Changes to Public Charge Regulations: A Threat to Immigrant and Public Health

Panelists: Andrew Cohen, JD; Leah Zallman, MPH, MD; Lara Jirmanus, MPH, MD.

On December 5, Harvard FXB sponsored a panel on proposed changes in regulations around public charge and immigration.  Dr. Lara Jirmanus, Andrew Cohen, and Dr. Leah Zallman presented; Professor Nancy Krieger moderated the panel and the lively question and answer session afterwards. Below is a summary of the highlights along with further information about making public comments and resources for those concerned. The slides from the talk are also included at the end of this post.

By Lara Jirmanus

What are the issues?

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.

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.

Public Comment

As public health and healthcare practitioners, we have a very important role to play! There was a 60-day public comment period, which expired 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.

What to tell patients and others afraid of possible changes

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. One of the effects of such proposed changes is a chilling effect on those entitled to benefits–even those who would not be effected by the changes and even US citizens.
  • 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

  • Unique comments in your own words (not form letters) have the greatest impact.
  • Start and end your comments with: “I am writing in opposition to the proposed rule “Inadmissibility on Public Charge Grounds” and respectfully request that it be withdrawn.” 
  • Request the proposed rule to be withdrawn. Don’t suggest corrective action.
  • Express your subject matter expertise/perspectives as a student of public health, safety net provider, researcher, etc. 
  • Citing research and personal stories are effective.  If citing research, attach a pdf copy so it must be examined as part of the public comments. has links to research on public charge.
  • Use nonpartisan comments on specific aspects of the proposed rule and not the Federal Administration. Don’t discuss programs that are not included in the proposed rule.
  • All comments must be submitted in English (or translated into English).
  • If community members wish to submit a comment but remain anonymous, a representative can submit the comment on their behalf. It is also possible to submit comments anonymously. If you do not want to provide your name, type “Anonymous” in the first and last name fields and will automatically mark your comment as Anonymous.

For more information on campaigns such as this one, please, join the listserv of the Health and Law Immigrant Solidarity Network, a group of nearly 400 medical and legal professionals and community groups working to support immigrants in Massachusetts. Help us advocate on behalf of our patients in need!

The comments are now closed. More than 216,000 comments were received. You can read them in the docket folder for this regulation.

You can read Harvard FXB’s comment here.

More information:

Lara Jirmanus, MD, MPH is a fellow at Harvard FXB, a family physician at the Cambridge Health Alliance, a Clinical Instructor at Harvard Medical School, and founder of the Health and Law Immigrant Solidarity Network, a group of over 200 healthcare and legal professionals and community organizations supporting immigrants in Eastern Massachusetts.
Updated to include Harvard FXB’s comment and indicate that the deadline had passed.