The US Department of Homeland Security is proposing new changes to what is commonly referred to as their public charge’ rule.  If they’re adopted as-is, the new regulations would make it harder for families who are following all the rules of legal immigration to enter the U.S. or obtain a green card to become a legal, permanent resident. This means people trying to become new Americans legally would risk their status simply by turning to available services of Medicaid (and possibly CHIP/KidsCare), SNAP (aka food stamps), Medicare Part D, and housing assistance. You can learn more about what “public charge” is here

DHS is accepting public comments on their rule package through December 10.  We’d like your help to put together comments from the Arizona public health community.  Here’s some background:

DHS already uses information about whether applicants for legal permanent residency receive Temporary Assistance for Needy Families and Supplemental Security Income (SSI) when they evaluate applications.  After these proposed new rules are adopted, they’ll also consider whether applicants receive Medicaid (AHCCCS), Medicare Part D Low Income Subsidy, the Supplemental Nutrition Assistance Program (food stamps), and Section 8 Housing program.  Once adopted, applicants that receive any of these benefits will be far less likely to be approved for a status change or stay extension.  I didn’t see any exemptions for children- so presumably benefits used by any noncitizen family member including kids would count.  Here are some take-aways from the proposal:  

  • This is an issue of legal immigration- unauthorized migrants are largely ineligible for public assistance;

  • The use of public benefits by citizen children would not be considered a public charge;

  • This does not directly impact green card holders (the public charge test is not applied to green card holders applying for citizenship);

  • While CHIP (KidsCare) hasn’t been included in the proposed list of benefits that will count against individuals, the proposal draft seeks comments about whether CHIP should be included;

  • The proposed rule is not retroactive – meaning the public benefits received before the rule is final will not be counted as a public charge; and 

  • The proposed rules would not apply to refugees because existing statute prevents DHS from using the criteria for refugees.

  • Even though the new draft doesn’t include vaccinations (VFC), WIC and marketplace insurance- many families will believe that the regulations do include these benefits and will elect not to use these important safety net benefits- as doing so will risk their immigration status.  As a result, families will have a more difficult time improving the health status of their families.  An estimated 200,000 Arizonans will be impacted directly and many more may avoid using services they need due to fear and misinformation. The good news is that your voice matters! 

Turning in public comments matters because: 1) Federal law requires the government read and consider every unique comment before issuing a final rule and significant or copious comments could slow down the process and give policymakers more time to reconsider the final rule change; 2) Comments can later provide an opportunity to challenge the regulations in court; and 3) Comments give our communities a chance for their voice to be heard.

DHS will group all identical comments and count them as one comment. To make the most impact, it’s important to add your own words and ideas to your comments so it can be counted as a unique comment. Take a moment to highlight how your professional career or personal experiences has informed your view of what the Feds are proposing.  Below are example comments for you to consider using or modifying, along with your own words, and step by step instructions on how to submit your own comments.  

I oppose the Department of Homeland Security’s proposed rule change to “public charge.”  The policy will undermine access to essential health, nutrition, and shelter for immigrants and their family. One in four children in Arizona, and nearly 20 million children nationwide, live with at least one immigrant parent. By forcing choices no family should have to make, it puts our whole country at risk. This will policy is short-sighted and will only create costs shifts to states as well as create, bigger more expensive problems down the road. DHS should immediately withdraw its proposal. 

A community’s overall health depends on the health of all of its members. The proposed rule change will lead to higher rates of uninsured adults and children. Without insurance, families may delay care or forego it altogether. This means there will be more children in school, and adults in the workplace, without needed preventive services and untreated illnesses. Treatment for life-threatening conditions such as asthma keeps children in school. More people delaying care until the last possible moment will strain emergency resources. Hospitals’ and clinics’ uncompensated care burdens will increase. Children with Medicaid and CHIP have better health as adults, with fewer hospitalizations and emergency room visits; they also earn more and pay more in taxes. 

CHIP (KidsCare in Arizona) is designed especially for working families and should not be considered a public charge. Including CHIP would be a double hit to families who work hard and play by all the rules of our immigration system only to have the American dream become that much more unattainable. 

The loss of access to SNAP would further exacerbate food insecurity. SNAP is a critical source of support for struggling households; research shows how SNAP lifts people out of poverty, reduces hunger and obesity, and improves school attendance, behavior, and achievement. The consequences of food insecurity are especially detrimental to the health, development, and well-being of children.

We’ll be turning in public comments on the rule change before the December 10 deadline…  but please consider turning in your own unique comments!

History of Considering Public Benefits

The term “public charge” as it relates to admitting immigrants has a long history in immigration law, appearing at least as far back as the Immigration Act of 1882.  In the 1800s and early 1900s “public charge: was the most common ground for refusing admission at U.S. 

In 1999, the INS (DHS didn’t exist yet) issued Rules to “address the public’s concerns about immigrant fears of accepting public benefits for which they remained eligible, specifically medical care, children’s immunizations, basic nutrition and treatment of medical conditions that may jeopardize public health.” Here’s that final Rule from 1999, which didn’t include Medicaid our housing benefits in the public charge definition.