Center for American Progress

Trump’s Public-Charge Rule Would Threaten Disabled Immigrants’ Health and Safety

Trump’s Public-Charge Rule Would Threaten Disabled Immigrants’ Health and Safety

This column identifies the consequences of Trump’s redefined public-charge test for disabled immigrants’ health and safety.

A Palestinian family sits together at an airport on April 17, 2018. (Getty/Dogukan Keskinkilic)
A Palestinian family sits together at an airport on April 17, 2018. (Getty/Dogukan Keskinkilic)

In another wave of pointed attacks, the Trump administration has proposed a radical change in immigration policy that would have widespread negative consequences for people with disabilities and their families. Under current law, most immigrants seeking a green card, which grants them authorization to live and work permanently in the United States, must pass an archaic public-charge test. An individual can be designated a public charge if they are determined likely to become primarily dependent on long-term cash assistance from programs such as Supplemental Security Income (SSI) and Temporary Assistance for Needy Families (TANF) or institutionalized for long-term care paid for with Medicaid.

Even though the current public-charge test discriminates against immigrants with disabilities, relatively few disabled immigrants with family support in the United States fail it. But President Donald Trump is preparing to drastically expand the public-charge test, including by explicitly targeting disabled immigrants. The proposed changes harken back to a period when the federal government used the test to deny permanent residency to individuals it deemed “degenerates,” such as LGBTQ immigrants, and other groups seen as “morally deficient,” including unmarried mothers.

Disabled immigrants would bear the brunt of the Trump’s rule

President Trump’s proposed rule redefines public charge to include any green card applicant who is found likely to receive “any government assistance in the form of cash, checks or other forms of money transfers, or instruments and non-cash government assistance in the form of aid, services, or other relief, that is means-tested or intended to help the individual meet basic living requirements.” Under this more expansive definition, most people who are potentially eligible for income-tested programs that support work, health, and integration would fail the test. Such programs include but are not limited to the Supplemental Nutrition Assistance Program (SNAP); the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); the Earned Income Tax Credit (EITC); the Low-Income Home Energy Assistance Program (LIHEAP); Medicaid; Medicare Part D; and the Affordable Care Act’s premium tax credit for people purchasing health insurance. According to a recent Center for American Progress estimate, President Trump’s proposed test is so restrictive that about one-third of the U.S. population—more than 100 million people—would fail were they required to take it today.

While these changes threaten all immigrants and their families, they would have particularly devastating effects on disabled immigrants and families who live with them. For example, exclusion from energy assistance programs such as LIHEAP would especially affect people who require electricity to support medical equipment such as ventilators and power wheelchairs. Seventy-two percent of LIHEAP recipient households include a member with a serious medical condition, and 1 in 5 households participating in SNAP includes an adult with a disability. Thus, exclusion from these programs would create heightened food insecurity and higher utility bills for not only disabled parents but for their children as well.

This is just the beginning. The proposed changes would exclude from permanent residence eligibility any person with “any medical condition” who is also enrolled in government-subsidized health insurance, creating a dangerous Catch-22 for the disability community. Individuals who choose to report on their green card applications that they can’t afford health insurance without a subsidy would fail the public-charge test, but failing to report at all would leave disabled immigrants without health insurance—perpetuating a vicious cycle of stigmatization and neglect at the national level. The impossible choice is even greater for immigrant parents with disabilities, including those who have children who are citizens. Parents in this situation would be forced to decide between enrolling their children in health care programs that lawmakers have made them eligible for and thereby failing Trump’s test themselves, or instead opting out of potentially lifesaving medical services to keep their family together.

Selective exclusion of lawful immigrants from permanent residency eligibility based on a factor outside their control—whether that be income, health, or otherwise—must be seen for what it truly is: targeted discrimination.


These exclusionary provisions represent a massive step backward from the 1990 passage of the Americans with Disabilities Act (ADA) and its promises of full participation, equality of opportunity, economic self-sufficiency, and independent living. In recent statements, the DHS has dubiously claimed that the proposed changes to the public-charge rule are not “economically significant,” allowing it to bypass legal requirements to carefully assess the implications of the proposed changes for the disability community. Changes that would have such widespread effects merit a full regulatory impact analysis, especially since these changes are likely to negatively affect family unity. The ADA put in place key pieces that made the American dream accessible to the disability community, and the public-charge rule could undo that progress.

The rule is currently under review by the Office of Management and Budget’s Office of Information and Regulatory Affairs, after which the president is likely to make it official following a brief comment period. It is impossible to state the urgency of challenging this rule. For millions of immigrants—particularly those with disabilities—and their families, President Trump’s radical public-charge test could mean the difference between life and death.

Rebecca Cokley is the director of the Disability Justice Initiative at the Center for American Progress. Hannah Leibson is an intern for the Disability Justice Initiative at the Center.

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Rebecca Cokley

Director, Disability Justice Initiative

Hannah Leibson