In this letter to Department of Homeland Security Secretary Kirstjen Nielsen, MACPAC comments on an October 2018 proposed rule that would change the definition of public charge for purposes of immigration status. Specifically, the proposed rule would change the definition of who may be considered a public charge from an individual who is primarily dependent on public benefits to an individual who receives one or more public benefits. In addition, it would expand the list of public benefits that can be considered in a determination of public charge to include Medicaid.
While the proposed rule does not change Medicaid regulations or affect immigrant eligibility for Medicaid, the new definition of public charge has the potential to restrict access to care for those entitled to Medicaid coverage; increase uncompensated care for providers; and have downstream fiscal and administrative implications for states and localities.