Legislative Advocacy

Policy changes deeply affect the health of immigrants, as fear of immigration enforcement leads to negative health outcomes and prevents people from accessing necessary health and social services.

CURRENT Highlight

Public Charge


National Advocacy

In the last year, many policy changes have spread fear in immigrant communities which leads them to avoid seeking care for health conditions and decline necessary essential services to which they are entitled.

The Trump Administration seeks to make it even more difficult for immigrant families and their US relatives and citizen children to access necessary services by changing the definition of “public charge.”

In short, people who are applying for visas or green cards to the US need to prove they are not likely to become dependent on the US government in the future. While previously immigration officials only asked whether people had received cash benefits, now health and other benefits may be considered in this determination. If this policy change goes through, immigrant families will be forced to choose between vital services and reuniting with their loved ones. But even worse, the fear created by the policy change will likely cause many more to unenroll from necessary benefits.  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.

Details on the public charge rule change:

  • 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 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

    • Some immigrants will not be affected, like refugees and asylees or those on special visas for victims of crime or domestic violence.

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

There are 3 main points to remember.

1) 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.

2) 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.

3) We’re fighting back! We are trying to collect 100,000 comments before December 10, 2018. See more below regarding submitting comments.

Details to remember when submitting public 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.”  

  • More information on how to submit effective comments can be found here.

  • Visit the website of the Massachusetts Immigrant and Refugee Advocacy (MIRA) Coalition for further resources or the PIF national campaign:

  • Talk to your institutional leadership to see if they are aware of the public charge issue and prepared to make comments

If you have questions about the rule, submitting comments, or to organize a training in your institution, email the local Massachusetts Protecting Immigrant Families Campaign:

Mario Paredes; Liza Ryan; Maria R. Gonzales Albuixech; Andrew Cohen; Justin Lowe

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Local Advocacy

We are part of the Safe Communities Act Coalition and supported the original Safe Communities Act and the budget amendments to protect immigrant families.

Stay tuned for the next legislative cycle as we will be calling on more physicians to provide powerful testimony in support of the health of our immigrant communities.