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  POLICY/ADVOCACY
 

Public Charge

Due to a court decision on September 11, 2020, the new public charge rule is back in effect in NYS and will now be implemented nationwide. The public charge test only applies to individuals applying to enter the US or applying to become a lawful permanent resident (green card). Health center services and use of sliding fee scale are not included in the public charge determination test.


* * Download Preparing Health Center Staff for Public Charge Implementation Webinar Here * *

IMPACT OF PUBLIC CHARGE ON NEW YORK STATE HEALTH CENTERS AND PATIENTS

Overview: What is public charge, and what is in the final rule?

  • The US Department of Homeland Security (DHS) assesses individuals seeking admission to the US or applying for a green card to determine if they would be a “public charge.” In the final rule, a public charge is defined as an individual “who receives one or more public benefit for more than 12 months in the aggregate within any 36-month period (such that, for instance, receipt of two public benefits in one month counts as two months).”

  • The public charge test only applies to individuals applying to enter the US, applying to become a lawful permanent resident (green card), or to green card holders who leave the US for over 6 months consecutively and seek to return to the US.
    • The public charge test does not apply to refugees, asylees, survivors of trafficking, self-petitioners under the Violence Against Women Act, and special immigrant juveniles.

  • Individuals who are considered a public charge may be denied entry to the US or denied a green card.

  • The final rule expands benefits considered under public charge determination, including: non-emergency Medicaid, "SNAP" (also known as "food stamps"), Section 8 housing assistance and Section 9 public housing. Federal, State, local, and tribal Cash Assistance is already considered in public charge determination and will continue to be considered under the proposed changes.

  • Please note that CHIP, state-funded Medicaid, use of health center services (including sliding fee scale), and participation in WIC are not factors in a public charge determination.

  • However, a person does not have to have used benefits to be deemed likely to become a public charge. Individuals also come under a “totality of circumstances test” whereas the following factors may be weighed against an applicant:
    • Age (less than 18 or over 61, weighted negatively)
    • Health (diagnosed medical conditions affecting ability to work/study, or those that require institutionalization now or in the future, weighted negatively)
    • Family (household size)
    • Financial resources (income less than 125% FPL weighted negatively)
    • Skills and work experience (including English proficiency, education level, and caretaker status)

  • There are some exceptions to the public charge determination test:
    • Medicaid services received for an emergency medical condition
    • Health benefits received by a person under 21 years of age
    • Health benefits received by a person during pregnancy and for 60 days following birth
    • Benefits received by active duty and reserve members of the armed forces, their spouses, and children under 21
    • Benefits received while a person was exempt from public charge (i.e. DACA recipients, TPS holders, etc.)

NYS Health Center Facts

  • Health centers serve patients regardless of their immigration status, language spoken, income level, or insurance status.

  • NYS health centers serve 3 million patients annually, 59% of whom are enrolled in Medicaid/CHIP.

  • Medicaid & CHIP make up about 53% of NYS health center revenue.

  • About 20% of NYS Medicaid enrollees live in a family with at least one non-citizen.

Impacts to NYS Health Centers

  • NY FQHCs are increasingly worried about the chilling effects of the final rule, whereas individuals who are not subject to public charge drop benefits or do not re-enroll in benefits they are eligible due to fear or confusion surrounding the final rule.

  • CHCANYS estimates that 20% of NYS residents in families with at least one noncitizen will disenroll from Medicaid.

Due in part to the chilling effects, in one year, NYS health centers could see as many as 95,000 former
Medicaid enrollees become uninsured, with projected Medicaid revenue losses topping $100,000,000.

  • Over half of NYS health centers that responded to a CHCANYS survey have already reported an increase in the number of individuals who are eligible but not enrolling in Medicaid, SNAP, Section 8 Housing, and WIC due to concerns over deportation, inability to attain a green card, or inability to sponsor a loved one to attain legal permanent status.

  • Some NYS health centers have already reported that parents have refused benefits for their citizen children, fearing for their own ability to gain legal permanent status or the ability for other children in the family to gain legal permanent status.

