New rules that allow immigration officials to consider use of
Medicaid coverage and other non-cash benefits in considering whether to approve
applications for legal residence are likely to cause a chilling effect on
Medicaid enrollment, with the impact spilling over to utilization of other
health programs and services, even among family members not directly affected
by the rules.
The Supreme Court on Jan. 27 ruled that the Inadmissibility on
Public Charge Grounds final rule could take effect on Feb. 24 in every state
but Illinois while litigation works its way through the courts.
The rule changes the factors used to determine whether someone
is a "public charge" to include health, nutrition and housing
programs that were previously excluded and defined it as use of government
benefits for more than 12 months over a three-year period.
But officials still cannot consider use of Children's Health
Insurance Program (CHIP) coverage or Affordable Care Act exchange subsidies,
according to the Kaiser Family Foundation.
Despite that, some immigrants have grown fearful that applying
for any benefits could jeopardize their immigration status or that of family
members, leading them to avoid using health care services at all or giving up
exchange subsidies or CHIP coverage.
"This could have a negative impact on Medicaid enrollment —
though it's possible the related impact has already largely been absorbed and
the incremental effect of lifting the injunction may not be that
meaningful," said Evercore ISI analysts Michael Newshel and Joseph Amato.
Wendy Parmet, a professor of law and of public policy and urban
affairs at Northeastern University, says that Medicaid plans "need to be
clarifying who is not impacted. There are a lot of other groups who are not
impacted in a technical sense."
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