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HCA Seeks Home Care Exemption in Federal “Public Charge” Rule Change

Rule would limit, deny immigration for those on public assistance, with implications for home care patients and the individuals who support them

HCA today commented on a new federal proposal that would limit or deny permanent legal status to immigrants if they rely on a wide range of government services, such as Medicaid, food assistance, and housing assistance. Our comments seek exemptions of individuals employed or seeking employment as home care or personal care aides.

The proposal comes from the U.S. Department of Homeland Security (DHS). It would change the definition of “public charge,” a term used to determine whether individuals may enter the U.S. or adjust to legal permanent resident (LPR) status (i.e., obtain a “green card”) based on their use of public assistance.

The rule seeks to broaden the programs that the federal government would consider in so-called “public charge” determinations of an immigrant’s admissibility. These determinations would include health, nutrition, and housing programs, such as cash assistance for income maintenance, government-funded institutionalized long-term care and programs that were previously excluded from public charge determinations.

“Because home care services are almost exclusively covered by public programs like Medicaid and Medicare (by about 90 percent), wage pressures from state and federal government reimbursement rate shortfalls have resulted in wage stagnation and a labor environment where over half of all home care workers rely on some form of public assistance, including the 40 percent of New York home care workers who are immigrants and would have their immigration status imperiled by DHS’s proposal because they might rely on public assistance,” HCA states in our comments.

“Of greatest concern, this change in ‘public charge’ policy would cast a shadow on the prospects for many in the home care workforce to continue serving the medical, supportive and assistive needs of patients under the state’s Medicaid program, and statistics show that an access-to-care crisis would almost certainly result,” we add.

HCA’s comments provide background on the current workforce shortages that exist in home care at a time when demand is growing. Many of the individuals working in the home care field – up to a quarter, by one national estimate – are immigrants. Nearly half rely on some form of public assistance. “In many regions of the state and country, these extraordinarily dedicated individuals and the patients who rely on their services would be significantly affected by DHS’s proposal to change the federal ‘public charge’ policies.”

HCA’s comments are at