IMPACT OF PUBLIC CHARGE ON NEW YORK STATE HEALTH CENTERS AND PATIENTS
Overview: What is public charge and what are the proposed changes to the public charge rule?
The US Department of Homeland Security assesses individuals seeking admission to the US or applying for a green card to determine if they would be a “public charge.” Public charge refers to any individual who is likely to become “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.” Individuals who are considered a public charge may be denied entry to the US or denied a green card.
The proposed changes to public charge will expand benefits considered under public charge determination, such as: non-emergency Medicaid, “SNAP” (also known as “food stamps”), Medicare Part D Low Income Subsidy, and Section 8 housing assistance. Supplemental Security Income (SSI) and TANF (sometimes referred to as “welfare”) are already considered in public charge determination and will continue to be considered under the proposed changes.
Use of health center services, including sliding fee scale, and participation in WIC will not be a factor in a public charge determination.
NYS Health Center Facts
Health centers serve patients regardless of their immigration status, language spoken, income level, or insurance status.
NYS health centers serve 2.2 million patients annually, 59% of whom are enrolled in Medicaid/CHIP.
Medicaid & CHIP make up about 53% of NYS health center revenue.
About 20% of NYS Medicaid enrollees live in a family with at least one non-citizen.
Impacts to NYS Health Centers
In one year, NYS health centers could see as many as 95,000 former Medicaid enrollees become uninsured with projected Medicaid revenue losses topping $100,000,000.
An estimated 20% of NYS residents in families with at least one noncitizen will disenroll from Medicaid.
Over half of NYS health centers that responded to a CHCANYS survey have already reported an increase in the number of individuals who are eligible but not enrolling in Medicaid, SNAP, Section 8 Housing, and WIC due to concerns over deportation, inability to attain a green card, or inability to sponsor a loved one to attain legal permanent status.
Some NYS health centers have already reported that parents have refused benefits for their citizen children, fearing for their own ability to gain legal permanent status or the ability for other children in the family to gain legal permanent status.
NYS health centers have reported that the proposed changes to public charge have stoked fears over accessing Medicaid benefits, leading to:
Decreases in early access to prenatal care among expecting immigrant mothers, and;
Decreased medication adherence rates, including among high need populations (such as individuals with HIV).
Fears over deportation have also led to:
Increased behavioral health needs and corresponding challenges, such as poor performance in school among children and sleep disturbance;