As a public hospital serving one of the most diverse counties in the nation, Alameda Health System is committed to Caring, Healing, Teaching and Serving All by providing an array of services to our community members.

On October 10th, the Department of Homeland Security (DHS) published a proposed rule that would change the determination of public charge, making it harder for immigrants and their families to become lawful permanent residents if they receive public benefits. “Public Charge” refers to individuals who may depend on government benefits as their main source of support.

Individuals seeking to enter the United States or who already reside here and apply for a green card are subject to the “public charge test” and must demonstrate that they are not likely to become a public charge, i.e. not likely to receive public benefit. The proposed rule would expand the definition of public charge by increasing the types of public benefits, including non-emergency Medicaid and Medicare Part D low income subsidy, and lowering the threshold for public charge determination. Here is a chart that compares the changes to the rule.

Public Charge Comparison Chart

AHS serves a diverse population who speak multiple languages and come from different backgrounds, including many immigrants and their families. For decades, we have provided care to everyone, regardless of their ability to pay, immigration status, or other individual circumstances. We have strong concerns that the new draft regulation could discourage our immigrant communities from seeking health care services that they are eligible to receive for fear for impacting their ability to become permanent legal immigrants.

The proposed rule will likely have a negative impact on the health of the entire community.

If immigrants skip needed preventative care and wait until they are very sick and need acute services, this could lead to increased emergency department visits and inpatient hospitalizations. This trend would move health care in the wrong direction at a time when we’re working to increase preventive and primary care, not encourage use of emergency services.

Furthermore, forcing immigrants to choose between basic needs like health care, housing, nutrition, and potential immigration status could have a detrimental impact on families and communities – likely leading to increased stress, hunger, and untreated medical issues, which collectively perpetuate poverty.

When any members of our community forego needed health care services, it impacts the entire community.

The proposed rule was posted to the Federal Register on October 10th and the public has 60 days, until December 10th to submit comments. As a public health care system, AHS is joining other organizations including Alameda County, California Association of Public Hospitals and Health Systems in opposing this proposed rule and will share our comments with DHS.

It’s important to share with those we serve that until a final rule is in effect, the current public charge policy remains in effect and they should continue to get the care they need.

If you have any questions regarding the proposed rule on public charge, please contact Terry Lightfoot, Director of Public Affairs and Community Engagement (PACE) at 510-535-7626 or