Academy Wins Fight Against Harmful ‘Public Charge’ Rule

The Department of Homeland Security’s new public charge final rule, announced Sept. 9, fulfills the Academy’s aims by allowing noncitizens to access health care, nutrition and other benefits without penalizing their applications for citizenship or permanent residency. It reverses the previous administration’s interpretation of noncitizens’ health care benefit allowances — specifically, defining as a so-called “public charge” any immigrant who received “one or more public benefits,” including Medicaid and the Children’s Health Insurance Program.

The Academy warned in 2018 that this overly broad definition of public charge jeopardized U.S. public health, particularly that of children. In 2019, following the definition’s adoption in a final rule, the AAFP joined the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American Osteopathic Association, the American College of Physicians and the American Psychiatric Association in asking DHS to reverse itself.

“The order puts a governmental barrier between physicians and patients and stands in stark contrast to the mission our organizations share: ensuring meaningful access to health care for patients in need,” the groups said.

Last year, the Biden White House ordered DHS to halt enforcement of the rule until it could be reviewed. In a statement, the Academy applauded that move.

“The AAFP has repeatedly spoken out against the public charge rule, which evidence indicates caused a widespread chilling effect as immigrant families avoided seeking needed health care services and public benefits,” the AAFP said. “This rule jeopardized immigrant families’ own health and that of their communities, which is particularly alarming during the COVID-19 pandemic.”

When DHS proposed its new public charge rule in April 2022, the Academy called it “a critical step to securing the health and wellbeing of millions of children in immigrant families” in an April 25 letter to the agency. The AAFP — together with the American Academy of Pediatrics and 108 other organizations — urged swift finalization of the new regulation to correct “the gravest errors of the 2019 rule.” The groups also called on Congress and policymakers to consider wholesale revision of the idea that immigrants exert a negative impact on the social safety net.

“It is important to recognize that the concept of public charge is fundamentally rooted in racist ideologies, initially aimed to exclude immigrants who were viewed as racially or ethnically different,” that letter said.

Under the new rule, which goes into effect Dec. 23, applicants seeking status adjustment will complete a revised Form I-485 adjustment of status application.