On June 14, 2019, the U.S. Department of Health and Human Services officially published proposed changes to the nondiscrimination regulations under Section 1557 of the Affordable Care Act (ACA).1 The announcement triggered a 60-day public comment period. Section 1557, the nondiscrimination provision of the ACA, expands long-standing federal civil rights protections to certain healthcare programs and activities. The proposed rule changes will negatively impact multiple at-risk populations. Among other revisions, the changes would:

• Exempt most health insurance companies from nondiscrimination language
• Allow hospitals and providers to deny care based on religious beliefs
• Eliminate references to “sexual orientation” and “gender identity” as well as “sex stereotyping” virtually erasing LGBT protection
• Undo protections for HIV positive individuals that resulted from a complaint originating over HIV drug price inflation in Florida
• Remove the requirement for informing limited English proficiency (LEP) individuals of the availability of language assistance services

Potential Impact
Health care policy professionals, providers, and advocates are weighing in on how these changes negatively impact women’s reproductive healthcare access, as well as healthcare access for the LGBT, HIV+, and LEP populations. Raising the stakes for Florida, the state ranks 3rd for size of Medicaid population,6 10th for highest LGBT population percentage7 and 3rd highest for HIV infection rate in the United States.8 Additionally, Florida’s LEP population ranks 4th largest in the country with 2.1 million individuals.  

Florida Health Justice Project (FHJP) Next Steps
Alongside national, state and local partners, FHJP will be submitting official comments to the Department of Health of Human Services detailing the potential negative impact of the proposed changes on Floridians and discouraging implementation. In the coming days, FHJP will be gathering data and conducting research to inform our comments and conclusion. In addition, FHJP will share our research with other interested entities and encourage our partners to formally submit comments as well. Please contact Timothy Loftus, M.D., FHJP Law Clerk, at tloftus@law.miami.edu for questions.

By Matt Childers, Ph.D.
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Updated November 14, 2018

On October 10, 2018, the Trump Administration published proposed changes to the “public charge” immigration rules that govern how the use of public benefits affect an immigrant’s legal status. These changes are likely to harm millions of immigrant families across the nation, but states with large immigrant populations will disproportionately feel the impact. In this brief, we analyze the effects that the proposed changes will have on healthcare coverage among U.S.-born children in “mixed-status” families in Florida and its major metropolitan areas (by “mixed-status,” we refer to families whose children are citizens, but one or both of the parents are not).  We find that over 107,000 kids will lose health insurance in Florida and over half of them reside in the Miami metropolitan area.

By Matt Childers, Ph.D.

Updated November 14, 2018


On October 10, 2018, the Trump Administration published proposed changes to the “public charge” immigration rules that govern how the use of public benefits affect an immigrant’s legal status. These changes are likely to harm millions of immigrant families across the country, but states with large immigrant populations will be disproportionately affected. In this brief, we analyze the impacts that the proposed changes will have on SNAP enrollment (food stamps) among U.S.-born children in “mixed-status” families in Florida and its major metropolitan areas. (By “mixed-status,” we refer to families whose children are citizens, but one or both of the parents are not.) We find that over 80,000 kids will lose SNAP benefits across the state and over half of them reside in the Miami metropolitan area.

(Miami) - A draconian proposal by the Trump administration to overhaul how immigration officials determine what constitutes a “public charge” (which could result in denial of lawful permanent residence or entry to the U.S.) was announced on Saturday night.  There will be a 60 day public comment period.
 
The proposed new rule radically revamps longstanding immigration law.  For the first time, immigration officials could consider use of critical non-cash benefits intended to safeguard the health, nutrition, housing and economic security of America's low-income families in making public charge determinations. States with large immigrant populations like Florida will be disproportionately impacted.

Miriam Harmatz, Co-executive Director of the Florida Health Justice Project, explained that this represents a major shift from long-standing policy in which the only benefits considered in a public charge determination are cash assistance or long-term institutional care.  "The chilling effect will result in Florida’s families and children being poorer and sicker.”

Local public officials across the country have been speaking out against  the long rumored rule, and the Miami-Dade County Board of County Commissioners passed a resolution on 9/5/18 urging the federal government to maintain the status quo. Citing data provided by Dr. Matt Childers, Director of Policy Research for the Florida Health Justice Project, the Commission’s Resolution opposed any federal regulatory change that would negatively impact immigrant families.

