Public Charge Rule – Medical Conditions & Health Insurance

Public Charge Rule – Medical Conditions & Health Insurance

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Connie Kaplan

The US Supreme Court overturned the injunction which prevented the Public Charge Final Rule from taking effect on October 15, 2019. As such, all adjustment of status (green card) applications postmarked on or after February 24, 2020 will be subject to this new set of policies. ONE of the major areas of focus is an applicant’s health status and insurance coverage.


Provided that the applicant is not exempt from the public charge ground of inadmissibility, the Rule will be used to consider an applicant’s receipt of Medicaid as a basis to deny. Individuals who received Medicaid while under the age of 21 or while pregnant (or up to 60 days after giving birth) are not subject to this policy.


In the absence of private health insurance, having a medical condition likely to require extensive medical treatment and/or result in institutionalization will be treated as a heavily weighted negative factor in the determination of whether an applicant is likely to become a public charge. Private health insurance includes plans purchased on the healthcare marketplace that were subsidized by the US government based on the applicant’s income.


For applicants who do not have any medical conditions which are likely to require extensive medical treatment and/or result in institutionalization, unsubsidized private health insurance coverage is considered a heavily weighted positive factor in the determination of an applicant’s likelihood of becoming a public charge. 


Before applying for adjustment of status or any other immigration option requiring a finding of admissibility, an entire line of inquiry needs to be developed and met, and some of these questions are addressed here:

  1. Are you currently using Medicaid or have any health insurance?
  2. Do you have any medical conditions which are likely to require extensive medical treatment and/or result in institutionalization?
  3. Did you purchase private health insurance?
  4. Is that insurance with or without government subsidies?
  5. Did you already complete the civil surgeon medical exam?


The open enrollment period ended on December 18, 2019 so most individuals can no longer purchase a plan from the insurance marketplace. However, anyone who moved to the United States, got married or had a child in the last 60 days may qualify for a special enrollment period. Those who do not qualify may still be able to get coverage by enrolling in short-term insurance or a traveler’s insurance policy.

You should schedule an appointment with us to determine exactly what category you fall under from above, and if there are any other possible inadmissibility issues you need to worry about.  This is a topic for which implementation rules have not been released yet, so it is ever changing.  We work with insurance brokers who are authorized to sell marketplace plans and are knowledgeable about the Public Charge Rule.  Do not take this lightly – you do not want to spend time and money on a green card application without minimizing any negative factors.  Contact us before you apply.

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