U.S. Department of Homeland Security Issues “Public Charge” Final Rule > Hospital Association of Pennsylvania


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U.S. Department of Homeland Security Issues “Public Charge” Final Rule

August 14, 2019

The U.S. Department of Homeland Security (DHS) this week issued a final rule that would impact the ability of lawfully present immigrants to change or prolong their legal immigration status if the federal government determines that they may rely too much on public benefits.  

This rule—known as the “public charge”—would allow government agencies to analyze the use of public benefits, weighing the cost of the benefits the individual has received, as well as the duration of the use of these benefits, and using that to determine their eligibility to continue to stay legally in the United States.

In a statement, Rick Pollack, president and CEO of the American Hospital Association (AHA), called upon DHS to reconsider the rule, noting that it would create “barriers to appropriately caring for the sick and injured, and to keeping people healthy.” Additionally, AHA cautioned that the public charge rule “would lessen access to services under Medicaid and Medicare Part D for legal immigrants. Access to nutrition aid, housing support and other programs that address the social determinants of health would also be jeopardized.”

During December, HAP sent a letter to DHS' then-Secretary Kristjen Nielson, outlining the hospital community’s concerns about the rule as proposed. HAP noted that the rule could lead to:

  • Increases in the uninsured rate, due to individuals disenrolling from public health insurance coverage
  • Poorer health outcomes, due to patients forgoing medical care
  • Reduced resources for medical providers and significant reductions in Medicaid payments

As stakeholders consider legal challenges, new analyses will be forthcoming that will estimate the expected impact of the rule in its final form, which goes into effect in two months.

Additionally, HAP and 14 Pennsylvania health care provider and advocacy organizations sent a joint letter to Nielson, expressing the wider health care community’s opposition to the public charge rule. The letter emphasized the potential for negative impacts of the rule, including reduced access to preventive and routine medical care, and increases in food insecurity.

HAP will continue to monitor the progress of the public charge rule and any legal challenges that arise.

For more information, contact Jeff Bechtel, HAP’s senior vice president, health economics and policy, or Laura Stevens Kent, HAP’s vice president, federal legislative advocacy.

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