On July 20, 2026, the U.S. Department of Homeland Security (DHS) issued final regulations lifting current rules used to determine whether an immigrant is likely to become a “public charge”. The final rule, which takes effect on September 18, eliminates a century of established policy, carefully calibrated to address policy issues and undefined terms in the law, without offering a reasoned policy alternative. The change impacts lawfully present immigrants applying for “green cards,” granting DHS officers almost unlimited discretion to “use their judgment” in determining who might become a public charge—creating more chaos and further limiting pathways to legal immigration.
The rule also jeopardizes the health and well-being of many U.S. citizen children who are part of immigrant families by scaring their families away from health coverage or other benefits they are eligible to receive – if they have not already been scared away by the Trump Administration’s extreme deportation agenda and sharing Medicaid data with U.S. Immigration and Customs Enforcement (ICE).
Late last year, CCF submitted official comments to the proposed rule outlining how it would cause uncertainty, fear and significant harm to children and families, primarily citizen children. Our comments warned that the rule would cause Medicaid/CHIP enrollment declines as a consequence of the “chilling effect,” which, in turn, would increase the number of children without health coverage, jeopardizing their health and well-being into adulthood.
Thousands of public comments were submitted urging DHS to rescind the proposed rule. They were explicitly ignored.
The preamble to the final rule states:
DHS received 8,846 comments on the proposed rule, the majority of which opposed the rule. Following careful consideration of public comments received, DHS is issuing this final rule as proposed.
This policy decision is likely to exacerbate the troubling trend for child health coverage. The child uninsured rate hit the highest level in nearly a decade in 2024, and there are troubling signs that it is getting worse. Our Medicaid/CHIP enrollment tracker shows that, as of today, there are 2.13 million fewer children enrolled in Medicaid/CHIP since January 2025. We don’t know how to account for such a sharp drop in enrollment, but the “chilling effect” is undoubtedly one of the causes.
The public charge rule is just one of many actions the Trump Administration has taken to create an extraordinarily hostile climate for “mixed-status” families. This is a big deal because one in four children in the U.S. lives in a “mixed-status” household, and the vast majority of these children are citizens.
Parents avoid enrolling their children in Medicaid or CHIP due to fear of interacting with the government, and this public charge rule change exacerbates that fear. Given the unprecedented actions taken by the Trump Administration – like allowing CMS to share the personal data collected through the Medicaid program with ICE – the chilling effect is undoubtedly stronger than ever. And since we submitted our comments, we all have seen the horrifying behavior of DHS/ICE agents on full display. It’s disturbing that this is the same agency that will now have largely unfettered discretion to decide who might become a “public charge,” which is broadly defined as use of any public benefit.
Worse, a DHS post on social media earlier this year seems to celebrate the loss of health coverage for children.
Families will be forced to make painful decisions as they try to predict how the rules will be applied or may change in the future, including forgoing needed health coverage and other benefits for their U.S. citizen children out of confusion, fear, and an abundance of caution. The last thing families need right now is to put largely unfettered discretion into the hands of DHS officers – which is what this rule does.