In observing that “this is a disgraceful attack on immigrants legally living and working in our communities,” Maria Rodriguez, Executive Director of Florida Immigrant Coalition, also noted that nothing changes until the Administration reviews and responds to public comments.  She urged all members of the public to submit comments.  “This is an attack on the entire community.”

Jonathan Fried, Director of WeCount, similarly decried the proposal’s impact.  “Key sectors of Florida’s economy, including agriculture and tourism, are dependent on immigrant workers who earn less than a living wage.  Their families will forego Medicaid, food stamps, and housing assistance - services to which they are legally entitled - jeopardizing their health, safety and security, as well as Florida’s economic sustainability."
 
For more information on the rule’s impact in Florida and how to submit comments, contact Matt Childers.
Email: childers@floridahealthjustice.org
Phone: 619-807-1724

​Pursuant to a draft rule now being considered by the Trump Administration, the federal government would, for the first time, consider use of virtually any publicly funded benefit intended to safeguard the health, nutrition, housing and economic security of America's low income families in making public charge determinations. The range of benefits that could be considered would include Medicaid, CHIP, marketplace subsidies, SSI, state and local government cash assistance programs, public assistance for long- and short-term institutionalized care, state and local subsidized health insurance, WIC, SNAP, LIHEAP, transportation vouchers, public housing assistance, and educational benefits like Head Start.

This represents a major shift from long standing policy in which the only benefits considered in a public charge determination (which could result in denial of lawful permanent residence or entry to the U.S.) are cash assistance or long term institutional care.  The Administration's stated intent is to “provide a strong disincentive for the receipt or use of public benefits by aliens, as well as their household members, including U.S. children.”

This brief estimates the potential loss of one particular benefit on a single subset of the potentially impacted Florida population-- citizen children in Florida currently enrolled in Medicaid/CHIP.

 Decreased Enrollment in Medicaid/ CHIP Among Florida’s eligible children.
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Lawfully present immigrants eligible for Medicaid or CHIP, as well as US citizen children with one or more immigrant parents, are already far more likely to be uninsured than those without immigrant family members based on currently (unfounded) fears of negative immigration consequences. If the draft rule goes forward, this disparity will grow as the new rule explicitly intends to have a chilling impact. The implications for loss of coverage among Florida's children--particularly in South Florida-- are significant.  The universe of those impacted is larger than the data provided in this brief because, among other things, significant numbers of eligible children are not currently enrolled, and, as a result of the new rule, their parents will likely not pursue enrollment.  
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There are currently over 400,000 Florida citizen children enrolled in Medicaid or CHIP with a non-citizen parent. As illustrated in the graph below, half of them live in the Miami metropolitan area which includes: Miami-Dade, Broward, and Palm Beach Counties.

If the rate of disenrollment ranges from 15 to 35% among these families, between 46,000 and 107,000 children will lose insurance in Florida overall.

Note:   The number of citizen children whose coverage would be adversely impacted under the draft rule is significantly higher than the data above since this analysis does not include an estimate of the children who are currently eligible but not enrolled.  

For more information, please visit the Protecting Immigrant Families website. If you have any questions about the public charge rule, please contact Miriam Harmatz, harmatz@floridahealthjustice.org. If you would like more information about our methodology, please contact Matt Childers, Ph.D., at childers@floridahealthjustice.org.

​Click here to download a copy of this brief.

Leaked policy proposals, including to the long standing public charge rule, indicate the Administration’s intent to make life more difficult for immigrants, including their U.S. citizen children, by restricting their ability to access basic programs safeguarding the health care, nutrition, housing, and economic security of low-income families. 

The Florida Health Justice Project is part of a national Protecting Immigrant Families Campaign bringing together local, state and national advocates to defend against these threats through outreach and education. The public, press and policy makers need to understand the harmful impact such changes would have on Florida’s families and communities. 

The resources below provide Information and data on the public charge issue and include  materials for Florida's health care providers, immigrant advocates and impacted individuals willing to share their stories.  It is vitally important that we hear from you.