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Immigrant Eligibility for Publicly Funded Health Care Benefits - THREATENED CHANGES SEPTEMBER 2018

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Posted: 06 Mar, 2009
by Cathy Roberts (Empire Justice Center)
Updated: 23 Sep, 2018
by Valerie Bogart (New York Legal Assistance Group)

Sept.23, 2018 ALERT - Trump Proposes Harsh "Public Charge" Rule Changes 

On Sept. 22, 2018, the the Department of Homeland Security (DHS) issued a press release and the text of the highly anticipated public charge rule. which will change the definition for deciding whether an immigrant  who receives Medicaid or other government benefits is considered a "public charge" -- which can result in denial of Lawful Permanent Resident status (green card),  denial of an extension of a non-immigrant visa,  deny a change  of non-immigrant status (e.g., from a student visa to an employment visa), or deny admission to the U.S. Public charge is not a consideration when a lawful permanent resident applies to become a citizen.

The rule is likely to be published as a proposed federal regulation in the next few days, and then will be open for public comment for 60 days.   

See this quick summary of the proposed rule by Protecting Immigrant Families Campaign #ProtectFamilies, a national coalition led by the National Immigration Law Center.   See their news page for press about the proposed rule.  Here are some points from the NILC summary: 

  • Certain immigrants—such as refugees, asylees, survivors of domestic violence, and other protected groups—are not subject to “public charge” determinations and would not be affected by this proposed rule.  Public charge is also not a consideration when lawful permanent residents (green card holders) apply to become U.S. citizens.  The regulation also proposes to exclude benefits received by active duty service members, their spouses and children.

  • Before, only receipt of cash assistance (public assistance and SSI) and Medicaid for nursing home care were considered in determining who is likely to become a “public charge."   

  • The proposed rule would now also include:

  • Regarding Medicaid, before,  undocumented immigrants who were not eligible for regular Medicaid based on being "PRUCOL" could only receive emergency Medicaid.  The proposal would not consider treatment of an emergency medical condition as constituting a public charge.  However, documented immigrants who in NYS qualify for regular non-emergency medicaid as PRUCOL could be at risk when receiving any Medicaid services other than for emergency conditions.    The Part D Low Income Subsidy is specifically included.  

  • Medicaid and other  benefits received by an immigrant’s family members will not be considered (though since many people won't know that, there will be a chilling effect deterring many family members from receiving crucial health, income, housing and food assistance. 

  • Benefits that are  totally state, local or tribal programs other than those specifically listed will not be considered.  In NYS that would exclude EPIC and SCRIE/DRIE from being considered.  The Children’s Health Insurance Program (CHIP),  is not included in the current regulatory text.

  • The rule will not be retroactive. This means that benefits -- other than cash or long-term care at government expense -- that are used before the rule is final and effective will not be considered in the public charge determination.

  • Adopts a new bright-line threshold for households that hope to overcome a “public charge” test - by requiring that the immigrant (not just the sponsor) earn at least 125 percent of the Federal Poverty Level .

  • See NILC summary for more about the new rule.   Sign up for emails about the new rule here 

  •  Fact Sheets on Public Charge from the New York Immigration Coalition can be downloaded here in English, Spanish,  Chinese, French, Korean, and Arabic. (these pre-date the 9/22/18 DHS release of the rule)

  •  NYLAG Know Your Rights Information for Immigrants - in Various Languages, including foldable Know Your Rights pocket flyer

  • New England Journal of Medicine article, A New Threat to Immigrants’ Health — The Public-Charge Rule, Sept. 8, 2018  
  • New York Immigration Coalition Website --  Access to Health Care, Food, and Other Public Programs for Immigrant Families under the Trump Administration, Things to Keep in Mind When Talking with Immigrant Families  (April 2018 -pre-dates rule issued in Sept. 2018))

  • Urban Justice Center International Refugee Assistance Project and network of legal services providers in NYS.   

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New York’s Exchange Portal: A Gateway to Coverage for Immigrants, published 9/14/15, by Empire Justice Center reviews current rules on eligibility and describes how immigrants can access health care through NYSof Health portal, including for emergency care for those who are undocumented and not PRUCOL.   

The Community, Migrant & Homeless Health Center Handbook on “Immigrant Eligibility for Publicly Funded Health Care Benefits,” written by Empire Justice Center's senior staff attorney Barbara Weiner, in collaboration with CHCANYS (the Community Health Care Association of New York State) and the Immigrant Eligibility Coverage Workgroup, is available here. (LINK WILL BE UPDATED)

Click here for an interactive Marketplace eligibility questionnaire, designed to help enrollment assistors and consumers better assess their potential eligibility for Marketplace coverage based on immigration status, age and income. This questionnaire is not an official assessment of eligibility. To receive an official determination of eligibility contact the New York State of Health Marketplace at http://www.nystateofhealth.ny.gov or 1-855-355-5777

  • This tool was created jointly by the Children's Defense Fund - New York, the Empire Justice Center, and the Community Service Society through their work in the Health Care for All New York coalition.

Note - please see 2013 updates re PRUCOL status for people applying for or granted DACA status in this article.

Also read
item Medicaid for Immigrants who are Not Permanent Residents (Do Not have "Green Cards")-- PRUCOL and Temporary Non-Immigrant Eligibility
item Emergency Medicaid in New York State - Limited Medicaid Coverage for Undocumented Immigrants
item The Language Access Resource Center - Empire Justice Center
item Temporary Protected Status (TPS) and Public Health Insurance
item Empire Justice Center Reports on Immigrant Access to Health Care in NY's Health Insurance Exchange
item Know Your Rights: NYLAG Webinars on Medicare and Medicaid -

Also listed in
folder Medicaid -> Immigrant Access

External links
http://www.wnylc.com/health/client/images/icons/article_out.svg Immigrant Eligibility for Publicly Funded Health Care Benefits (Empire Justice/CHCANYS/IECW)
http://www.wnylc.com/health/client/images/icons/article_out.svg Guide to Public Benefits for Immigrants (Public Advocate / NYIC)

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