Public Charge Final Rule Published, Pursues Health Equity For Immigrants

The US Department of Homeland Security (DHS) released its public charge final rule which clarifies how HHS and states will supply benefits for noncitizens—namely, that the use of most public services and benefits will not impact immigration or public charge status.

“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.” 

Under the final rule, noncitizens who have applied for admission to the US or lawful permanent residency will not be penalized for most public payer benefits. Immigrants and those who have applied for admission can receive most Medicaid benefits except for public payer-funded long-term institutionalization.

Apart from health-related benefits, the rule also clarifies that immigrants and applicants can access other public benefits without fear of penalization. Those benefits include the Supplemental Nutrition Assistance Program (SNAP) and disaster assistance received under the Stafford Act or pandemic assistance.

Some public benefits—specifically cash-based benefits—will be considered on a “totality of circumstances” basis. This means that using benefits such as Supplemental Security Income (SSI) or Temporary Assistance for Needy Families (TANF) will not eject applicants from the application process.

HHS officials underscored that this move sought to advance health equity by reducing stereotypes, discrimination, and unnecessary barriers to healthcare access.

“People who qualify for Medicaid, CHIP, and other health programs should receive the care they need without fear of jeopardizing their immigration status,” added 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.”

DHS indicated that it will not include family members’ benefits as part of its public charge determination. The department will issue a policy manual update for US Citizenship and Immigration Services (USCIS) officers.

The rule will go into effect on December 23, 2022.

The public charge rule has had a complicated history in the past three years. In 2020, the Supreme Court approved the Trump Administration’s extension of the public charge rule to include immigrants’ need for public services. That same year, a court case originating in Illinois sought to vacate the public charge rule. In 2021, the US Court of Appeals vacated the public charge final rule, rendering it non-enforceable as of March 9, 2021.

Due to this complex legal background, misinformation about the rule has been rampant. As late as March 2022, researchers have indicated that consumers are still confused about the impact of this defunct rule. They have called on Medicaid programs, Affordable Care Act marketplace plans, and Children’s Health Insurance Program (CHIP) programs to take action.