By Lara Jirmanus, MD, MPH

On September 22, 2018, the Trump Administration proposed federal changes to the “public charge” regulation, which would significantly impact immigrants’ access to vital services, such as health care, nutrition and housing assistance. According to leading experts and published research, the proposal would lead to decreased participation by lawfully present immigrant families in essential services for which they are eligible. Already six major physicians organizations have declared their opposition to the sweeping rule. 

Currently, only those who received cash assistance could be considered a “public charge,” and could have visa or Green Card applications denied on this basis.  Under the new rule, visa or Green Card applicants meeting the criteria below may be denied legal status on the basis of being found a potential “public charge": 

• Immigrants who earn less than 125% of the Federal Poverty Level ($31,375 for a family of four)
• Immigrants who receive listed benefits such as non-emergency Medicaid, Housing Assistance, Medicare Part D Low Income Subsidy or SNAP (food stamps) 
• Immigrants under 18 or over 61
• Anyone with a health condition requiring treatment the affects the applicant's ability to work, attend school or care for themselves, unless they have access to private health insurance or resources to pay for treatment
• DHS has also asked for input regarding whether the Children’s Health Insurance Program (CHIP) should be included, but it is not included in the proposed regulatory text

A detailed analysis and FAQ of the public charge policy change is available from the Protecting Immigrant Families national campaign, and profiles of some of the individuals who will be harmed by this proposed rule can be read here

As healthcare providers, we have a very important role to play! There is a 60-day public comment period, which expires on December 10, 2018. Healthcare providers are encouraged to share with the federal government the ways they have already seen or anticipate this policy may affect patients, and also to help educate patients and the community about this issue. 

Here are the three main points to remember:

• Nothing has changed. The policy is not yet in effect. The government will need to respond to public comments first, which is why it is important to generate many comments.
• Keep your benefits! There is no reason to drop benefits at this point. The policy will be forward looking and will also have a 60-day grace period after it takes effect. People should continue to use and apply for benefits. 
• We’re fighting back! We are trying to collect 100,000 comments before December 10, 2018. See more below regarding submitting comments. 

Important issues to remember when submitting comments:

• Use your credentials. List all of your titles and affiliations, describe your training, mention how many years you have been in practice, how many immigrants you see, any relevant publications you have in peer-reviewed journals. Emphasize your expertise in this area.
• Cite the literature. See here for a folder of research on the anticipated impact of the policy change 
• Tell patient stories. The comments will be also used for the purposes of litigation by advocates seeking to overturn the rule. You can submit information regarding stories anonymously, for example using first name, last initial, but put your contact information in case an advocate would like to approach you for more information. 
• You can submit as many comments as you want.
• Don’t copy paste. The Federal Government will use software to group comments with identical text, so write comments in your own words. No form letters.
• Use the Massachusetts Protecting Immigrant Families Comment Tool to submit your comment, so that they can keep track of how many we have submitted. Or submit directly to the Federal Portal if you wish to upload your comment as a PDF on letterhead. 
• Start and end your comments with “I am writing in opposition to the proposed rule ‘Inadmissibility on Public Charge Grounds’ and respectfully address that it be withdrawn.”  
• Visit the website of the Massachusetts Immigrant and Refugee Advocacy (MIRA) Coalition for further resources or the PIF national campaign: protectingimmigrantfamilies.org/resources. 

For more information on campaigns such as this one, please, join the listserv of the Health and Law Immigrant Solidarity Network, a group of over 200 medical and legal professionals and community groups working to support immigrants in Massachusetts. Help us advocate on behalf of our patients in need!