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Accessing Children’s Health Insurance Program and
Most Medicaid Benefits Will Not Affect Immigration Status
Today, the U.S.
Department of Homeland Security (DHS) issued a final rule applicable to
noncitizens who receive or wish to apply for benefits provided by the U.S.
Department of Health and Human Services (HHS) and States that support
low-income families and adults. The rule, which details how DHS will interpret
the “public charge” ground of inadmissibility, will help ensure that
noncitizens can access health-related benefits and other supplemental
government services to which they are entitled by law, without triggering
harmful immigration consequences. By codifying in regulation the “totality
of the circumstances” approach that is authorized by statute and which has
long been utilized by DHS, the rule makes it clear that individual factors,
such as a person’s disability or use of benefits alone will not lead to a
public charge determination.
The final rule
applies to noncitizens requesting admission to the U.S. or applying for
lawful permanent residence (a “green card”) from within the U.S. When
assessing whether a noncitizen is “likely to become primarily dependent on
the government for subsistence,” DHS will not penalize individuals who
choose to access the vast majority of health-related benefits and other
supplemental government services available to them, including most
Medicaid benefits (except for long-term institutionalization – such as
residing in nursing home – at government expense) and the Children’s
Health Insurance Program (CHIP). DHS will also not consider non-cash
benefits provided by other government agencies including food and nutrition
assistance such as the Supplemental Nutrition Assistance Program (SNAP);
disaster assistance received under the Stafford Act; pandemic assistance;
benefits received via a tax credit or deduction; and government pensions or
other earned benefits. Receipt of cash-based benefits, such as Supplemental
Security Income (SSI), Temporary Assistance for Needy Families (TANF), and
other similar programs, will not automatically exclude an individual from
admission or green card eligibility, and will instead be considered in a
“totality of the circumstances” analysis.
“People who qualify
for Medicaid, CHIP, and other health programs should receive the care they
need without fear of jeopardizing their immigration status,” said HHS
Secretary Xavier Becerra. “As we have experienced with COVID, it’s in the
interest of all Americans when we utilize the health care and other
services at our disposal to improve public health for everyone.”
“This final rule
reinforces a core principle of the Biden-Harris Administration: that
healthcare is a right, not a privilege, and no one should be deterred from
accessing the care they need out of fear,” said CMS
Administrator Chiquita Brooks-LaSure. “Today’s final rule is an
important step toward achieving this goal for many Medicaid and CHIP enrollees
and their families, and CMS will continue to do everything in our
authority to make sure people have access to programs that keep
them safe and healthy.”
“Federal civil rights
laws require that all people be afforded fair and just decisions when applying
for health benefits and other supplemental government services, free of
bias, stigma, and discrimination,” said Office for Civil Rights Director
Melanie Fontes Rainer. “Today’s rule sets up safeguards to help ensure that
people with disabilities and older adults who are not U.S. citizens can
access health care without fear. OCR will continue our robust
enforcement of civil rights laws to ensure the rights of historically
marginalized groups are upheld and defended.”
“People with
disabilities and older adults who are not U.S. citizens no longer have to
fear that using services that can help them maintain their health, live
independently and contribute to their communities will cost them legal
residency in our country,” said Alison Barkoff, Acting Administrator of the
Administration for Community Living. “The rule explicitly rejects
stereotypes that people with disabilities are more likely to become a
public charge and is in keeping with the civil rights protections that are
the bedrock of American values.”
This final rule is
the product of action first taken by the Biden-Harris Administration in
2021 to reverse the previous administration’s 2019 public charge rule,
which had the harmful effect of discouraging many immigrants from seeking
benefits, such as CHIP and other government services for which they, their
children, or their families were eligible, out of fear of jeopardizing
their immigration status. This chilling effect extended even to those
categories of noncitizens who, by law, are exempt from the public charge
ground of inadmissibility, including refugees, asylees, noncitizens
applying for or re-registering for temporary protected
status (TPS), special immigrant juveniles, T (trafficking victims) and
U (crime victims) nonimmigrants, and self-petitioners under the Violence
Against Women Act (VAWA). With the publication of today’s final rule,
the Biden-Harris Administration is continuing its efforts to reverse these
harmful effects and ensure that these programs remain accessible for eligible
individuals and families in need.
The final rule does
not expand eligibility for Medicaid, CHIP, or other benefits to more people
but clarifies DHS policy regarding recipients.
The final rule will
be effective on December 23, 2022.
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