- President Donald Trump's administration sent guidelines to states Friday instructing that the income and resources of a legal immigrant's sponsor should be factored into determining eligibility for Medicaid and CHIP, part of a broader tightening of immigration rules.
- Those sponsors are also responsible for reimbursing the state for the benefits provided, CMS said in a statement on Friday.
- "Today's guidance reminds states of their obligation to comply with the sponsor deeming requirements, along with information on the repayment and recovery of costs requirements," the administration said.
The guidelines follow the administration's controversial finalization of a "public charge" rule. That rule defines a concept in existing law, penalizing legal immigrants for using Medicaid and other public programs for the purposes of their citizenship applications, even though they are legally allowed to use the benefits.
The public charge rule drew swift rebuke from industry groups such as the American Hospital Association and the Federation of American Hospitals.
Those groups say the public charge rule will act as a deterrent for those who need public services such as healthcare. California is among the states suing the administration to block that rule, which puts more than 8 million children at risk for losing health and nutrition benefits.
Despite vocal opposition to the public charge rule, industry players like the AHA and AHIP have not taken public positions yet on the eligibility requirements for immigrants. In theory, fewer Medicaid patients could mean more unpaid bills for health systems.
In the Friday's news on eligibility guidelines, the Trump administration points to the Immigration and Nationality Act as the justification for these guidelines regarding a sponsor's income and resources.
"The INA generally requires that the income and resources of the sponsors of certain immigrants be counted in determining the immigrant’s eligibility for federal means-tested benefit programs, including Medicaid and CHIP," CMS said.
A state can use CMS' methodology for determining eligibility regarding lawful permanent residents or a state can seek out their own methodology pending CMS approval.
A CMS spokesman told Healthcare Dive the requirements outlined in the guidance have been around since 1996, suggesting some states may not have implemented those requirements. The official did not specify a particular state.