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By Caren Howard, MHA Advocacy Manager

“Self-sufficiency” has always been a basic principle of U.S. immigration law. To be admitted to the United States and to qualify for eventual citizenship, an individual must show that he or she has a reasonable prospect of earning a living, or that someone – such as a relative – can provide his or her support. If an individual can’t show this, and is likely to become a “public charge,” he or she generally is not admitted.

After decades of operating under this policy, the Administration recently published a proposal. It will add an additional layer of bureaucracy into the decision about whether the U.S. will decide to allow people from other countries to enter or stay in the U.S.

Here’s how the new rule would work. Even if a parent, for example, is employed, the government would assign negative points to an applicant who either receives or has previously applied for public health benefits, like Medicaid.

This means that a person will be less likely to be approved to live or stay in the U.S. if the applicant has applied for or is currently receiving health care coverage for themselves or their children through Medicaid.

If enacted, the change will be especially detrimental to low income parents and children with a mental health condition. Medicaid is the largest payer of behavioral health care and children’s health care in the U.S. It pays for nearly a third of all behavioral health services and covers nearly half of all births.

The U.S. is experiencing a mental health crisis in youth ages 12-17, with more reporting depressive symptoms, self-harm, and suicidality. Research shows that mental health conditions affect low income families at nearly double the rates of higher income families.

At Mental Health America, we want these families to be aware that services exist, and we want families to access them in any way they can, including through the Medicaid program. This is because early treatment leads to recovery, and that’s a good thing.

Penalizing immigrant families for accessing mental health and substance use treatment services for which they otherwise qualify would send exactly the opposite message. It encourages families to delay care and treatment and instead wait until there’s a crisis to get care— in a hospital or jail – when recovery is that much harder and so much more expensive.

Instead of implementing an immigration policy that drives up costs and makes residents sicker, the Administration should be ensuring families are equipped to get prevention and early intervention care through services for which they qualify, Before Stage 4.

There’s an opportunity to make your voice heard on this important issue. To weigh in on the importance of children and families having access to health coverage, please submit a comment on the Inadmissibility on Public Charge Grounds rule before December 10th by visiting