Starting Friday, Sept. 18, immigration officers reviewing many green card applications can consider an applicant's use of Medicaid, food assistance, housing aid, and other income-based benefits under a Department of Homeland Security final rule. The rule applies to applications for admission made on or after that date and to adjustment of status applications postmarked or submitted electronically on or after that date.
The change arrives amid legal uncertainty. On Monday, Sept. 14, New York Attorney General Letitia James led 21 other states and the District of Columbia in suing to block it. New York City filed a separate lawsuit with Chicago, San Francisco, Santa Clara County, Seattle, King County in Washington, and the Public Rights Project. Both cases were filed in federal court in Manhattan. As of Sept. 15, an immigration law firm noted, no publicly reported court order had blocked the rule, and filing a lawsuit does not by itself delay its effective date.
For families, the health stakes are practical. City and state officials warn that immigrant families may drop Medicaid or avoid medical care out of fear, even when the rule does not apply to them.
The Standard Shifting on Sept. 18
The public charge test asks whether a person is likely to depend on government support. Under the 2022 rule, officers could consider only cash assistance for income maintenance and long-term institutional care at government expense, according to the Legal Aid Society.
The new rule rescinds the 2022 regulation without replacing it with new regulatory text, America's Essential Hospitals explained. Officers will review each case based on the totality of the applicant's circumstances and may consider past or future use of means-tested benefits for any length of time. The rule also removes a definition stating that applying for or receiving benefits on behalf of family members did not count as the applicant's own receipt.
Guidance issued Aug. 18 by U.S. Citizenship and Immigration Services explains the factors officers will weigh. USCIS said the update aligns with congressional intent that noncitizens be self-sufficient and not dependent on taxpayer-funded benefits. The Legal Aid Society says federal agencies have indicated that SNAP, WIC, Medicaid, federal housing assistance, the Earned Income Tax Credit, the Child Tax Credit, Head Start, and Early Intervention will be among the benefits considered, though no complete list has been published.
Timing matters. Under the Federal Register notice, only cash assistance for income maintenance and government-paid long-term institutional care received before Sept. 18 will be considered. The Legal Aid Society also says green card applications filed before Sept. 18 will be decided under the 2022 rule.
Mixed-Status Households and Local Health Systems
The biggest household concern involves children. Under the new rule, officers may consider means-tested benefits received by an applicant's dependents, such as a U.S. citizen child whose eligibility is based on a parent's income, according to the Legal Aid Society. The states' lawsuit argues that a parent's green card application could be put at risk because a citizen child used state-provided health insurance.
The coalition says federal officials have acknowledged that a previous version of the policy was followed by benefit disenrollment rates as high as 35% among mixed-status families. According to the attorney general's office, DHS itself predicts that this chilling effect will cost states $4.05 billion a year in Medicaid and Children's Health Insurance Program funding and $1 billion a year in SNAP funding. Those figures are projections, not measured losses.
The coalition argues that the effects would reach beyond immigrant families. People who lose coverage tend to delay care and turn to emergency rooms, straining safety-net hospitals and community health centers, the states say. Schools could also lose automatic certification for free and reduced-price meal programs if SNAP and Medicaid enrollment falls below required thresholds.
"Hardworking families should not be forced to go without the support they need because they fear asking for assistance will get them deported," James said.
"New Yorkers will be afraid to see a doctor or ask for help they are legally entitled to," New York City Mayor Zohran Mamdani said. "That fear will not stop at the families that the federal government is targeting."
Exemptions, Pending Lawsuits, and Steps to Take First
Many immigrants, including most current green card holders, refugees, and asylees, are not subject to the public charge test. The Legal Aid Society also lists people applying for citizenship, Deferred Action for Childhood Arrivals (DACA) recipients, Temporary Protected Status (TPS) holders, U and T visa applicants and holders, Violence Against Women Act self-petitioners, and Special Immigrant Juveniles among the exempt groups. Green card holders generally face the test only after trips abroad of more than 180 days or in certain other circumstances.
The people most likely to be affected are those seeking a green card through a family member, an employer, or the diversity visa lottery. For them, the key decisions involve filing timing, documentation, and whether any household benefits could be considered.
The Legal Aid Society advises against stopping or declining benefits before determining whether the rule applies, and it recommends speaking with an immigration professional before disenrolling. Dropping coverage can leave a child without routine vaccines, a pregnant person without prenatal care, or an adult without medication for a chronic condition. Anyone facing a medical emergency should seek care. New York City residents can reach the city's free Immigration Legal Support Hotline at 1-800-354-0365 or by calling 311.
Neither the rule nor the USCIS guidance explains how much weight officers will give to benefit use, according to the Legal Aid Society, so the effect on approvals will not be clear until decisions begin.
The next step rests with the courts. The states are asking the U.S. District Court for the Southern District of New York to declare the rule unlawful and vacate it. In 2020, James led a coalition that won a court order blocking a similar Trump administration rule, a ruling later upheld by the Second Circuit, according to her office.
Unless a court intervenes, the rule takes effect Friday. Families who might be affected should confirm whether the test applies to them, keep records of benefits received, and get individualized legal advice before changing health coverage.
Key Questions Answered
What changes on Sept. 18? Immigration officers can consider an applicant's use of means-tested benefits, such as Medicaid and SNAP, when deciding whether the person is likely to become a public charge. The rule applies to adjustment of status applications filed on or after Sept. 18 and to applications for admission made on or after that date.
Will benefits I received before Sept. 18 count against me? For benefits received before Sept. 18, officers will consider only cash assistance for income maintenance and government-paid long-term institutional care, as under the 2022 rule.
Who is exempt from the public charge test? Exempt groups include U.S. citizens, most current green card holders, refugees, asylees, DACA recipients, TPS holders, and U or T visa applicants and holders, according to the Legal Aid Society.
Can my U.S. citizen child's Medicaid affect my application? The Legal Aid Society says officers may consider benefits received by dependents when a child's eligibility is based on a parent's income. Speak with an immigration attorney about your situation.
Has a court blocked the rule? Twenty-two states, the District of Columbia, and a coalition of cities and counties sued on Sept. 14. As of Sept. 15, no court order blocking the rule had been publicly reported.
Should I cancel Medicaid now? Legal aid groups advise against dropping benefits before confirming whether the rule applies and speaking with an immigration professional. Losing coverage can interrupt needed care.
