On March 11, 2021, President Biden signed the American Rescue Plan Act of 2021 (the ARP), a wide-ranging package of health care and economic measures responding to the coronavirus pandemic. The ARP includes a broad expansion of the Affordable Care Act’s (ACA) main health insurance subsidy, the premium tax credit (PTC), the first major expansion of the health care reform law since its passage. This piece highlights the policymaking considerations that states must account for in light of the PTC expansion and uncertainty about future federal action. A key theme that emerges is that states will benefit from approaches that give them the flexibility to adjust policies year by year as the federal landscape develops.
Public Charge Rule
On August 14, 2019, the Department of Homeland Security (DHS) published a final rule, Inadmissibility on Public Charge Grounds. The rule makes significant changes to the standards DHS will use to determine whether an immigrant is likely to become a “public charge”—a person dependent on the government for support—which will make it more difficult for certain immigrants to obtain lawful permanent residence (a green card) in the US. Although the rule was originally scheduled to take effect in October 2019, multiple preliminary injunctions issued by federal courts across the country temporarily blocked the rule. As a result of decisions by the Supreme Court, the rule went into effect nationwide on February 24, 2020. Because litigation is ongoing, the status of the rule could change once again in the months ahead. Individuals whose application for a visa or green card is processed outside the U.S. are subject to Department of State (DOS) public charge rules, which DOS has aligned with the new DHS standards. Individuals with questions about their specific situation should consult an immigration attorney.
State Health and Value Strategies, in partnership with Manatt Health, has developed a variety of resources for states regarding the revised public charge rule and implications for states. We will continue to update this page with new resources as they become available. If you have materials you are willing to share with other states through this page, please contact Sally Mabon email@example.com.
State Health and Value Strategies Resources
Public Charge Final Rule: Frequently Asked Questions. This document provides answers to frequently asked questions about whom the rule will impact, what benefits are implicated by the rule, and how the rule might be administered.
The Department of Homeland Security Begins Implementing Its Public Charge Rule on February 24, 2020. In this Expert Perspective, our colleagues at Manatt Health review the Supreme Court’s decisions granting the Administration’s requests to stay preliminary injunctions that had blocked the Department of Homeland Security public charge final rule from taking effect in October 2019.
Talking Points on Public Charge for State Health Officials. This document, developed by communications experts at GMMB, provides talking points for marketplaces and other state health officials to use in communicating with consumers about the changes to public charge.
Final Public Charge Rule: Analysis and Potential Implications. On September 3, the Robert Wood Johnson Foundation’s State Health and Value Strategies program hosted a webinar on the public charge final rule, facilitated by experts at Manatt Health. The webinar reviewed the final rule, highlighted changes from the proposed rule, and explored the rule’s potential impacts on consumers, states and providers. Speakers identified the key ways the proposed rule departs from current guidance, with a particular focus on the implications for Medicaid and other health-related public benefits, as well as communications and messaging.
Families USA report: analysis of Census Bureau data documenting recent health insurance changes for U.S.-citizen children with immigrant parents.
Protecting Immigrant Families Letter to State Officials Regarding I-944 Form: the letter highlights the information state officials will need to provide and best practices for responding to requests for information.