Medicaid Payments at Risk for Hospitals Under Public Charge

Prepared on behalf of America’s Essential Hospitals, the Association of American Medical Colleges, the American Hospital Association, the Catholic Health Association of the United States, the Children’s Hospital Association and the Federation of American Hospitals

Under long-standing immigration law and guidance, individuals who are likely to become a “public charge”—or likely to rely on the government for financial support—can be denied admission to the U.S. or, if they are already in the country legally, may be denied the ability to adjust their status and get a green card as a lawful permanent resident. If finalized, a new proposed rule issued by the U.S. Department of Homeland Security (DHS) would direct DHS to consider immigrants’ enrollment in Medicaid when making public charge determinations.

The new rule could deter enrollment in Medicaid and very likely the Children’s Health Insurance Program (CHIP), and as a result, children and adults who are lawfully in the country could become uninsured. The loss of coverage would result in poorer health and health outcomes for affected individuals. It also could lead to reduced Medicaid payments and drive up uncompensated care costs for the nation’s hospitals, causing financial strain, particularly for hospitals in states and communities with large immigrant populations.

In a new analysis, Manatt Health estimates the overall Medicaid and CHIP funds and hospital payments at risk if the proposed DHS rule is finalized. Key findings include:

  • The potentially affected Medicaid and CHIP population is estimated at 13.2 million as of 2016. This includes 4.4 million noncitizen adults and children who receive Medicaid or CHIP coverage, as well as 8.8 million citizen adults and children with Medicaid or CHIP coverage who are the family members of a noncitizen. This does not count all legal immigrants and family members who are eligible for Medicaid or CHIP, but only those who actually receive coverage.
  • These enrollees accounted for an estimated $68 billion in Medicaid and CHIP healthcare services in 2016, including enrollees who are noncitizens ($26 billion) and those who are citizen family members of a noncitizen ($42 billion). All dollar estimates in this analysis are one-year numbers and represent combined federal and state spending; the health and financial implications of this rule would extend indefinitely.
  • Because hospitals provide a substantial share of the care delivered to Medicaid and CHIP enrollees, their payments at risk under the public charge proposed rule total an estimated $17 billion in 2016 ($7 billion for noncitizen enrollees and $10 billion for citizen enrollees who have a noncitizen family member).

Click here to read the report.



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