Proposed Changes to “Public Charge” Policies Could Lead to Declines in Medicaid and CHIP Enrollment as Immigrant Families Face Rising Fear and Uncertainty About Using Public Programs

As the Trump administration proposes changes to federal “public charge” policies, the resulting fear and uncertainty among immigrant families about using public programs could drive down enrollment in Medicaid and the Children’s Health Insurance Program, potentially by millions of people, a new analysis by KFF (the Kaiser Family Foundation) shows.

More than 14 million enrollees in Medicaid and CHIP live in a household with a noncitizen, half of them U.S. citizen children. (Undocumented immigrants are not eligible to enroll in Medicaid or CHIP.) “Public charge” policies govern how reliance upon public benefits may affect an individual’s ability to obtain legal permanent resident status in the U.S.

A proposed rule published Oct. 10 in the Federal Register would newly define a “public charge” as an individual who uses public benefit programs and would expand the list of public programs that the federal government would consider in public charge determinations to include Medicaid and other previously excluded health, nutrition and housing programs. The new analysis examines the share of noncitizens who originally entered the U.S. without legal permanent resident status who have characteristics that the government could potentially weigh against them in public charge determinations.

The analysis presents three scenarios to illustrate the possible magnitude of likely Medicaid and CHIP enrollment declines, based on prior research and experience. It shows that enrollment declines would occur both among those directly affected by the proposed rule as well as among other lawfully present and citizen individuals in immigrant families.

A KFF issue brief released last month explains the proposed changes in public charge policies for immigrants in greater detail.