The new public charge policy may directly affect a limited group of immigrants. But experience with a similar policy during President Donald Trump's first administration shows that its effects can extend to families not directly subject to the assessment.
According to Leonardo Cuello, research professor at the Georgetown University Center for Children and Families, One of the reasons is the difficulty in determining who is subject to the rule and what an immigration official may take into account.
“If this policy were properly understood and everything were applied as required by law, the group of impacted immigrants “It would be very small,” Cuello said. “But the problem is that there’s confusion.”
The Department of Homeland Security (DHS) itself acknowledged in the public charge final rule that eliminating some definitions could generate confusion or misunderstandings and reduce participation in public benefit programs among people who are not subject to evaluation. The DHS also recognizes that some exempt individuals They might stop using benefits out of fear. or by confusion.
What happened during the first Trump administration
Cuello said that during Trump's first administration, the fear related to the public charge policy It had effects on the use of Medicaid, the Children's Health Insurance Program (CHIP), SNAP, and other programs.
Un Urban Institute national analysis This effect was documented. The research was based on a national survey conducted in December 2019 and analyzed the responses of 1,747 adults aged 18 to 64 who were born outside the United States or lived with at least one family member born outside the country.
15.6% said that he or a member of his family had avoided a non-monetary public program, such as Medicaid, CHIP, SNAP, or housing subsidies, for fear of jeopardizing a future green card.
The survey was conducted before the Trump administration's first public charge rule went into effect in February 2020. The same analysis also found widespread confusion about how the policy worked, even among those who said they knew about it.
Cuello described a similar pattern during the interview Enlace Latino NC : people who didn't know that politics had changed, others who knew it existed but didn't understand it, and others who thought they understood it but were wrong about basic aspects of its application.
“A problem that should affect a certain number of thousands of people ends up affecting millions of people, because millions of people are afraid that they will be affected,” Cuello said.
What changes on September 18th
On July 20, the DHS published a final rule eliminating the public charge regulations adopted in 2022. The new policy is scheduled to take effect on September 18, 2026, and will give officials greater discretion when evaluating each case.
The public charge assessment does not apply to all immigrants. It may apply to certain individuals seeking admission to the United States or the adjustment of status permanent residents, while there are exempt categories established by law, including refugees, asylum seekers and other humanitarian categories.
The DHS also notes that exempt individuals can continue to use the public benefits for which they are eligible. Beginning September 18, 2026, officials may also consider certain public benefits intended for low-income individuals; however, the new policy does not list specific programs, and receiving one of those benefits does not automatically disqualify an individual.
Protecting Immigrant Families (PIF) It published a guide, also available in Spanish, to help families determine if the assessment might apply to their situation.
For Cuello, a key difference with the new policy is the uncertainty generated by the greater discretion of officials.
“It used to be clear, now it isn’t,” he said. “Which creates more confusion, more anxiety, more stress.”
Related: Public charge and green card: what changes from September 18
When confusion affects health
The fear that using public benefits will have immigration consequences can lead some families not to apply for, renew, or drop Medicaid or CHIP, even when the person receiving coverage—for example, a U.S. citizen child—is not directly subject to the public charge assessment. Research on these types of policies describes this phenomenon as a deterrent effect or chilling effect.
For Cuello, the problem isn't limited to the loss of coverage. Once a person loses their insurance, they can face higher medical costs due to their age. This fear of not being able to afford a consultation, tests, or treatment can lead to postponing medical care until the problem becomes more serious.
“People are less likely to seek medical care because of the cost,” Cuello said. “And when they do seek it, it’s often because the problem has gone from minor to an emergency.”
In families without health insurance, she added, children may also receive less preventative care, vaccinations, or mental health services. Furthermore, medical bills can compete with other essential expenses, such as rent, food, or clothing.
Cuello pointed to a full test which mentions that around 1.7 million U.S. citizen children could leave Medicaid or CHIP due to fear or confusion related to public charge and other immigration policies
You may be interested: These are the new Medicaid work requirements in North Carolina
The rule faces lawsuits
The new policy also faces legal challenges before it comes into effect.
On September 14, New York led a coalition of states and the District of Columbia in filing a federal lawsuit to try to block the rule. The coalition asked a federal court to declare the policy illegal and invalidate the new rule. Those arguments have yet to be resolved in court.
A separate coalition of local governments, including New York, Chicago, San Francisco, Santa Clara County, Seattle, and King County, filed another lawsuit that same day.
As of September 16, the rule was still scheduled to take effect on September 18 while those challenges continued.
During the interview, before the lawsuits were filed, Cuello had already anticipated that he expected litigation against the new policy and noted that the possibility of further judicial changes could add another layer of uncertainty.
To explain why this fear might persist, Cuello recalled what happened with the public charge policy of the first Trump administration. He pointed out that even after that policy was discontinued, some people continued to believe the restrictions were still in place and avoided enrolling in health programs.
“There are people who think, 'No, I think Trump changed that and now it can't be done.' And you come in and say, 'No, a court stopped it,' but they're not sure,” Cuello said.
Public Charge Final Rule
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