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The "Public Charge" Inadmissibility Rule: Exploring the Effects

By Lucia Buffaloe, Senior Manager, NP KA Medicaid

For the second of our three-part series on Public Charge, we will now explore the discussions we have had with our clients and their patients surrounding the changes to the Rule (to read the first part of our series, click here).  We will also detail some potential impacts that the rule change could have on programs such as Medicaid and charity care/financial assistance.

As we continue to explore the effects that the recently adopted Public Charge rule could have on naturalization, CBIZ KA Consulting Services (CBIZ) has initiated strategy meetings with several of our clients to evaluate potential outcomes and to help minimize the potential financial impact.

In our first article, we briefly discussed a patient who was undergoing treatment for a chronic medical condition. The patient declined to proceed with a Medicaid application under the direction of her attorney despite being entitled to benefits (she had been a legal permanent resident for over five years). As a result, the patient felt pressured to pay out of pocket for all of her treatments.

The actions of this patient, and many others similar to her, have demonstrated the need for discussions on how best to assist communities given this updated law. A patient with a chronic condition requires multiple visits, medication and additional diagnostic testing, all of which can be financially costly to the patient. If more patients in this same situation decide that routine follow up becomes too expensive and they forgo treatment altogether, they run the risk of additional complications, which can result in emergency room visits and increased chances for hospitalization.

Impact on Hospitals

This scenario impacts the hospital on multiple levels. With patients refusing services, their overall health will be in danger; more complications will occur. Resources such as hospital beds could potentially be consumed by patients that present to the emergency room with complications from treatable conditions. Financially, the hospital runs the risk of these patients further becoming a liability because of their refusal to apply for financial assistance for their medical bills.

Many families that will be affected by the New Rule experience financial hardship that extend far beyond their medical bills. These families have trouble with rent and ensuring that their loved ones don’t face food insecurities. In addition to Medicaid, the Public Charge rule also takes into account benefits received including but not limited to housing assistance, SNAP-Supplemental Nutrition Assistance Program, and TANF-Temporary Aid to Needy Families. These are vital programs that needy participants might not utilize because they fear the implications of the new Public Charge rule. Furthermore, many patients living in mixed immigration status families are declining these benefits for fear that it can be held against any petitioning family members.

Next Steps

United States Citizenship and Immigration Services (USCIS) will apply the new standards to applications or petitions that are postmarked on or after February 24, 2020. As this date nears, all of our clients have suggested that additional education is paramount. Patient education should be on the forefront for all providers. Patients need to understand the New Rule to determine their best course of action when it comes to planning for their healthcare. Many of our clients have recommended collaborative efforts through community organizations to assist families in need.

CBIZ also offers an education session for hospitals on the Public Charge inadmissibility rule. Our one-hour in-service outlines how hospital staff can address the concerns of patients in how to navigate these new changes.

    For more information, please contact Juan Chico at 609-918-0990.

    Copyright © 2020, CBIZ, Inc. All rights reserved. Contents of this publication may not be reproduced without the expressed written consent of CBIZ.