Medicaid and the Public Charge Rule: What do I Need to Know?

Back of the woman cooking in the kitchen in a humble household

If you are seeking a green card and permanent residency in the United States, you may have heard of the Public Charge Rule. A public charge is someone who needs government assistance to survive.

One of the longstanding principles of the United States immigration system is the idea that people who seek permanent residency will be self-sufficient. In other words, you need to prove that you will able to take care of yourself without financial aid from the government.

The Public Charge Rule is a complicated analysis that will be used by your adjudications officer to determine whether you will need government assistance in the future. 

Recent changes in the rule, however, have permitted the USCIS to consider certain Medicaid benefits that were not considered in the past. This has caused controversy because it could make it more difficult to obtain a green card and permanent residency in the United States. 

What is the Public Charge Rule?

The Public Charge Rule is an analysis that will be performed by your adjudications officer to determine whether you have used certain government sponsored benefits in the past or will need benefits in the future. In general, the Public Charge Rule applies to:

  • Employment-based green card applicants
  • Family-based green card applicants
  • Lottery-based green card applicants
  • Marriage-based green card applicants

Refugees and asylees are among those who are exempt from the Rule.

What is Medicaid?

Medicaid is a federal and state government program that provides healthcare benefits to people and families with a low income. The federal government uses a Modified Adjusted Gross Income (MAGI) formula to determine eligibility for Medicaid. 

An elder couple sitting in arm chairs at home

The Medicaid system is complex with many exceptions, but federal law generally provides coverage for:

  • people who are age 65 and older,
  • individuals and families with low income,
  • pregnant women,
  • the disabled, and
  • the elderly.

State governments are free to provide coverage to additional classifications of people who might not qualify under federal law.

The issue with Medicaid and the Public Charge Rule is that the recent changes in the Rule allow the USCIS to consider non-emergency Medicaid benefits that were not considered in the past. The fear is that this could have a chilling effect on the immigration process and make it more difficult to obtain permanent residency.

How does the Public Charge Rule Work?

The new rule focuses on the probability that you could become a public charge at any time in the future. In general, you will be deemed a public charge if you have received, or it is more likely than not that you will receive, at any time in the future:

  • one of more public benefits,
  • for more than 12 months in total, and
  • within any 36-month period.

The first step in this process is to file an I-944 form, otherwise known as a “Declaration of Self-Sufficiency.” This is the document that the adjudications officer will use to help determine whether you have used any public benefits in the time periods set forth above.

The adjudications officer will use this document and a totality of the circumstances test to determine whether it is more likely than not that you will receive one or more public benefits in the future.

The Totality of the Circumstances Test

In addition to your I-944 form and other documents that are part of the green card process, the adjudications officer will consider your:

  • age,
  • health,
  • family status,
  • financial assets and resources,
  • education and skills, and
  • immigration status and period of admission.
Green card adjudication officer studying applicant's financial situation to conduct the totality of circumstances test.

All factors will be considered when determining whether you are a public charge. There is no single factor that will grant permanent residency or cause your application to be denied.

At a minimum, however, applicants must demonstrate a household income of at least 125% above the federal poverty guidelines. Proof of income 250% above the poverty guidelines would be heavily weighted in your favor. 

Public Benefits that Factor into The Public Charge Rule

Generally, any federal, state, or local cash benefit will be considered. This includes:

  • Supplemental Security Income,
  • Temporary Assistance for Needy Families,
  • Supplemental Nutrition Assistance Program (food stamps),
  • Section 8 Housing Assistance under the Housing Choice Voucher Program,
  • Section 8 Project-Based Rental Assistance,
  • Public Housing, and
  • Federally funded Medicaid, subject to certain exceptions.

The following benefits will not be considered by the adjudications officer:

  • emergency medical assistance,
  • disaster relief,
  • national school lunch programs
  • the Special Supplemental Nutrition Program for Women, infants, and Children,
  • the Children’s Health Insurance Program,
  • Head Start,
  • foster care and adoption subsidies,
  • student and mortgage loans subsidized by the government,
  • energy assistance programs, and 
  • aid provided by food pantries and homeless shelters.

Other exempt categories include benefits received by service members and their families.

The Controversy Involving Medicaid

Not all Medicare Benefits are part of the Public Charge analysis. There are some exceptions. The following Medicaid benefits are exempt from the analysis:

  • treatment of an emergency medical condition,
  • services provided with the Individuals with Disabilities Act,
  • school-based services or benefits provided to those who are at or below the oldest age eligible for secondary education as determined under state law or local law,
  • by aliens under the age of 21, and
  • by pregnant women and by women within the 60-day period beginning on the last day of pregnancy.

The problem is that many believe that these exceptions are too narrow. In other words, there are disabilities and illnesses that Medicare covers that will now be part of the Public Charge analysis because they not an “emergency medical condition” or do not fit within another exception. 

This could result in people who would have previously obtained permanent residency in the United States being denied for using Medicaid benefits. It could also result in people failing to seek out needed medical care because they fear it will harm their immigration status.

At the very least, there is confusion as to what Medicaid benefits could make an applicant inadmissible.

Be Prepared in Advance

Historically, the Public Charge Rule has been a possible pitfall for many green card applicants. The new version of the rule will only make it more difficult for those seeking permanent residency in the United States. Your best bet is to be prepared in advance.

Make sure you submit your I-944 form on time. Collect and maintain records that will demonstrate you are self-sufficient and will not need government assistance to survive, regardless of whether you have used Medicaid.

Remember – no single factor is determinative. Proving that you have the financial resources to support yourself will go a long way.

Do not wait, however, until the day before your interview to start thinking about the Public Charge Rule. Just like other aspect of the green card process, being prepared in advance is the key to overcoming the Public Charge test and becoming a permanent resident of the United States.



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