NYC Health + Hospitals could lose $362M in first year of public charge rule

Father and daughter with concerned looks on their faces; the father is holding the daughter and the girl is holding an American flag
The public charge rule would impact the immigration status of individuals if they have family members on Medicaid or CHIP programs. (Getty Images/rrodrickbeiler)

Trump's proposed "public charge" rule would have vast impacts on New York's residents, as well as one of its largest health systems, NYC Health + Hospitals.

In a statement coming out against the draft rule, the nation's largest public health system warned that up to 350,000 New Yorkers would be impacted, potentially costing the provider up to $362 million in the rule's first year. The loss would come from the reduction in Medicaid and CHIP claims as immigrant populations drop this coverage.

“As New York City’s single largest provider of healthcare to Medicaid recipients, we are alarmed as we hear about legal immigrants who are dropping their Medicaid coverage out of sheer fear that it may jeopardize their path to getting a green card or visa approved in the future,” said Mitchell Katz, M.D., president and CEO of NYC Health + Hospitals, at a news conference. “New Yorkers should not have to choose between the healthcare services to which they are entitled and a green card.”


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During fiscal year 2018, which ended in June, the health system reported (PDF) $7.8 billion in operating revenue.

The New York health system released this analysis at a Wednesday event with the Mayor's Office of Immigrant Affairs. The groups urged New Yorkers to submit a comment opposing the rule before the comment period ends on Dec. 10.

RELATED: Hospital groups: ‘Public charge’ rule could drive up costs

The administration's changes to the public charge rule wouldn't immediately kick any citizens off Medicare or CHIP coverage. But analysts fear that immigrant families will drop this coverage anyway to avoid endangering a relative's hope of gaining permanent residency.

The rule change allows the Department of Homeland Security to consider whether someone will be reliant on government services when determining their permanent residency status. Unlike in previous years, DHS would be allowed to take relatives' health coverage, including the applicant's citizen children, into account when making this determination.

An analysis by the Urban Institute found that portions of the immigrant population are already dropping their public health coverage out of fear of the proposed rule, even though it wouldn't apply retroactively. Analysts noted that of the 10.3 million citizen children in the U.S. with at least one noncitizen parent, 6.8 million were enrolled in Medicaid or CHIP. 

“A recent report by the Mayor’s Office of Immigrant Affairs projects that up to 20% of our community is likely to drop important health care coverage in fear of endangering their immigration status," New York State Assembly member Yuh-Line Niou said at the press conference. "This is a defective and unfair consequence for immigrant families seeking health services for which they are eligible. New Yorkers should not have to choose between the health services they are entitled to and lawful immigration status."

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