Public Charge Task Force
Last Updated: May 9, 2018
- Public Charge Resources (see more below)
- About this Task Force
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Federal Proposal to Expand the “Public Charge” Definition to Include Health Care, Nutrition and Education
The Department of Homeland Security’s U.S. Citizenship and Immigration Services (USCIS) requires that immigrants seeking permanent residency in the U.S. (a green card) must first prove that they will not be a “public charge,” i.e. likely to become dependent on cash assistance or long-term care “at government expense.” Those determined to be a “public charge” may be denied legal permanent residency in the U.S. or even deported (as was the case in the 1990s).
Refugees, asylees and certain other groups are exempt altogether from the “public charge” definition. For a full list of groups who are exempt, see the USCIS’ Public Charge web page.
How Does this Affect Community Health Center Patients?
AAPCHO health centers are already reporting that proposed changes to “public charge” policy are having a chilling effect on patients’ willingness to seek medical care.
Draft language by USCIS to expand the definition of “public charge” was leaked to the public via:
- The Washington Post – March 28, 2018
Trump proposal would penalize immigrants who use tax credits and other benefits
- Reuters – February 8, 2018
Exclusive: Trump administration may target immigrants who use food aid, other benefits
The draft regulation, if finalized, would categorize use of all government programs as a “public charge,” including:
- Health coverage programs, e.g. Medicaid, CHIP, ACA exchange subsidies
- Food programs, e.g. WIC, SNAP
- Education programs
- Federal, state, and locally-funded programs
- U.S.-born children who use services could jeopardize their families’ legal permanent residency
The leaked draft from the media is not official. We expect that the Administration will release the official version anytime between now and July 2018. At that time, the public will have at least 60 days to submit comments. The Administration must review the comments before revising and finalizing the draft.
This proposal has a disproportionate impact on children and families. Members of the public, especially health care providers, need to get ready to submit public comments. Families who are directly affected will be reluctant to speak out so it is important for health care providers to submit specific comments that help policymakers and the public understand the devastating effects of the proposed policy on children, the elderly, and families.
Public Charge Resources
Recent Articles on the Trump Administration’s Leaked Public Charge Draft Rule
- The Health 202: Under Trump, immigrants back away from Medicaid, Obamacare subsidies (The Washington Post – Aprill 11, 2018)
- Asian American Health Leaders Oppose Potential Denial of Immigration Status to Immigrants Using Needed Critical Services – Joint press Release on public charge (AAPCHO and APIAHF – February 12, 2018)
- The Leaked Rule that Could Ban Immigrants Based on Income, Explained by the Experts (TalkPoverty – March 1, 2018)
- Here’s the Trump administration attack on immigrants you haven’t heard about (The Washington Post – February 16, 2018)
- “Leaked Draft of Possible Trump Executive Order on Public Benefits Would Spell Chilling Effects for Legal Immigrants” (Migration Policy Institute – February 2017)
- For one U.S. immigrant family, short-term public aid meant long-term security (Reuters – February 13, 2018)
- “Trump Plans New Limits on Family Immigration and Access to Services” (Center for American Progress – February 12, 2018)
- Trump’s draft plan to punish legal immigrants for sending US-born kids to Head Start (Vox – February 8, 2018)
- Immigration Crackdown Raises Fears of Seeking Health Care (Roll Call – January 25, 2018)
- Related recent ethnic media and in-language coverage:
- World Journal – February 9, 2018
What to Say to Patients About Public Charge
- Things to Keep in Mind When Talking with Immigrant Families (National Immigrant Law Center – last revised February 8, 2018)
- Sample messages to patients by community health centers:
Preparing to Talk with the Media About Public Charge
- Are you a health center provider, staff or patient willing to tell your story about how immigration policies or public charge affects you? Are fewer patients coming in for services because of rumors about Public Charge, immigration laws, or Medicaid? We need your stories! Click here to share your story.
- Whether it’s a tweet, a patient story, or a data point, framing is critical to building a winning argument. Avoid common communication pitfalls by watching Narratives that Reshape the Immigration Conversation by the Frameworks Institute, February 7, 2018 (Marisa Gerstein Pineau, 22 min). Slides (PDF). Hosted by The Immigrant Learning Center.
- Top 6 Reasons Communications Won the Day on Health Care by Beth Canter and Emily Gardner, Spitfire, August 8, 2017. Lessons learned from successful efforts to preserve the ACA and Medicaid.
Public Charge: Estimate of Patients Impacted and Potential Loss of Revenue
Medicaid and Federal Community Health Center Funding is why community health centers in the U.S. serve 27 million people each year.
- Here’s a calculator to (1) estimate the number of patients impacted and (2) potential loss of revenue if they disenroll from Medicaid and other health coverage: Public Charge Impact Calculator (Asian Health Services – last updated March 12, 2018)
When the Draft Rule on Public Charge is Officially Released: Tips on Submitting Public Comments
Right now, the Trump Administration is preparing an official draft rule that proposes to expand the definition of who is considered a “public charge.” After the official draft is released, the public will have 60 days to submit comments (so far we’ve only seen a leaked unofficial version).
AAPCHO will alert members to submit as many comments as possible. Numbers count, and so does the quality of the comments. Here are tips to help prepare:
- Submitting Effective Comments (Regulations.gov)
- Taking the Mystery Out of Filing Comments on Proposed Rules (National Council of Non-Profits)
- How to Comment on a Rule (Center for Effective Government)
Know Your Rights: Operational Readiness for Health Centers
- Creating a Safe Space at Your Health Center (AAPCHO – September 18, 2017)
- Immigration Sample Policies and Procedures for Health Centers (California Primary Care Association – January 29, 2018) – Six sample policies and procedures for health centers to prepare for the unlikely possibility of an immigration raid.
- Know Your Rights Red Cards (Immigrant Legal Resource Center) – All people in the United States, regardless of immigration status, have certain rights and protections under the U.S. Constitution. These cards can be distributed to remind us of our rights in situations such as when ICE agents go to a home.
- Know Your Rights Resources (Asian Americans Advancing Justice – Atlanta – last updted August 3, 2017) – Resources in 22 languages
About this Task Force
The AAPCHO Public Charge Task Force is a joint national initiative led by AAPCHO and it’s member health centers and clinics located in communities with high concentrations of medically underserved Asian Americans (AAs) and Native Hawaiians and Pacific Islanders (NHPIs).
The Task Force works to respond to any proposed changes to public charge guidance or regulations—including advocating against any threats to the health access and status of AA, NHPI, and other vulnerable communities that would be disproportionately impacted by any detrimental changes to public charge policy.
We coordinate our efforts with our member health centers and other partners including but not limited to the Protecting Immigrant Families coalition and the National Association of Community Health Centers.