Under long-standing immigration law and guidance, individuals who are likely to become a “public charge”—or likely to rely on the government for financial support—can be denied admission to the U.S. or, if they are already in the country legally, may be denied the ability to adjust their status and get a green card as a lawful permanent resident. If finalized, a new proposed rule issued by the U.S. Department of Homeland Security (DHS) would direct DHS to consider immigrants’ enrollment in Medicaid when making public charge determinations.

The new rule could deter enrollment in Medicaid and very likely the Children’s Health Insurance Program (CHIP), and as a result, children and adults who are lawfully in the country could become uninsured. The loss of coverage would result in poorer health and health outcomes for affected individuals. It also could lead to reduced Medicaid payments and drive up uncompensated care costs for the nation’s hospitals, causing financial strain, particularly for hospitals in states and communities with large immigrant populations.