Trump Administration Publishes Final Rule Aimed at Legal Immigrants Using Public Benefits

The Trump administration on Monday released a final rule that would change immigration procedures in the United States by including most forms of Medicaid and other types of assistance—such as for food and housing, which are components of social determinants of health—as counting against documented immigrants seeking to become citizens.

The Department of Homeland Security (DHS), in announcing the rules, said it was promoting the ideals of self-sufficiency, self-reliance, industriousness, and perseverance. But DHS also noted that the vast majority of the 266,000-plus comments on the rule, which is supposed to go into effect October 15, opposed the change. It also acknowledged that some healthcare-related businesses might be harmed by the change, and that some people may choose to drop out of benefit programs.

In response Monday, the National Immigration Law Center announced that it will file a lawsuit challenging the new rule.

In a statement, the president of the Center on Budget and Policy Priorities (CBPP) said the rule would have many negative effects, saying it would “almost certainly lead many immigrants who are in the United States legally as well as their family members to forgo health coverage, nutrition assistance, and housing assistance that they need and are eligible for under federal law.”

“This fear will be even more severe if the Trump Administration adopts another rule it has under consideration, one that reportedly would use receipt of benefits under the expanded public charge definition as a basis to deport some groups of immigrants,” said Robert Greenstein.

The rule redefines the term “public charge” to mean an immigrant who receives 1 or more designated public benefits for more than 12 months in the aggregate within any 36-month period; DHS said that means that receiving 2 public benefits in 1 month counts as 2 months.

“Public benefit” is defined as cash benefits for income maintenance, Supplemental Nutrition Assistance Program (commonly referred to as food stamps), most forms of Medicaid, 2 forms of Section 8 housing assistance, and certain other forms of subsidized housing. Previously, immigrants labeled as public charges could be denied legal entry to the United States, but under current policy, only the use of cash assistance like Temporary Assistance for Needy Families or Supplemental Social Security Income is counted.

The rule gives individual immigration officials the ability to reject applications from individuals who, even if they do not receive public benefits, may do so in the future. Two groups who are likely to fit into that category, DHS said, are children under the age of 18 years and people aged 61 years or older.

CBPP said that the rule will hurt workers who are here today who perform low-wage jobs, who now may have to decide whether to leave the United States to keep their families intact or leave.

In the comments, DHS acknowledged that some wrote to express concern about the healthcare workforce, such as low-paid direct care aides, nursing assistants, and others, especially in the context of a rapidly aging US population.

The New York Times reported that the rule has been the main priority of Stephen Miller, the creator of President Donald Trump’s agenda to stem immigration. Health organizations have been concerned about the rule’s impact on public health ever since word of it leaked out in 2017.

In the final rule published Monday, DHS acknowledged that some people “may choose to disenroll from or forego enrollment in public benefits program.”

DHS said there will be some exemptions it will consider, such as for “certain members of the US Armed Forces and their families; certain international adoptees; and receipt of Medicaid in certain contexts.” Pregnant women and women within 60 days post childbirth also fall into that category.

DHS said that it quantified the direct costs of the final rule over the first 10 years of implementation as $352 million (undiscounted) and also noted that there may be affects on certain business as well as state and local economies and various business communities.

That would reduce transfer payments not only from states to individuals, but also from the federal government to the states; percentages vary whether the program is food stamps or Medicaid and whether the state is a Medicaid expansion state.

As such, “the 10-year undiscounted amount of state transfer payments of the provisions of this final rule is about $1.01 billion annually.” The 10-year discounted amount of state transfer payments would be about $8.63 billion at a 3% discount rate and about $7.12 billion at a 7% discount rate.

DHS noted that “the rule might result in reduced revenues for healthcare providers participating in Medicaid, companies that manufacture medical supplies or pharmaceuticals, grocery retailers participating in SNAP, agricultural producers who grow foods that are eligible for purchase using SNAP benefits, or landlords participating in federally funded housing programs.”