Tying Immigration to Medicaid Foolish, TMA President Says

AUSTIN August 26, 2019 - The rule issued by U.S. Citizenship and Immigration Services (USCIS) is "penny wise and pound foolish" because it will prevent people from seeking medical services until an emergency arises, the Austin colon and rectal surgeon told KRLD radio in Dallas.

"Waiting until the disease process becomes advanced makes it more expensive to take care of and makes it less likely that we'll be successful in being able to take care of it," Dr. Fleeger said. "So the patient suffers and ultimately the state and society suffers."

The 837-page rule redefines the factors immigration officials will use to determine whether a legal immigrant will be a “public charge” – someone who depends primarily on the government for assistance. Immigration officials already may consider whether a green card applicant uses cash assistance programs or long-term institutional care. But in 1999, the federal government clarified that health care, nutrition, and housing services were excluded from the definition in order to improve the health of patients and the public. 

The new rule will directly affect 383,000 green card holders and applicants nationwide, according to the Department of Homeland Security (DHS). However, the nationwide lobbying firm Manatt estimates that the rule will impact tens of millions more by deterring immigrants and their American-born children from using health care and other services for which they are eligible. 

In December 2018, TMA submitted a letter from then-TMA President Douglas W. Curran, MD, urging USCIS to withdraw the proposed rule.

"Adoption of the rule will worsen Texas’ sky-high rate of uninsured, already the highest in the country, and immeasurably harm the health and well-being of Texas and Texans," Dr. Curran wrote. He also pointed out that a higher rate of uninsured would "jeopardize the financial health of thousands of physician practices."

Even when it was just a proposal, the rule sowed confusion that will keep children who are U.S. citizens from using benefits, Dr. Curran said. About 1 million children in Texas have one parent who is not a citizen, and many of those parents are trying to obtain green cards, he said. Those parents will be less likely to use programs like the Children's Health Insurance Program (CHIP) for fear of being labeled a public charge.

"Anecdotally, this trend is already under way in Texas," Dr. Curran wrote. "Pediatricians and family physicians from across the state have reported being contacted by immigrant parents who have decided not to renew their child’s Medicaid or CHIP coverage as a result of the proposed rule, even for children with chronic conditions."

As a result of public comments, the rules were amended to exclude legal immigrants who are:

  • Active-duty military or their spouses or children;
  • Pregnant women enrolled in Medicaid;
  • Children younger than 21;
  • Adults receiving emergency Medicaid;
  • Refugees or asylum seekers;
  • Recipients of Medicare Part D low-income subsidies;
  • People using Medicaid in schools;
  • Some victims of human trafficking or domestic violence.

The rule is scheduled to take effect Oct. 15. However, 14 states have sued to challenge the policy.

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