negative factor in immigration decisions. The rule was posted on the agency’s website.

Public charge determinations currently are made based on the likelihood that an individual will become primarily dependent on the government for subsistence based on 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, he or she is denied entry or a green card.

DHS proposes to make various changes to the definition of public charge, including:

  • an expansion of the list of programs considered in a public charge determination, including non-emergency Medicaid benefits and low-income subsidies for Medicare Part D beneficiaries;
  • new income requirements for the individual seeking entry or a green card;
  • new standards for consideration of whether an individual might become a public charge, including age, health, income, and education; and
  • an increase in the bond amount necessary for admission for individuals deemed a public charge.

The proposed rule differs from a leaked version circulated in March in a few key respects. The leaked version had included benefits received by U.S. citizen dependents of applicants in the public charge definition, which the draft proposed rule omits. The leaked version also would have included subsidies received on the Affordable Care Act health insurance exchanges and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) benefits, both of which are not included in the draft proposed rule.

America’s Essential Hospitals released a statement urging the administration to withdraw the proposal because of anticipated effects on essential hospitals and their patients. The association is  analyzing the proposed rule and will release a detailed Action Update in the coming days. DHS will accept comments on the rule, due 60 days after the rule is published in the Federal Register.

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


About the Author

Rachel Schwartz is a former policy associate at America's Essential Hospitals.

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