The Potential Chilling Effects of the Public Charge Rule on Medical Care and Program Participation

Principal Investigators
Harvard T.H. Chan School of Public Health
Funded on

In January 2020, the Supreme Court allowed the Department of Homeland Security to implement a new rule regarding the definition of “public charge.”  The rule directs the federal government to use participation in public programs (including Medicaid, the Supplemental Nutritional Assistance Program (SNAP), and subsidized housing), overall health status, and income as criteria to determine whether legal immigrants are able to gain permanent residency.  Some have voiced concerns that this policy will dissuade individuals from participating in these programs or obtaining needed medical care, and that this “chilling effect” may impact people outside the policy’s intended scope (such as citizens with immigrant relatives).  

To examine these important and timely issues, our team is collecting primary data from two distinct populations to explore awareness of the public charge rule, sources of information about the rule, and how the rule may affect decisions on obtaining medical care and participating in public programs. In one project, we are conducting a telephone survey of low-income adults in Texas, and in the other project, we are conducting in-person interviews with patients at community health centers in Massachusetts, in order to better understand how this new policy is affecting care for vulnerable populations.