Health Law Daily Medicaid participation by migrants may hurt citizenship chances under final rule
Tuesday, August 13, 2019

Medicaid participation by migrants may hurt citizenship chances under final rule

By Cathleen Calhoun, J.D.

What does "inadmissible on public charge grounds" mean for those on Medicaid?

Participation in public programs, including Medicaid, will count against migrants seeking citizenship status under a final rule issued by the Department of Homeland Security (DHS). An alien applying for admission to the United States, or adjustment of status, is inadmissible if he or she is likely at any time to become a public charge under §212(a)(4) [8 U.S.C. 1182] of the Immigration and Nationality Act (INA). With some exceptions, the meaning of "public charge" has been outlined by the final rule to include consideration of Medicaid participation for a defined period of time.

Background. Since 1999, "public charge" has been interpreted to mean a person who is "primarily dependent on the Government for subsistence, as demonstrated by either the receipt of public cash assistance for income maintenance or institutionalization for long-term care at Government expense." As a result, reliance on or receipt of non-cash benefits such as the Supplemental Nutrition Assistance Program (SNAP), or food stamps, Medicaid, and housing subsidies are not currently considered by DHS in determining whether an alien is deemed likely at any time to become a public charge.

Rule change. Effective October 15, 2019, DHS is revising its interpretation of "public charge" to incorporate consideration of certain benefits. Under the final rule, "public charge" means an alien who receives one or more designated public benefits for more than 12 monthsin the aggregate within any 36-month period. This means that the receipt of two public benefits in one month will count as two months. Most forms of Medicaid will be included.

Exceptions. DHS has excluded consideration of the receipt of Medicaid by aliens under the age of 21 and pregnant women during pregnancy (and during the 60-day period after pregnancy). Active duty military members and their families, and children in certain contexts, are also excluded. Also, among other additional exceptions, receipt of Medicare Part D low-income subsidies is excluded from the public benefit definition for purposes of the public charge inadmissibility determination.

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