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ACL Policy Update: What the Changes in the “Public Charge” Immigration Rule Mean for the Aging and Disability Networks

July 30, 2021
Vicki Gottlich, Director - Center for Policy and Evaluation


Summary:  Earlier this year, the Department of Homeland Security (DHS) rescinded the “public charge” rule implemented in 2019. This means that receiving or applying for most Medicaid benefits, public housing, or nutrition assistance are no longer grounds for denying an individual seeking a visa to come to the United States or to become a lawful permanent resident. Services provided through ACL’s programs, and medical treatment or preventive services for COVID-19, including vaccinations, also will not count against people seeking legal entry to the country.   


The “public charge” doctrine allows U.S. immigration officials to bar a person from getting a visa or becoming a lawful permanent resident if they are determined to be likely to become a “public charge,” meaning a person who is likely to primarily rely on the government for assistance.  This long-standing policy was put into immigration law in the 1990s.  In 1999, Interim Field Guidance clarified that this policy applies only to immigrants likely to become dependent on direct cash assistance, like Supplemental Security Income (SSI) or Temporary Assistance for Needy Families (TANF), or to individuals who rely on Medicaid-financed “long-term institutionalization,” such as a nursing or psychiatric facility.

The Trump administration issued a new public charge rule in 2019 to significantly expand the policy to include anyone who lawfully used virtually any public benefit for more than 12 cumulative months over any 36-month period.  For example, enrollment in Medicaid for acute medical care or for home and community-based services (not just institutional care), or receiving housing or nutrition assistance, could all be used to designate a person as a “public charge” and deny them a visa or permanent legal residency.   

What Changed

One of the first executive orders issued by President Biden directly addressed immigrant access to public benefits and the public charge rule. Implementation of the order caused a series of actions by DHS and the Department of Justice that ultimately resulted in the 2019 rule being removed from the Code of Federal Regulations, and DHS announced in March that it would revert to 1999 Interim Field Guidance.

In an April letter to interagency partners, the U.S. Citizenship and Immigration Services also stated that “medical treatment or preventive services for COVID-19, including vaccinations, will not be considered for public charge purposes. This policy will help ensure that noncitizens are able to access important government services for which they may be eligible.”

Recently, the Centers for Medicare and Medicaid Services issued an informational bulletin reminding state Medicaid agencies that they may not share information with immigration officials about an person’s Medicaid coverage (or application) for the purposes of a public charge determination. 

Looking Ahead

The 2019 Public Charge Rule had a chilling effect on immigrants accessing benefits to which they are legally entitled – research has shown that immigrant families have avoided both programs specified in the 2019 rule and those outside the rule for fear of immigration-related consequences. It created particularly devastating consequences for older adults and people with disabilities, who often rely on Medicaid to stay healthy and to live in their communities. That’s why sharing information about the changes is so critical.

As trusted messengers in your communities, the aging and disability networks have a particularly important role to play in dispelling fear and confusion. Please help spread the word that using public benefits to which people are entitled (with the longstanding exception of cash assistance and Medicaid-funded institutional care) will not adversely affect the immigration status of older adults and people with disabilities.

We will continue to keep you updated about policy changes like this one as they arise.

Last modified on 08/02/2021

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