New Public Charge Guidance Leaves Key Questions Unanswered, Likely Deepening Chilling Effects Among Immigrant Families
Introduction
On July 20, 2026, the Department of Homeland Security (DHS) published a final rule that largely rescinded 2022 Biden-era public charge regulations. The new rule gives immigration officials broad discretion to decide whether to deny a green card to someone applying for Lawful Permanent Resident (LPR or “green card”) status because they are likely to become a “public charge.” The new rule provided limited details in place of the prior regulations, suggesting in the preamble that DHS would provide additional information through sub-regulatory guidance. On August 18, 2026, U.S. Citizenship and Immigration Services (USCIS) issued accompanying Policy Manual guidance on how officers should make public charge determinations under the new rule. The rule took effect on September 18, 2026. This issue brief discusses the sub-regulatory guidance issued by USCIS to guide public charge determinations under the new rule and implications for immigrant families’ access to health coverage and care.
The 2026 final rule removed the 2022 regulatory definitions and the determination framework for determining whether someone is a public charge without replacing them. The updated sub-regulatory guidance also does not provide a specific definition of who may be considered a public charge and does not provide an exhaustive list of benefits that would count towards public charge determinations, granting immigration officers significant authority in making such determinations. The lack of an exhaustive list of benefits that may be considered when making public charge determinations will likely result in increased confusion and fear among immigrant families that may limit their participation in public programs that help pay for health care, food, and housing, including among citizen children in these families. The lack of details in the guidance also increases uncertainty and challenges for those serving immigrant families to advise on the potential implications of participating in specific programs.
Overview of the 2026 Public Charge Rule
Under longstanding immigration policy, federal officials can deny a green card or entry into the U.S. to someone they determine is likely at any time to become a public charge. By statute, officers must at a minimum consider age; health; family status; assets, resources, and financial status; and education and skills. Some groups, such as refugees and asylees, are exempt from public charge determinations. Under 2022 regulations consistent with longstanding guidance, a public charge was defined as someone likely to become primarily dependent on the government, as shown by use of cash assistance for income maintenance or long-term institutionalization at government expense. The regulations excluded noncash programs, including Medicaid (except for long-term institutionalization) and the Children’s Health Insurance Program (CHIP), and prohibited consideration of family members’ use of programs from determinations.
On July 20, 2026, DHS published a final rule largely rescinding the 2022 Biden-era public charge regulations governing determinations for individuals seeking adjustment to LPR status. The 2026 final rule removes the 2022 definitions and the determination framework without replacing them, giving officers broad discretion and moving away from the “primary dependence” standard. DHS received over 8,800 comments in response to the proposed rule and acknowledged that most opposed the rule but finalized it as proposed. DHS stated that USCIS would issue nonbinding sub-regulatory guidance that would provide additional information to guide determinations. The rule took effect September 18, 2026. While the same statutory grounds apply to individuals seeking entry into the U.S., those public charge determinations are generally made by consular officers at the U.S. Department of State (DOS) for visa applicants or by U.S Customs and Border Protection for applicants seeking admission at a port of entry. According to media reports, in November 2025, DOS issued new guidance directing visa officers to consider a wide range of health conditions when making public charge determinations for visa applicants seeking entry into the U.S.
Overview of Public Charge Guidance
On August 18, 2026, USCIS released updated Policy Manual guidance (Volume 8, Part G) to direct how officers make public charge determinations under the new rule. The guidance supersedes prior guidance, including the 1999 Interim Field Guidance that was largely consistent with the Biden-era regulations and governs USCIS adjustment of status adjudications only (not determinations by U.S. Customs and Border Protection, DOS, or immigration courts). Unlike a statute or regulation, this policy guidance can be revised or rescinded without formal rulemaking or a notice and comment period.
The guidance reaffirms statutory requirements related to public charge, including exemptions for certain groups and that determinations are based on a totality of circumstances, which must include consideration of certain factors. As specified in statute, groups exempt from public charge determinations include refugees and asylees, special immigrant juveniles, Violence Against Women Act (VAWA) self-petitioners, T and U visa holders, certain Cuban and Haitian entrants, and Afghan and Iraqi special immigrants. The guidance reaffirms the statutory requirement that public charge decisions will be made based on a “totality of circumstances,” meaning that any one factor, including benefit use, does not determine whether someone is a public charge. It also identifies the minimum statutorily required factors officers must consider in making determinations, including age; health (including disability); family status; assets, resources, and financial status; and education and skills.
