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August 14, 2019 Update: On August 14, 2019, the Department of Homeland Security issued a final version of its public charge rule. The rule includes modest changes relative to the October 2018 proposed rule. (For a brief overview of the final rule and it’s likely impacts, see here.) Manatt Health previously analyzed the “chilling effect” likely to result from the proposed rule, which would impact the universe of noncitizens and their dependents who may drop or not apply for benefits either because they are certain they will be affected or believe they might be affected by the rule. The original analysis can be used to consider the potential impact of the final rule as well.
On October 10, 2018, the Department of Homeland Security (DHS) issued a proposed rule that would overhaul a key element of immigration policy known as “public charge.” Under the proposed rule, some noncitizens seeking to obtain lawful permanent residence (a green card) or to extend or change their immigration status would face potential immigration consequences if they are deemed likely to use certain cash, healthcare, nutrition or housing programs. It would treat applicants unfavorably if they are low-income, have certain health conditions (without private health insurance), are children or seniors, have limited English proficiency, have a large family, lack sufficient education or credit history, or based on other factors. If finalized, this policy change would represent a fundamental shift in immigration policy that will have a major impact on immigrants, their citizen family members, the providers who serve them, and their state and local communities.
Generally speaking, the proposed rule could lead to noncitizens opting to disenroll from, or forgo enrolling in, benefits for which they are eligible, such as Medicaid, food or housing benefits. (In general, federal law already imposes strict limitations on immigrant eligibility for public benefits, imposing, for some, a five-year waiting period and other restrictions.) In addition, if the proposed rule is adopted, citizen family members also could be dissuaded from using benefits due to concerns that their receipt of benefits would put their immigrant family members’ immigration status at risk. Noncitizens and their family members are highly likely to be aware of the proposed DHS policy change and, fearing immigration consequences related to benefit use, avoid using health, food and housing benefits for which they are eligible.1
In addition to concerns related to benefit use, noncitizens are also at risk under the proposed public charge rule if their family income is below defined thresholds. The proposed public charge rule places greater negative weight on applicants who use one of the newly listed benefits after the rule is in effect, or who have health conditions that affect their ability to work, attend school or care for themselves (if they lack private insurance). Individuals with income under 125% of the federal poverty level (FPL) are also accorded negative weight. The only noncitizens given “heavily positive” weight under the proposed rule are those with an income above 250% FPL or equivalent resources.
Population Data Findings
Using data from the American Community Survey, Manatt estimates the number of people potentially affected by the rule, referred to as the “chilled population.” The chilled population is all noncitizens and their dependents; this is the universe of people who may drop or not apply for benefits either because they are certain they will be affected or believe they might be affected by the new rule. Nationwide, 22.2 million noncitizens and a total of 41.1 million noncitizens and their family members currently living in the United States (12.7% of the total U.S. population) could potentially be impacted as a result of the proposed changes in public charge policy. Of citizen family members, more than half (10.7 million) are citizen children living in families with one or more noncitizen family members.
While all noncitizen families may be dissuaded from using benefits regardless of their current observed income level, lower-income families are most likely to forgo benefits, in part due to the fact that they are more likely to be eligible for means-tested public benefits. In addition, the proposed public charge rule stipulates that, relative to immigrants with income in the 125–250% FPL range, immigrants with income above 250% FPL are significantly less likely to be deemed a public charge, and those with income below 125% FPL are significantly more likely to be deemed a public charge. In total, nationwide there are 13.9 million noncitizens below 250% FPL and a total of 25.9 million noncitizens and their family members who are more likely to experience chilling impacts under the proposed public charge rule. Of these, the group at greatest risk is the 7.5 million noncitizens, and the total universe of 14 million noncitizens and their family members, below 125% FPL.
The interactive dashboards below provide detailed information sizing and segmenting the potentially chilled population by state, county and metropolitan area. For additional information or questions about the data provided in these dashboards, please review the Methodology tab, or feel free to contact us by email at HealthcareAnalytics@manatt.com.
1 The public charge rule addresses only the public charge ground of inadmissibility (governing entry or admission to the United States); it does not address the public charge ground of deportability. DHS indicated that DOJ may address deportability in a forthcoming, parallel rule. Such a rule, if proposed, would significantly exacerbate the magnitude of chilling effect among noncitizens and their families, as noncitizens who are ineligible or are not seeking to adjust status and their family members would be more directly impacted.