Changes to Public Charge Regulations Will Likely Lead More Immigrant Families to Avoid Health Care and Assistance Programs
Under longstanding policy, federal officials can deny entry to the U.S. or adjustment to lawful permanent resident (LPR) status (i.e., a “green card”) to someone they determine to be a public charge. The Trump administration released a proposed rule that would rescind 2022 Biden-era public charge determination regulations. Media reports also indicate new guidance directs visa officers to consider a wide range of health conditions when reviewing applications to enter the U.S.
These changes would significantly increase immigration officers’ discretion in making public charge decisions and could allow them to consider factors that had been excluded under the 2022 rule, including use of health, nutrition, and housing programs such as Medicaid, the Children’s Health Insurance Program (CHIP), and the Supplemental Nutrition Assistance Program.
The 2022 regulations were implemented to address chilling effects of a 2019 Trump administration rule that led many immigrant families, including citizen children, to forgo health care and coverage. While few lawfully present immigrants are eligible for these programs, and even fewer will be eligible under the 2025 tax and budget law, confusion and fear have led to disenrollment and forgone enrollment among a broader group of immigrant families than those subject to public charge.
The proposed rule would likely further increase confusion and anxiety at a time when immigrant families are already experiencing starkly increased fears due to President Trump’s immigration policies. New KFF/New York Times 2025 Survey of Immigrants data show:
- The share of immigrant adults who reported skipping or postponing health care in the past 12 months increased from 22% to 29% between 2023 and 2025, with 19% of this group citing immigration-related concerns.
- The share of immigrant adults who said they avoided applying for a government program that helps pay for food, housing, or health care in the past 12 months because they did not want to draw attention to their or a family member’s immigration status rose from 8% to 12% between 2023 and 2025, with an increase from 11% to 18% among parents (Figure 1).
- 11% of immigrant adults say they have stopped participating in such a program since January 2025 because of immigration-related worries, including 17% of parents.
The proposed rule would likely lead to further declines in use of health care and programs among immigrant families. The Department of Homeland Security (DHS) suggests that one of the benefits of the rule would be “a reduction in the number of aliens dependent on public benefit programs” and notes that it will result in reduced federal and state payments for individuals who disenroll or forgo enrollment in programs, including U.S. citizens in mixed status households. KFF analysis of federal data show that about 13.4 million Medicaid or CHIP enrollees were living in a household with a noncitizen as of 2023.
DHS further notes that the proposed rule may lead to worse health outcomes; increased use of emergency rooms; higher prevalence of communicable diseases; increases in uncompensated care; and increased poverty, housing instability, reduced productivity, and lower educational attainment. It also recognizes that it may result in reduced revenues for certain health, food, and housing providers.
There is a 30-day comment period for the proposed rule. DHS plans to provide interpretive and policy tools to guide public charge determinations if it is finalized. The 2022 regulations remain in effect until it is finalized.