The guidance does not define who may be considered a public charge and does not provide an exhaustive list of benefits that would count towards public charge determinations; instead, it indicates officials may consider receipt of any means-tested benefits. The guidance does not define a “public charge.” Instead, it indicates that immigration officers should assess whether the individual is, “likely at any time to depend on means-tested public benefits.” The guidance also does not provide a definition or list of means-tested benefits that immigration officers may consider when making public charge determinations. Instead, it describes means-tested benefits generally as those for which eligibility is based on income or assets falling below a threshold and that are provided by government agencies or funds. Examples include, but are not limited to, government-funded health coverage such as Medicaid or CHIP; food assistance such as the Supplemental Nutrition Assistance Program (SNAP) or the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); public or assisted housing; postsecondary financial aid; and cash assistance from any federal, state, Tribal, territorial, or local government. It specifies that benefits for which eligibility is based on payments into the system, such as Social Security, Medicare, and unemployment insurance, are not considered means-tested and therefore not subject to public charge. The rule’s preamble suggests that universal programs will not be considered, indicating, for example, that school meals available to all students in a school (through community eligibility or statewide programs) should not be considered. Illustrative case studies in the guidance also make a distinction between receipt of school lunches as part of a universal school lunch program and receipt of school lunches due to an applicant’s income falling below a certain threshold, suggesting that officers should consider “the nature of the free school lunch program.” Illustrative case studies discussed in the guidance also suggest that officers should not consider benefits use in isolation when making public charge determinations and instead take into account an individual’s totality of circumstances, as statutorily required.
Unlike prior regulations and guidance, the 2026 rule and guidance state that family members’ receipt of benefits may be considered when making public charge determinations in specific circumstances. The 2026 guidance states that USCIS will not attribute to the applicant benefits received by relatives, including children, or received on behalf of others. However, when making public charge determinations, officers may consider benefits received by family members the applicant is legally obligated to support when eligibility was based on the applicant’s income falling below a threshold. It is unclear from the guidance how officers would consider benefits used by family members, including U.S. citizen children. The application form for adjustment to LPR status (Form I-485) only asks about the applicant’s own benefit use. However, officials could potentially ask about this information during an interview process.
The guidance clarifies that the rule will only apply to applications submitted and benefits used on or after its effective date of September 18, 2026. For benefits received before September 18, 2026, officers will consider only cash assistance for income maintenance and long-term institutionalization at government expense, consistent with the 2022 public charge final rule. For benefits received on or after September 18, 2026, officers may consider receipt of any means-tested benefit. Per the final rule, benefits approved for a period extending past the effective date will be considered unless the applicant shows they disenrolled or withdrew. However, the guidance does not clarify what evidence applicants must provide to show they disenrolled from benefits before September 18, 2026, or how benefit agencies will help with those requests.
The guidance also does not detail how USCIS will conduct oversight and quality reviews or how the new public charge rule could interact with other policies. In the final rule,USCIS stated that it will “provide guidance and training to officers” and apply “general quality control processes.” However, the guidance does not detail what these processes are and how they will be carried out. In addition, the guidance does not address how public charge determinations interact with other policies that may heighten fears among immigrant families, such as the Centers for Medicare and Medicaid Services’ (CMS) sharing of noncitizen Medicaid enrollee data with Immigration and Customs Enforcement (ICE), which DHS deemed out of scope, or separate State Department public charge standards for visa applicants.
Looking Ahead
While the public charge guidance provides more detail than the rule, it leaves several key details unspecified and grants substantial discretion to individual officers, leaving immigrant families without clear information. Families will likely experience increased confusion and fear due to a lack of clear information about what benefits may be considered. As a result, many may avoid participating in programs, with effects extending beyond those directly affected by the rule, including citizen children. Previous KFF analysis found that if the final rule leads to disenrollment rates ranging from 10% to 30% as suggested by past experience, about 1.4 million to 4.1 million people living in a household with a noncitizen could disenroll from Medicaid and CHIP, including about 560,000 to 1.7 million citizen children. Among the nearly 1.7 million eligible but uninsured people in these households, between about 166,000 and 498,000 could forgo enrolling, including over 60,000 to more than 181,000 citizen children.
Providers and organizations working directly with immigrant families will likely also face increased confusion and challenges due to the guidance’s lack of clarity. Immigrant-serving organizations, health care providers, benefits navigators, and legal service providers may find it challenging to advise families about which programs could affect their green card applications. Providers may also face increased strains serving immigrant families if they are less likely to participate in assistance programs and more are uninsured.
DHS acknowledges that the new rule could lead to adverse health and economic impacts but maintains that these impacts are outweighed by the rule’s self-sufficiency goals. DHS estimates a $13.05 billion annual reduction in federal and state transfer payments due to disenrollment or forgone enrollment in programs including Medicaid, CHIP, WIC, SNAP, Temporary Assistance for Needy Families, Supplemental Security Income, and Federal Rental Assistance. DHS also acknowledges the rule may lead to worse health outcomes, increased emergency room use, higher prevalence of communicable disease, increases in uncompensated care, and reduced revenues for health care providers.