NAHC: ‘Public Charge’ Immigration Proposal Would Hurt Home Care Workforce

A proposed change to the nation’s immigration policies could spell further trouble for home care providers that are already facing steep workforce challenges, according to the National Association for Home Care & Hospice (NAHC).

In September, the Trump Administration put forward a proposal that would change the so-called “public charge rule.” This change would broaden the criteria that officials take into account when considering whether an immigrant should be granted entry to the country or given a green card.

Specifically, if immigrants utilize programs such as Medicaid or the Supplemental Nutrition Assistance Program (SNAP), they could be considered at high risk of becoming a “public charge” — dependent on the government to get by — and denied entry or permanent legal resident status. Critics of the proposal say that green card candidates will likely forgo medical care to avoid appearing on Medicaid rolls, endangering themselves and their children and driving costs up for the health care system, due to a spike in emergency room visits.


About 30% of home care workers are not natural-born U.S. citizens, and about the same percentage rely on Medicaid and SNAP, NAHC pointed out in its Dec. 10 letter commenting on the proposal.

“Barring immigrants on the basis of public assistance will only exacerbate an already prevalent workforce shortage leaving many employers unable to care for patients in need,” NAHC wrote. “This will cause patients to seek out more costly institutional settings for the same care they could have received in their home.”

In total, the proposed rule lists 15 factors that the Department of Homeland Security would start evaluating to determine whether an immigrant is likely to become a public charge. In addition to use of Medicaid and other public assistance programs, the factors include employment history, age and English fluency. Only those who have a household income above a certain threshold — nearly $41,200 for a couple with no children — will be exempt from the public charge evaluation.


Given that the median annual income for home care workers was $15,100 in 2017, most of these individuals will fail to meet the threshold, NAHC pointed out. And, in part, wages are so low in home care because Medicaid rates for these services are low, preventing agencies from paying their workers more. So, the new rule could create a vicious cycle.

“… The very programs that are considered in determining whether an immigrant is a ‘public charge’ are the reason why these crucial home care workers may qualify for that public support,” the letter states.

NAHC is far from the only organization to comment on this potential rule change. More than 210,000 comments came in during the 60-day comment period for the proposed rule, which ended on Monday, Vox reported. Now, the Department of Homeland Security will consider these comments and issue a final version of the rule, probably within months.

Written by Tim Mullaney

Companies featured in this article: