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  • Washington Highlights

    AAMC Submits Comment Letter on Proposed Public Charge Rule

    Ivy Baer, Senior Director and Regulatory Counsel

    The AAMC submitted a comment letter to the Department of Homeland Security (DHS) on its proposed rule, “Inadmissibility on Public Charge Grounds.” The letter urges DHS not to finalize the proposal and to defer to the Department of State’s public charge determinations instead.

    The proposed rule would significantly change the longstanding guidance on the public charge law and establish new standards about which public benefits will be considered when immigrants seek to enter the United States or change their status.

    Among the health care-related benefits that would be considered in public charge inadmissibility determinations are Medicaid (other than certain limited Medicaid benefits such as emergency Medicaid available only to undocumented immigrants) and Medicare Part D Low Income Subsidy. Other public benefits that would be considered include Temporary Assistance for Needy Families; federal, state, or local cash benefit programs for income maintenance; the Supplemental Nutrition Assistance Program; housing assistance under the Housing Choice Voucher Program; and institutionalization for long-term care at government expense. The Children’s Health Insurance Program is not included, though DHS asked for comments on whether it should be.

    The AAMC’s comments highlight that the result of the changes proposed by DHS will force individuals and entire communities into precarious circumstances that will undermine their ability to gain the self-sufficiency that the government hopes to encourage. The letter also includes analysis from Manatt Health that estimates that if the rule is finalized as proposed, there will be a large “chilling effect” that may result in 13.2 million individuals (4.4 million noncitizens and 8.8 million citizen family members of noncitizens) who are legally entitled to benefits being discouraged from accessing them for fear that they will trigger the public charge rule.

    Payments to hospitals that are subject to the chilling effect are estimated to be $17 billion for one year. The AAMC estimates that 88% of member teaching hospitals will be affected, with the following potential impacts:

    • Nearly $6 million for noncitizen enrollees and over $3 million for citizen enrollees who have a noncitizen family member;
    • The average affect per hospital is estimated to be over $24,400,000.