  • NYS health centers have reported that the proposed changes to public charge have stoked fears over accessing Medicaid benefits, leading to:
    • decreases in early access to prenatal care among expecting immigrant mothers, and;
    • decreased medication adherence rates, including among high need populations (such as individuals with HIV).

  • Fears over deportation have also led to:
    • increased behavioral health needs and corresponding challenges, such as poor performance in school among children and sleep disturbance;
    • food insecurity, and;
    • housing instability.

Download PDF

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RESOURCES

Overview: What Is Public Charge?

  • National Immigration Law Center, Overview of Public Charge
    • Overview of the existing public charge policy, pre-implementation of any 2018 proposed changes

  • US Citizen and Immigration Services, Public Charge Fact Sheet
    • Lists benefits that are and are not subject to public charge consideration

  • US Citizen and Immigration Services, Public Charge Frequently Asked Questions

  • Read the Final Rule, posted on August 14, 2019 and effective October 15, 2019.
    • The effective date may be pushed back, pending legal challenges to the final rule.

Resources for Health Centers

  • Added February 2020:  Preparing Your Health Center for Public Charge Checklist NEW

  • Added January 2020:  NY State of Health: Public Charge Fact Sheet NEW

  • Added January 2020:  Protecting Immigrant Families, Executive Summary: Navigating Public Charge: Best practices in Community Based Organizations to Mitigate the Harm for the Immigrant Community (January 2020) NEW

  • Added January 2020:  Protecting Immigrant Families, Public Charge Best Practices Webinar Recording NEW

  • Added January 2020:  Protecting Immigrant Families, Full report: Navigating Public Charge: Best practices in Community Based Organizations to Mitigate the Harm for the Immigrant Community (January 2020) NEW

  • Added October 2019: Screening Tool and Attorney Referral Information for Community‐Based, Social Services, and Advocacy Organizations 
    Developed by the Legal Aid Society, Make the Road NY, and Empire Justice Center
  • Added October 2019: Click here for the National Immigration Law Center’s public charge one pagers available in English, Arabic, Bengali, Chinese, French, Korean, and Spanish 

  • Added September 2019: Public Charge Applicability 
    • Who is Subject to Public Charge?

  • Added September 2019: Public Charge Benefits Chart 
    • Know Before You Go: Use of Health Center Services Are Not Included in a Public Charge Test

  • Updated August 2019: Protecting Immigrant Families, Let’s Talk About Public Charge
    • Core community messages for understanding public charge and talking to potentially affected communities

  • Updated August 2019: Protecting Immigrant Families, Getting the help you need
    • Messages for helping potentially affected individuals to understand public charge and how it does or does not relate to them
  • Updated August 2019: National Association of Community Health Centers, Caring for Immigrant Patients
    • Links to resources for health centers serving immigrant patient populations
  • National Immigration Law Center, Access to Health Care, Food, and Other Public Programs for Immigrant Families under the Trump Administration
    • Things to keep in mind when talking with immigrant families

  • California Primary Care Association, Immigration Sample Policies and Procedures
    • Sample policies and procedures for health centers to address immigration issues

 

Reports: Impact of Proposed Changes to Public Charge

  • Kaiser Family Foundation, Estimated Impacts of the Proposed Public Charge Rule on Immigrants and Medicaid

  • Migration Policy Institute, Chilling Effects: Chilling Effects: The Expected Public Charge Rule and Its Impact on Legal Immigrant Families’ Public Benefits Use

  • Fiscal Policy Institute, Only Wealthy Immigrants Need Apply: How a Trump Rule’s Chilling Effect Will Harm the US

  • Manatt, Public Charge Proposed Rule: Potentially Chilled Population Data Dashboard

 

CHCANYS Comments and Testimony on Public Charge

  • December 10, 2018 / Department of Homeland Security
    Notice of Proposed Rulemaking on “Inadmissibility on Public Charge Grounds

  • November 15, 2018 / Committee on General Welfare, Committee on Immigration, and the Committee on Health
    Oversight Hearing: The Impact of the Proposed “Public Charge” Rule on NYC

Download PDF

 

 
 
 

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