Starting today, immigration officials can deny some applicants a green card if they use, or may use in the future, public benefits such as Section 8 housing vouchers, food stamps and Medicaid.
Immigration advocates and health experts believe the rule, known as "public charge," is the Trump administration's harshest policy affecting legal immigration. They believe it's already causing many low-income immigrants not to seek help they need, like going to the doctor. That, in turn, could shift health care costs to local emergency services, critics say, and increase the spread of infectious diseases.
The Trump administration has said this updated rule is important to ensure that immigrants will be self-sufficient, rather than relying on public services.
Some community health clinics in Southern California are prepping for the change.
LEGAL CHALLENGES
A draft of the public charge rule, which is an expansion of an existing rule, was introduced to the public two years ago. Then finally in August, the Department of Homeland Security published the rule in the Federal Register, and it was set to go into effect in October.
But federal judges in three states, including California, issued temporary injunctions to block the rule.
However, in January, the Supreme Court voted 5-4 to let the public charge rule go into effect.
WHAT EXACTLY IS THE RULE?
When applying for a green card or a visa in the U.S., some immigrants have to pass a "public charge" test. Immigration officials review a person's age, income, health, education and skills. They also review the affidavit of support from the immigrant's sponsor.
Under the updated rule, officials will now also look at whether an applicant uses, or is likely to use, specific, federally funded benefits, including:
Public assistance programs NOT counted against green card applicants in the new rule include food banks, shelters, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), free school lunches, and state or local health care programs.
The public charge rule does not apply to asylees, refugees or young people with Special Immigrant Juvenile status.
HEALTH CARE CONFUSION
Health care advocates say the updated rule is causing confusion because some immigrants may not know whether their health care program is federally funded or state-funded.
For example, Medi-Cal that insures DACA recipients and children who aren't in the country legally is funded only by the state. However, immigrants who have become citizens and some legal permanent residents may be enrolled in federally funded Medi-Cal programs.
Altamed, a large community health provider in Southern California, reported a drop in the number of patient visits since the draft public charge rule was unveiled two years ago.
Berenice Núñez Constant, VP of Government Relations at Altamed, says their clinics will never turn down services to patients. But they also want to make sure patients are educated about the rule.
"We're also focused on making sure that our clinic staff that interfaces with the patient on a day-to-day basis, that they're aware of how to respond to this rule," Núñez Constant says.
"We've trained them and provided them with the script to respond to the rules and provide [patients] with vetted legal resources." These resources include immigration lawyers and public assistance lawyers.
California immigrant advocacy groups and health care providers are also promoting the website Keep Your Benefitsto patients. It includes a questionnaire that helps people figure out if they are impacted by the rule.
IS THIS THE FINAL, FINAL RULE?
State Attorney General Xavier Beccerra says California will keep fighting against the new public charge rule. In a statement released after the Supreme Court ruling, he said, "This rule harms our children and families in communities across the country. It hurts our economy and the healthcare of so many Californians."
The rule will be implemented nationwide. A Supreme Court decision Friday overruled a lower court's order to pause implementation in Illinois.
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