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Latest News: Public Health News

Update on Public Charge Rule - Key Provisions

Tuesday, August 27, 2019  
Posted by: Jamie Michael
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*Adapted from ASTHO (Association of State and Territorial Health Officials) Legislative Alert (August 22nd)


Last week, the Department of Homeland Security (DHS) published the final rule to the Federal Register on Inadmissibility on Public Charge Grounds (CIS No. 2637-19; DHS Docket No. USCIS-2010-0012). NALBOH has been discussing this proposed rule to determine what we as board of health members can do to lower the impact of public health concerns.


The final rule amends current DHS regulations on how DHS will determine if an alien who is applying for adjustment of status or admission to the United States is admissible or not under section 212(a)(4) of the Immigration and Nationality Act, because he or she is likely at any time to become a public charge. An official summary and factsheet of the rule can be found here.


ASTHO’s high level summary of key provisions can be found here.



Many organizations that provided comments on the proposed rule expressed concern regarding a potential “chilling effect,” or when some individuals may disenroll or forego enrollment in public benefits programs. DHS states that “it is unclear how many individuals would actually disenroll from or forego enrollment in public benefits programs due to the final rule” due to difficulties in prospectively estimating disenrollment but estimates that 241,089 members of households that include foreign-born non-citizens expected to disenroll or forego enrollment across each of the public benefits programs in order to preserve their chances of adjusting status.


The detailed DHS economic analysis estimates potential impact of this rule. DHS includes in its own economic analysis of the final rule a list of consequences “that could occur because of follow-on effects of the reduction in transfer payments due to disenrollment or forgone enrollment in public benefits programs as identified in the final rule.” A list of “non-monetized potential consequences of the final rule caused by disenrollment or foregoing enrollment in public benefits program by aliens who are otherwise eligible could lead to the following:

  1. Worse health outcomes, including increased prevalence of obesity and malnutrition, especially for pregnant or breastfeeding women, infants, or children, and reduced prescription adherence.
  2. Increased use of emergency rooms and emergent care as a method of primary healthcare due to delayed treatment.
  3. Increased prevalence of communicable diseases, including among members of the U.S. citizen population who are not vaccinated.
  4. Increases in uncompensated care in which a treatment or service is not paid for by an insurer or patient.
  5. Increased rates of poverty and housing instability.
  6. Reduced productivity and educational attainment.

Included in comments on the proposed rule submitted on Nov. 30, 2018, ASTHO expressed grave concern about these six areas, given their responsibility to protect and promote the health of their jurisdictions and prevent diseases statewide. Since the public health risks and health impacts are known and articulated, this final rule could potentially affect all Americans regardless of their immigration status.