Last Saturday, the US Department of Homeland Security (DHS) proposed a regulation that would prohibit adult immigrants from staying in the US if they received food aid, public housing, Medicaid or other non-cash benefits.  The existing law, in place since 1999 “specifically bars authorities from considering such non-cash benefits in deciding a person’s eligibility to immigrate to the United States or stay in the country”, the New York Times reports.  Currently, people going through the immigration process are entitled to Medicaid, low income housing subsidies and Supplemental Nutrition Assistance Program support (SNAP, also called Food Stamps). Immigration officials are allowed to exclude someone as a “pubic charge” (someone likely to be dependent on financial aid) but this has been narrowly defined as “a person ‘primarily dependent on the government for subsistence’, either through direct cash assistance or government-funded long-term care.”

Under DHS’ newly proposed regulation, adults receiving one or more public benefits (cash or non-cash) when applying for entry or a green card (permanent residency) will be much less likely to be approved. Some may be deemed eligible only if they post a $10,000 bond to offset the possibility of them becoming a public charge. As VOX points out, “there’s a complicated formula for how much support an immigrant can receive before damaging her chances for a future green card.” VOX provides a good summary of the history of this issue.

The newly proposed regulation is already causing immigrants to withdraw from essential services. Politico reports that, “immigrants are already turning down government subsidies to help them buy staple foods and infant formula for fear that it could bar them from receiving a green card… local health care providers in at least 18 states saw drops of up to 20 percent in benefit enrollment.” Ironically, the Washington Post reports that the ratio of US immigrants using accepting non-cash benefits in 2015 (22.7%) was close to the ratio of native-born Americans using those resources (22.1%).

The Kaiser Family Foundation notes that lowered health care participation as a result of this regulation will precipitate negative health outcomes “especially for pregnant or breastfeeding women, infants, or children,” as well as increasing demand for emergency and tertiary care due to avoidance of earlier treatment. From a public health perspective, the general population will also likely experience an increase in easily transmitted diseases — including tuberculosis, HIV and other STIs, influenza, etc. – as a result of decreased access to health care for one part of the population.

This regulation does not require Congressional approval for implementation. DHS reported on Sept. 22 that the entire regulation will be published in the Federal Register in the coming weeks and that “the comment period will last 60 days, starting on the day the proposed rule is published”.  The Academy will post this information as soon as it becomes available.

Alabama’s Medicaid Work Requirements Proposal Harshest to Date

Last June, the Centers of Medicare and Medicaid Services (CMS) rejected Alabama’s first request to be allowed to institute Medicaid work requirements. Since then, the state has revised and resubmitted their reques. Politico reports that “So far, CMS has only approved work requirements in states that have expanded Medicaid”, thus imposing work requirements on people whose income is at or below 133% of the federal poverty level. The highest work time limit yet approved is that participants devote 80 hours per month to meeting their work requirement obligation.

Alabama, however, has not expanded its Medicaid program. There, Medicaid is available only to people who earn 100% of the federal poverty level or less. According to Health Insurance.org, “parents of minor children are only eligible if their income doesn’t exceed 18 percent of the federal poverty level. For perspective, that’s $312/monthin total income for a family of three in 2018.”

If Alabama’s waiver is approved, it will inevitably put Medicaid recipients into what Seema Verma, Administrator of CMS, has called the subsidy cliff. While children will remain eligible for Medicaid, the parents will become ineligible for Medicaid as soon as they become employed.

Junk Insurance and Medicaid Work Requirements Banned in California!

On September 22, California Governor Jerry Brown signed bills (Senate Bills 910 and 1108) that ban the sale of short-term health plans and work requirements for people who receive Medi-Cal, California’s Medicaid program.

SB 1108 prohibits work requirements because they place unrealistic barriers in the way of people dependent on Medicaid and can potentially lead to recipients’ loss of insurance coverage altogether.

Passage of SB 910 makes California the first state to prohibit the sale of “junk insurance” to consumers — policies sold at low cost because they deny coverage to people with pre-existing conditions and do not, in many cases, cover prescription medicines and necessary medical services (See WA 8/23/18).

Senator Ed Hernandez, drafter of bills, told the Sacramento Bee that, “These plans can bankrupt people. They don’t have the protections of the Affordable Care Act. They’re junk. It’s a huge threat.”

Anthony Wright, executive director of Health Access California said, “These junk insurance plans, whether through so-called short-term insurance or through association health plans, leave people at risk of being uncovered for what they actually need, and they also threaten to destabilize the market and spike premium rates.” Other states have policies that constrain or prohibit the sale of insurance policies that are not ACA-compliant but California is the first to prohibit the sale of junk insurance altogether.

The Academy THANKS its California members who, at our request, contacted their Governor and urged him to sign this legislation!

View the latest Policy Update here.