Immigrants could soon face a harder time gaining legal resident status if they accept Medicaid, cannot cover predictable medical costs, or become diagnosed with conditions that interfere with their ability to work.
Rules proposed by the Trump administration will have immigration officers more strictly judge whether visa applicants can provide for themselves and limit the government services that applicants can access, setting new standards when considering their cases.
The proposal, which is pending as the government solicits feedback from the public, would define applicants who do not meet the new standards as “public charges,” limiting their chances at permanent residence and likely decreasing all forms of immigration to the country.
But, in a reversal, this proposal will no longer penalize immigrants who receive subsidies on Affordable Care Act insurance, allowing them to continue to access these important health plans.
The Trump Administration’s Immigration Proposal
The new rules proposed by the Department of Homeland Security prohibit immigration applicants from receiving a host of government services as they make their cases for visas.
These services include Medicaid, food stamps and benefits from the Children’s Health Insurance Program (CHIP). The rules define applicants accessing these programs as burdens on taxpayers.
While US law has long barred immigration applicants deemed to be “public charges,” in the past this term has been narrowly defined to apply only to applicants whose income relied on cash handouts from the government and those institutionalized for long-term care at the government’s expense. The new rules would expand this definition, which had been in place for almost 20 years.
Are Recipients of ACA Subsidies Affected by the Proposal?
ACA subsidies were not outlined in the administration’s new list of restrictions.
A previous draft of the proposal would have penalized immigrants who received these common subsidies as a part of ACA health insurance plans. This draft, released in March, explicitly mentioned them in its list of “heavily weighted negative factors” for immigration decisions, which would have sharply reduced immigrants’ healthcare options.
Placing ACA subsidies off-limits for immigrant applicants would have effectively priced them out of Obamacare marketplaces — most consumers who receive their insurance through Obamacare receive subsidies. Without the subsidies available, immigrants’ only options would have been employer-provided coverage and pricey private plans.
In an about-face, the subsidies were omitted from newly released rules, meaning that immigration applicants should be able to continue to receive them and stay in ACA plans.
However, the rules will not become official until after a public commentary period, which extends until next month.
DHS could change the rules before the final version is adopted.
Options for Non-Citizen Medicaid Recipients
Medicaid recipients will be more clearly affected by the new proposed regulations.
Under the rules, immigration applicants cannot receive Medicaid benefits, but, with rare exceptions, they also cannot go uninsured. The rules bar applicants who have “neither the prospect of obtaining private health insurance, or the financial resources to pay for reasonably foreseeable medical costs.”
Basically, unless applicants have a lot of reserve cash to cover medical bills that may arise, they need to pay for health insurance.
Immigration applicants who come off Medicaid seeking affordable options could look toward ACA bronze plans, the lowest cost Obamacare option. They could also purchase short-term health insurance plans as a stopgap while they consider what to do. These plans will allow applicants to qualify for immigration, but do not cover pre-existing conditions.
Anyone thinking about a healthcare change in order to protect their immigration status, should contact an immigration lawyer or advocate.
Serious Medical Conditions Are Another Negative Factor
The new rules also account for the health of immigration applicants.
The rules heavily weigh against applicants with medical conditions that interfere with their ability to work or attend school.
If an applicant has an acute medical history or suddenly becomes very sick, that could affect whether he or she is able to stay in the country under the new rules.
You Can Weigh In On Healthcare and Immigration Rules
DHS is soliciting feedback about its proposed rules through December 10.
You can submit a form by visiting www.regulations.gov or by mailing feedback to Samantha Deshommes, Chief, Regulatory Coordination Division, Office of Policy and Strategy, U.S. Citizenship and Immigration Services, Department of Homeland Security, 20 Massachusetts Avenue NW, Washington, DC 20529-2140.
In either case, reference the DHS docket number — USCIS-2010-0012 — in order for your commentary to be considered.