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Biden orders a review of the public charge rule and rescinds Trump memorandum

The rule has been criticized for causing immigrants to disenroll from public programs like Medicaid.

Mallory Hackett, Associate Editor

Photo by Anna Moneymaker-Pool/Getty ImagesPhoto by Anna Moneymaker-Pool/Getty Images

Hospital groups are applauding President Joe Biden's executive order that directs federal agencies to review Trump-era immigration policies that affect immigrants' access to healthcare. 

The order, signed on Tuesday, requires a "top-to-bottom review" of the public charge rule that allows the federal government to deny entry into the country or citizenship based on the receipt of public benefits such as Medicaid.

It also rescinds a memorandum requiring family sponsors to repay the government if relatives receive public benefits.

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The action received praise from America's Essential Hospitals for allowing legal immigrants and their families to receive affordable healthcare.

"The damaging change that applied the public charge determination to nonemergency Medicaid created a chilling effect on immigrants' access to health care services, causing many to forgo needed treatment for fear of losing their status as legal residents," said Dr. Beth Feldpush, the senior vice president of Policy and Advocacy at America's Essential Hospitals. "The policy created an unacceptable risk of people seeking care only as a last resort when they are sicker and more costly to treat."

The American Hospital Association also gave kudos to the Biden administration for its action.

"We appreciate the administration's review of this misguided policy and look forward to its reversal," said AHA General Counsel Melinda Hatton.

WHAT'S THE IMPACT?

Rescinding the public charge rule has been top of mind for the AHA. In its outline of priority policies for the Biden administration, the organization included the rule in what it considers "ongoing critical challenges."

The public charge rule was expected to lead to immigrants disenrolling from public programs out of fear and confusion. Nearly 80% of noncitizens have at least one characteristic that could be labeled as a public charge.

A Kaiser Family Foundation report projected that as many as 4.7 million individuals could disenroll from Medicaid and CHIP because of the rule.

"Even before the rule was finalized, there were reports of parents disenrolling themselves and their children from Medicaid and CHIP coverage, choosing not to renew coverage, or choosing not to enroll despite being eligible," the report said.

Decreased rates of participation in safety net programs increase uninsured rates among immigrant families, ultimately reducing their access to care and contributing to worse health outcomes, KFF said in a separate report about the public charge rule.

Beyond the potential health outcomes of millions of people, coverage losses result in falling Medicaid revenue, which could affect the ability of healthcare safety net providers, such as community health centers, to serve all residents of their communities, according to an amicus brief from 2019. The brief's signees include the American Public Health Association, American Academy of Nursing, and more than 60 deans and scholars from 27 schools of public health, public policy, nursing and medicine.

KFF shared similar sentiments, saying that losses in enrollment would likely decrease revenues and increase uncompensated care for providers.

THE LARGER TREND

First announced in August 2019, the Trump administration's final rule expanded the programs considered in the federal government's public charge determination. Programs like Medicaid, the Supplemental Nutrition Assistance Program and the Children's Health Insurance Program, which were previously excluded, could be used to bar entry into the country because of the rule.

The rule's purpose was to ensure that people who enter the country are self-sufficient and don't rely on public resources to meet their needs.

"DHS is revising its interpretation of 'public charge' to incorporate consideration of such benefits, and to better ensure that aliens subject to the public charge inadmissibility ground are self-sufficient, i.e., do not depend on public resources to meet their needs, but rather rely on their own capabilities, as well as the resources of family members, sponsors, and private organizations," the Department of Homeland Security said in the final rule.

President Biden has issued a number of executive orders targeted at improving healthcare. Last week, his orders aimed to strengthen Medicaid and the Affordable Care Act, and to expand access to reproductive healthcare.

One part of last week's orders created a special enrollment period for uninsured consumers to get coverage through the Affordable Care Act. It will run from February 15 through May 15.

Twitter: @HackettMallory
Email the writer: mhackett@himss.org