The Trump administration's proposal to change "public charge" policies may prevent immigrants from using Medicaid and ultimately lead to more uncompensated care, Kaiser Family Foundation said in a new report.
The proposed rule change would affect those entering the U.S. legally who then try to gain permanent resident status. Those using Medicaid and earning income below 125% of the federal poverty level would be more likely to be considered ineligible for legal status.
KFF said between 2.1 million and 4.9 million people may drop out of Medicaid and the Children's Health Insurance Program if the rule is finalized. Most provider groups oppose the change, calling it a recipe for higher costs and a threat to public health.
Researchers used 2014 Survey of Income and Program Participation data to figure out the share of noncitizens who entered the country without legal permanent status whom DHS could now give a public charge determination. They also determined the number of Medicaid enrollees who would likely dis-enroll.
KFF found that 94% of noncitizens who entered the country without legal permanent status have at least one characteristic DHS could look upon negatively under the proposal. Between 2.1 million and 4.9 million people may dis-enroll from Medicaid and CHIP because they're afraid that participating in those programs would negatively affect their long-term chances of becoming a legal resident.
NEW: Proposed changes to federal “public charge” policies may lead to fear and uncertainty among immigrant families about using public programs, which likely would drive down enrollment in Medicaid & CHIP, potentially by millions of people. https://t.co/JDRms4UV77 pic.twitter.com/iASeAd9DjF— Kaiser Family Foundation (@KaiserFamFound) October 12, 2018
"The disenrollment rates draw on previous research on the chilling effect welfare reform had on enrollment in health coverage among immigrant families," according to the report. "Decreased participation in Medicaid would increase the uninsured rate among immigrant families, reducing access to care and contributing to worse health outcomes. Coverage losses also would result in lost revenues and increased uncompensated care for providers and have spillover effects within communities."
These developments could lead to sicker families, more pent-up healthcare needs and hospitals faced with fewer insured patients. Fewer insured people would result in lost revenues for providers, more emergency room visits and increased uncompensated care.
Community health centers, which care for a large percentage of Medicaid patients, spoke out against the proposal, saying they already run on margins of less than 1%. The proposal would make matters worse, Tom Van Coverden, CEO of the National Association of Community Health Centers, said in a statement.
"As patient-centered organizations, by mission we seek to provide appropriate and meaningful access to care for all those who come through our doors and fear that this rule works in contrast to this long-standing goal," he said. "We ask that the administration reconsider this effort immediately and work with us to ensure that health centers and the patients they serve are not put at risk."
DHS is seeking public comment on the proposal until Dec. 10.