Imagine this scenario: It is 2023, and a woman we’ll call Jessica and her husband, Pedro, make the difficult decision to leave Venezuela for the United States after they become targets of political repression. Soon after their arrival, they apply for asylum.

While their case winds through the immigration system, Jessica and Pedro are thrilled to learn that Jessica is pregnant. But they also worry about the cost of prenatal care. Their jobs picking fruit on a farm don’t provide health insurance, and they cannot afford to pay for the care themselves.

They learn about a government program that provides free prenatal care, but their friends and co-workers tell them to be careful about “taking” anything from the government, lest it affect their immigration status.

Ultimately, they go without care. Jessica feels fine until the last trimester of her pregnancy, when she goes into labor early and has an emergency hysterectomy. They later find that pesticide exposure on the job may have caused the birth complications – something she could have avoided had she been warned about it in a prenatal care appointment.

Several months later, they learn that enrolling in the program providing prenatal care would not have affected their asylum application at all.

New immigration rule

This kind of ordeal is very common.

About 1 in 7 immigrants across the country don’t apply for government benefits even if they are eligible for them. Examples of these programs may include the Supplemental Nutrition Assistance Program, which helps low-income people buy groceries, and Medicaid, a federal health insurance program for low-income people.

Many immigrants fear that enrolling in these programs, even if they qualify for them, will make it harder for them to stay here legally.

Their fears are often unfounded because historically the government has penalized immigrants for using only certain benefits.

But that could change soon because the Department of Homeland Security finalized a new rule on July 16, 2026. The rule reinterprets a provision in the Immigration Act of 1882 that allows immigration officers to deny the immigration applications of anyone they believe might need government assistance.

The Department of Homeland Security also reinterpreted the public charge law during the first Trump administration.

The second Trump administration’s change eliminates any guardrails on immigration officers’ ability to consider government benefits use by green card applicants and their relatives when determining whether someone could become what’s called a “public charge.”

Once this policy change takes effect on Sept. 18, immigration officers will be free to consider an immigrant’s use of any means-tested government benefit when assessing applications for lawful permanent residence, better known as “green cards.”

If any of an applicant’s relatives have gotten benefits, immigration officers may apply that to their assessment of the applicant’s own financial standing – something that had not been allowed before.

What’s slated to change

We study immigration policies. One of us (Makhlouf) is a law professor who has counseled hundreds of immigrants who in real life, like Jessica and Pedro, want to know about their eligibility for government benefits. The other (Kreisberg) is a sociologist who researches how immigration policies can restrict access to social services, education and jobs.

Although many people, such as refugees, will be exempt from this new rule, we expect that it will nonetheless lead more immigrants to believe that they have to choose between getting healthcare and having their immigration application approved – potentially harming their health.

The policy change will likely be contested in court as an overreach of authority by DHS; as what’s called an “arbitrary and capricious” policy under the Administrative Procedure Act; and as a violation of the equal protection clause of the 14th Amendment – all of which were the basis of legal challenges to the 2019 public charge rule.

Clinton administration defines public charge

Despite changing interpretations, the public charge law has, in effect, always served one purpose: to prevent immigrants who could become dependent on the government from becoming permanent residents. However, the government largely enforced it inconsistently after 1882. This was, in part, because the government never clearly defined public charge until the Clinton administration.

In 1996, when Congress restricted government benefits and strengthened immigration laws, the public charge provision was amended to state that immigration officers should consider applicants’ age, health, family status, income and assets, educational background and skills when determining whether they are or might become public charges.

In addition, immigration officers also needed to consider whether the applicant had a sponsor who signed an affidavit of support, promising to financially support them if they were to prove unable to support themselves.

The changes created mass confusion. In response, the Clinton administration published guidance in 1999 to clarify what a public charge is, defining it as an immigrant who is “primarily dependent on the Government for subsistence.”

Under the new guidance, the use of only three government programs: Temporary Assistance for Needy Families, Supplemental Security Income and Medicaid, but only for long-term care.

One goal of the guidance was to improve public health by encouraging eligible immigrants to use government benefits that provide healthcare, nutritious food and affordable housing.

First Trump administration

Two decades later, the first Trump administration changed the public charge policy. In 2019, it directed immigration officers to consider a broader range of benefits in the analysis, including enrollment in Medicaid for any reason, the Supplemental Nutrition Assistance Program and housing assistance.

That policy was challenged in court, leading to only intermittent implementation.

In 2021, the Biden administration stopped defending Trump’s public charge policy in court and also rescinded it. In 2022, it issued a new regulation that codified the 1999 administrative guidance.

Those changes essentially restored the more limited public charge policy that had been in place since 1999.

Biden restored prior approach

Green card denials based on public charge grounds have historically been low. They stood below 1% during the first Trump administration, according to the Migration Policy Institute, a nonpartisan think tank.

And immigration officers have not historically considered whether an applicant’s relatives have received government benefits, including when an applicant belongs to a “mixed-status family” that includes both U.S. citizens and noncitizen immigrants. An estimated 6 million children who are U.S. citizens live in such households.

The 2022 regulation specifically stated that the authorities would not consider whether an immigration applicant’s relatives used government benefits. Trump’s new policy, however, changes that.

For example, an immigration officer could see a U.S. citizen child’s enrollment in Medicaid as an indication of their parent’s financial insecurity and deny the parent’s green card application on that basis.

Given that the first Trump administration’s expansion of public charge policy led many eligible immigrants to avoid government benefits, it is likely that this policy change will do the same – jeopardizing the health of many immigrants and their relatives.

What’s at stake now

We will be watching green card denial rates to see whether this policy change makes it harder to become a permanent resident. It will come as no surprise if the changes deter immigrants and their close relatives, including children who are U.S. citizens, from using benefits for which they’re eligible.

This policy change is likely to affect many immigrants who are already uncertain about the trade-offs between getting help from government benefits and maximizing their chances of staying in the United States.

But the people affected by this policy change will include everyone in a family that includes an immigrant, regardless of their legal status.

For this reason, we recommend that immigrants with pending green card applications should consult with an attorney who is knowledgeable about public charge before making decisions about enrolling in or disenrolling from government benefits. This will give them the information they need to make the best choice for their family’s health and future.

Medha D. Makhlouf is the founding director of the Medical-Legal Partnership Clinic at Penn State Dickinson Law, where she supervises students providing free legal services to members of the community, including in matters relating to public benefits and immigration law.

Nicole Kreisberg receives funding from the National Institutes of Health.

By Medha D. Makhlouf, Professor of Law, Penn State, Nicole Kreisberg, Assistant Professor of Public Policy, Penn State. This article is republished from The Conversation under a Creative Commons license. Read the original article.