HHS, CMS Urge States To Correct Public Charge Rule Misinformation

July 26, 2021 - CMS and the Department of Health and Human Services (HHS) are urging all states to take steps to ensure that immigrants who are eligible for Medicaid are aware of their eligibility.

“As President Biden made clear in his executive order restoring faith in our legal immigration systems, we must reduce fear and confusion among immigrant communities who rely on critical benefits that are available to them by law,” said HHS Secretary Xavier Becerra. 

“We invite states and our community partners to spread this message far and wide: we are here to help and the public charge rule is no longer in effect. All our communities deserve the peace of mind that comes with having access to quality care.”

HHS has released a bulletin emphasizing that the 2019 Public Charge Final Rule is not enforceable or in effect as of March 9, 2021. The immigrant eligibility parameters for public assistance have returned to the standards that were in place prior to the 2019 update. These parameters had existed since 1999. 

All immigrant children may receive coverage under Children’s Health Insurance Program (CHIP). There is no way for immigrant children to lose CHIP eligibility.

Under these guidelines, only individuals who are in long-term care will not be eligible for public assistance such as Medicaid. However, those who undergo short-term rehabilitation will still be eligible for public payer coverage.

“Health care is a right, not a privilege, and no one should be deterred from accessing the care they need out of fear. Accessing health coverage through Medicaid or CHIP will not risk immigration status,” said CMS Administrator Chiquita Brooks-LaSure. 

“The Biden-Harris Administration is committed to making sure people have access to programs that keep them safe and healthy.”

CMS recommended a local approach to sharing this information. The agency urged states to coordinate with community-based organizations in order to disseminate the news about this year’s changes to the public charge policy. States should also correct any false information or misunderstandings about whether immigrant children are eligible for CHIP coverage, CMS and HHS reminded.

In January 2020, the Supreme Court granted a stay to the 2019 public charge rule which was established under the Trump administration. 

The 2019 public charge rule stated that immigrants could not enter or stay in the US if they required public assistance to obtain healthcare coverage. The Supreme Court’s “stay” allowed the policy to go into effect in every state except Illinois.

Shortly after the Biden administration entered the White House, the Department of Homeland Security (DHS) rolled back the public charge rule of 2019.

However, experts who supported the end of the public charge rule have expressed concern that the public charge rule may still be impacting immigrants’ healthcare and coverage decisions.

Using data from the Well-Being and Basic Needs Survey, Urban Institute researchers found that a fifth of immigrant adults with children avoided using public benefits in 2020 while the public charge rule was still in effect. More than half of nonpermanent residents who decided to forego necessary care in 2020 due to cost were uninsured.

Coming out of a year in which immigrants actively avoided these benefits, immigrants may be hesitant to leverage any of the benefits that now apply to them.

The rule has also potentially perpetuated racial coverage disparity trends that extended from 2016 to 2019. Some researchers have argued that changes to immigration policy in recent years have contributed to the return of coverage disparities as minority groups witnessed a steeper rise in uninsurance than White populations.

In the bulletin urging states to inform residents of the return to the 1999 public charge policy, CMS concluded by noting that states cannot share beneficiary or applicant coverage information.