Case managers across the nation say they are encountering immigrant patients who fear receiving healthcare services through Medicaid, Medicare Part D Prescription Drug Coverage, and Children’s Health Insurance Program (CHIP).

Their fears apparently arose from the Department of Homeland Security’s (DHS’s) proposed rule regarding “public charges,” issued in October 2018. Those are noncitizens deemed by immigration officials to likely rely over the long run on government programs for basic needs; such individuals are ineligible for visas or permanent residency.

A key part of the proposed change would make receipt or potential receipt of certain government healthcare services, such as nonemergency Medicaid, a negative factor weighing against noncitizens, potentially threatening their visa or permanent residency status.

Case managers can help alleviate fears and ensure patients continue receiving needed services with the following:

• Know the proposed public charge rule and what it means.

First, case managers could explain that the proposed rule is not a law and is not in effect, and would not be retroactive if finalized. The benefits people receive today would not be used against them.

Also, it might take years for DHS officials to read through and address the more than 200,000 comments received about the proposal. Some proposed rules are never made final, and others can take more than 10 years to become final.

According to the U.S. Citizenship and Immigration Services, affected people would be “Individuals seeking immigrant or nonimmigrant visas abroad, individuals seeking admission to the United States on immigrant or nonimmigrant visas, and individuals seeking to adjust their status from within the United States. The proposed rule also would consider certain receipt of public benefits by individuals within the United States in a nonimmigrant (i.e., temporary) status who are seeking to either extend their stay or change their status.”

However, case managers should not give patients a blanket statement that they would not be targeted. According to the proposed rule, while most lawful permanent residents are not subject to inadmissibility determinations, some can be subject to the public charge ground of inadmissibility. (

“The rule should not impact people who have legal status, as it is written. We don’t know what will happen, so our network is urging folks to talk to an immigration lawyer,” says Leslie Fried, JD, senior director at the Center for Benefits Access at the National Council on Aging in Arlington, VA.

Keep advice simple when speaking with immigrant patients, Fried advises.

“Tell them the Department of Homeland Security would not look at benefits retroactively,” she says. “Say you will inform them if the rule is finalized or if things change.”

• Emphasize the importance of patients continuing to receive medical care.

“This is a proposed rule, and no one should change their patterns of care as a result of this government proposal,” says Carmela Coyle, president and chief executive officer of the California Hospital Association in Sacramento.

“Make certain individuals who might be affected know that their hospital has their back and is on their side,” Coyle says.

Case managers are educators, ideally suited to help patients understand that they are safe to receive healthcare services and that this proposed rule is a long way from being finalized.

“Case managers can alleviate concerns,” Coyle notes. “They play an important role in this important moment.”