Seven health, human services and community development officials from across the Baker administration went on record Monday against a proposed federal rule change that would restrict the ability of immigrants to obtain green cards if they receive public benefits including Medicaid or food stamps.
Health and Human Services Secretary Marylou Sudders, Public Health Commissioner Monica Bharel, Assistant Secretary for MassHealth Daniel Tsai, Massachusetts Health Connector executive director Louis Gutierrez, Department of Transitional Assistance Commissioner Jeff McCue, Massachusetts Office for Refugees and Immigrants executive director Mary Truong, and Department of Housing and Community Development Undersecretary Janelle Chan all asked federal officials, in written comments Monday, to scrap their proposed changes to the so-called “public charge” rule.
The proposal was announced in September by the Department of Homeland Security, which said it would ensure individuals seeking to enter and stay in the country “can support themselves financially and will not be reliant on public benefits.”
Attorney General Maura Healey also joined a coalition of 23 state attorneys general who wrote to the Department of Homeland Security on Monday to oppose the recommended changes, stating that the proposed rule is “destabilizing, discriminatory, and will cause harm to immigrant populations and to the States.”
Under the proposed rule, the government would consider the likelihood that a person will ever receive a series of public benefits — including the supplemental nutrition assistance program, Section 8 housing choice vouchers and project-based rental assistance, public housing, “institutionalization for long-term care at government expense,” Medicare Part D Low Income Subsidy, and Medicaid.
Currently, an immigrant can be deemed a public charge if the government is expected to be the person’s primary source of support. The attorneys general said the proposed rule would change the standard from someone “very likely” to become dependent on government services to a person who “receives minimal public assistance for a relatively short term.”
“The proposed expansion of ‘public charge’ suggests that the United States is no longer a land of opportunity that welcomes ambitious but modest earners,” the prosecutors wrote, alleging an infringment of rights and a violation of law and longstanding policy.
Sudders, in her testimony, outlined some of the potential consequences concerning to Massachusetts officials.
She said the rule could result in fewer people receiving health care coverage, long-term harm to public health of all residents as a result of declines in preventive care like vaccines, increased reliance on hospital emergency rooms, greater uncompensated care costs for hospitals, increased food insecurity, homelessness and family separation among immigrant families, higher health insurance premiums for all Massachusetts residents, and “a real risk that our immigrant population may begin to view all of government with distrust as a consequence of what will inevitably be received as punitive and highly discretionary eligibility determinations made under the new rule.”
Tsai, who oversees the MassHealth program, said the rule would constitute an unfunded mandate because it would require Medicaid agencies “to undertake significant and costly systems and operational modifications,” the scope of which is unclear under the rule as currently written.
MassHealth would likely incur increased costs for interpreter services and may need to raise its customer service staffing levels, as well as developing new trainings and policies, he wrote.
Homeland security officials said the primary benefit of its proposed change “would be to help ensure that aliens who apply for admission to the United States, seek extension of stay or change of status, or apply for adjustment of status are self-sufficient, i.e. do not depend on public resources to meet their needs, but rather rely on their own capabilities and the resources of their family, sponsor, and private organizations.”
Monday marks the last day of the public comment period on the proposed rule. Several Massachusetts groups have already voiced their opposition, including Massachusetts Law Reform Institute, Massachusetts Immigrant and Refugee Advocacy Coalition, Health Care for All, and the Massachusetts Medical Society.
Healey signed on to the letter that came out of the office of Virginia Attorney General Mark Herring and New Mexico Attorney General Hector Balderas. She has said previously she’d be “prepared to sue” if the changes take place.
The attorneys general spent a good portion of their letter raising concerns about how the inclusion of Medicaid and the Children’s Health Insurance Program to the public charge consideration would increase costs for states and be disruptive for families. As of September, the letter from the coalition said Massachusetts has enrolled up to 1.6 million people in Medicaid and CHIP, an net increase of 23.35 percent since October 2013.
The attorneys general said inclusion of Medicaid and CHIP in the public charge determination would “have a significant impact on states with large non-citizen populations.” “It is well-documented that increasing access to healthcare helps the economy because it allows more people to work and decreases the transmission of diseases that inhibit work and boost hospital costs,” they wrote.
The group Mass Home Care also submitted comments Monday urging withdrawal of the proposal, cautioning that it could create a chilling effect leaving seniors in immigrant families afraid to access services they need.
“This issue is particularly troubling in Massachusetts when you consider that our state already has the second highest economic insecurity rate for adults 65 and older nationwide (behind only Mississippi),” wrote Mass Home Care executive director Lisa Gurgone.