Earlier this year, the Trump administration released a draft of planned policy changes that would expand the criteria used to consider a person a potential “public charge.” The proposed changes are already causing some Virginia immigrants to forgo using public health programs for fear this may jeopardize their immigration status. Given the impact on health care utilization in Virginia, we, as a health advocacy community, need to educate communities and address the proposed changes head-on.
What is public charge and what are the changes proposed?
The public charge designation assumes a person is likely to be reliant on the government for their livelihood and, most importantly, the designation makes that individual unable to become a citizen or change their immigration status. Currently, U.S. immigration officials can designate an immigrant a “public charge” if the individual accesses certain, specified public services, like cash assistance.
According to the proposed changes released earlier this year, the federal government is considering adding the use of health and nutrition programs, like Medicaid and CHIP (known as “FAMIS” in Virginia), or the receipt of a subsidy for health insurance on the health insurance marketplace, as new factors for immigration officials to consider when determining public charge. Not only would the proposed changes expand the number of programs for public charge designation, it would, for the first time, allow officials to consider the use of programs by dependents, even if those dependents are legal U.S. residents or citizens.
The impact of public charge policy change on health care utilization
In Virginia, naturalized citizens are already more likely to be uninsured (11%) than native-born citizens (9%). The proposed changes to the public charge designation would also cause a terrible dilemma for the 600,000 Virginians in mixed-status families, where some members are citizens and others are non-citizens who access public benefits. Immigrant parents will be forced to choose between enrolling citizen children in public benefits, to which they're legally entitled, and risk their own citizenship opportunities, or forgo benefits to keep the family together.
While the changes aren't final, they are already leaving a harmful impact on the health and well-being of many children and families in Virginia's immigrant communities. I encourage our health and advocacy partners to communicate with patients and community members that the proposed changes are not in effect and that enrollment for an individual or a child in a health or nutrition program does not currently affect public charge designation. Coalition staff and partners will continue to fight for all Virginians to have access to the programs they are legally entitled to, without fear of impacting immigration status, and provide up-to-date information on opportunities to voice your opinion on this issue, such as offering public comment. Sign up for our monthly Update for timely news and information on the public comment period, when it opens.