Impact of federal 'public charge' rule change on access to health care in Oregon

August 13, 2019

Salem, Ore. -- On Monday the Trump administration announced a new rule that could make it harder for some immigrants who rely on certain government benefit programs to obtain lawful permanent residency if they are found to be a "public charge." The new public charge rule expands the list of benefits that the federal government could consider. Benefits that would be considered include not only cash-assistance programs (including Supplemental Security Income and Temporary Assistance for Needy Families) and Medicaid-funded long-term care, but also nutrition assistance, housing assistance, and many other types of Medicaid for adults. However, the rule does exempt some categories of Medicaid eligibility and participation in other health programs. The Oregon Health Authority is the state agency responsible for protecting the health of all 4 million people living in Oregon. As part of our role, we want to inform state residents about the impact of the rule on programs that provide health coverage and health-related benefits in Oregon. Under the new rule:

Immigrant adults who receive some forms of Medicaid coverage would have their enrollment considered (among other factors) by the federal government to determine whether they are (or might become) a public charge. If an immigrant is deemed a public charge, he or she could be denied lawful permanent residency.
The public charge rule does not apply to some federal and state programs such as:

Medicaid for children under 21 and pregnant women (including 60 days postpartum).
Emergency Medicaid (CAWEM).
The Children’s Health Insurance Program (CHIP).
Women, Infants and Children (WIC) supplemental nutrition program.
Medicaid-covered special education services funded by the Individuals with Disabilities Education Act (IDEA).
Commercial health insurance premium subsidies offered through Oregon’s Health Insurance Marketplace.
School-based health services.

Oregon’s Cover All Kids program.
Most services offered by Oregon's Reproductive Health program.

In comments the Oregon Health Authority submitted to the federal government on the proposed rule in December 2018, the agency wrote:

We know that health coverage contributes to healthier pregnancies, births, and childhood outcomes. When people have health coverage, they are better able to work, go to school and contribute in other ways to their local economy. Employers benefit from a healthier workforce, insurance costs are lower, and there is less absenteeism. When people have health coverage there are reduced emergency department visits and hospitalizations as well as reduced uncompensated care. Ultimately fewer people turn to social services and draw on the safety net. When people have health coverage, they are healthier, on average, than people who lack health coverage, and communities are healthier too …

Health care is not a cash assistance benefit. Good health is the foundation for thriving, economically independent people, families and communities. This proposal punishes immigrants for taking responsibility for their health, the health of their loved ones and their neighbors by seeking health care. It fails to acknowledge that in a growing majority of states (like Oregon), which have expanded Medicaid, a high percentage of Medicaid members work, earn income and support themselves without public assistance. It stigmatizes Medicaid and CHIP as public assistance programs, instead of promoting them of as a vital cornerstone of a strong health care system.

As a result, this proposal is in direct conflict with our agency’s mission which is to help people and communities achieve optimum physical, mental and social well-being and improve access to quality, affordable health care.

The new rule will be posted in the federal register August 14 and is scheduled to take effect October 15, 2019. The rule is not retroactive.

The Oregon Health Authority encourages anyone who has questions about how the federal public charge rule may affect them or members of their family to seek counsel from a qualified immigration attorney. A list of attorneys can be found at the Oregon Immigration Resource: https://oregonimmigrationresource.org/.

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