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Public Charge and Health Benefits
How the public charge rule works, what benefits are and are not counted in the 2022 USCIS rule, and how to evaluate the risk when using Medicaid, CHIP, or other programs as an immigrant.
Immigrants considering whether to use Medicaid, CHIP, ACA Marketplace coverage, SNAP, or other public benefits and concerned about how doing so might affect a future immigration application.
For many immigrants, the fear of public charge consequences has led to avoiding healthcare and other public benefits — sometimes at significant risk to health. Understanding what the current public charge rule actually covers, and what it does not, is essential to making informed decisions. The 2022 rule issued by US Citizenship and Immigration Services (USCIS) is substantially narrower than many people assume. For context on which immigration categories can access Medicaid, see the Care for Visitors and New Immigrants guide.
What “public charge” means in immigration law
A “public charge” determination is an assessment by USCIS or a consular officer that a person is or is likely to become primarily dependent on the government for subsistence. This determination is used as one factor in decisions on:
- Applications for a green card (lawful permanent residence) inside the US (adjustment of status)
- Applications for an immigrant visa at a US consulate abroad
A public charge finding can result in denial of a green card or visa. It is not a criminal matter, and it does not mean you will be deported if you are already in the US.
Importantly, public charge inadmissibility does not apply to naturalization (citizenship) applications.
The 2022 USCIS rule: what is and is not counted
The 2022 final rule — which replaced a stricter 2019 rule — uses a narrow definition of which benefits count in a public charge determination.
Benefits that ARE counted:
- Supplemental Security Income (SSI)
- Temporary Assistance for Needy Families (TANF) cash assistance
- Medicaid — but only when used for long-term institutional care (such as a nursing home, long-term care facility, or intermediate care facility)
Benefits that are NOT counted:
| Benefit | Counted? |
|---|---|
| Regular Medicaid (non-institutional care) | No |
| Emergency Medicaid | No |
| CHIP (Children’s Health Insurance Program) | No |
| ACA Marketplace plans (with or without subsidies) | No |
| SNAP (food stamps) | No |
| WIC (Women, Infants, Children nutrition program) | No |
| Federal housing assistance | No |
| School lunch and nutrition programs | No |
| Head Start | No |
| Medicaid-funded home and community-based services | No |
| Medicaid for pregnant women | No |
| Medicaid for children under 21 | No |
This means that the vast majority of everyday Medicaid benefits — including doctor visits, hospital care, emergency care, prenatal care, and children’s coverage — are not counted.
Who the public charge test applies to
The public charge inadmissibility ground applies to people seeking to:
- Obtain an immigrant visa (green card) through a US consulate abroad
- Adjust their immigration status to lawful permanent resident inside the US
Documents and terms you’ll see
Documents and terms you’ll see
- Form I-485 — Application to Register Permanent Residence or Adjust Status; this is the form filed when applying for a green card inside the US. The public charge test is part of the review process for this form. See immigration status in the glossary.
- Form I-944 — Declaration of Self-Sufficiency, previously required under the 2019 rule; this form is no longer required under the 2022 rule. See medicaid for the program’s current status under public charge.
- Public charge bond — a bond that an immigration officer can impose as a condition of admission if a person is found likely to become a public charge at a port of entry; not used in the adjustment of status process. See immigration status.
- Affidavit of Support (Form I-864) — a legally binding promise by a US citizen or LPR sponsor to support an immigrant financially; required for many family-based and some employment-based green card applications. See immigration status.
The public charge test generally does not apply to:
- Refugees and asylees
- Violence Against Women Act (VAWA) petitioners
- Special Immigrant Juveniles (SIJ)
- T visa and U visa holders
- Applicants for asylum
- Applicants for naturalization (citizenship)
- Certain other protected categories
If you fall into one of these categories, using public benefits does not affect your immigration application through the public charge ground.
The totality of circumstances test
USCIS does not automatically deny a green card application because someone used a counted benefit. The law requires USCIS to consider the “totality of circumstances” — a broad assessment of an individual’s self-sufficiency that includes:
- Income, assets, and resources — earnings, savings, real property, and financial resources
- Family size and composition — larger households may have higher income thresholds
- Age, health, and education — factors affecting future earning capacity
- Skills and employment history — work experience and prospects
- Affidavit of Support — a binding sponsor’s promise of financial support significantly strengthens a public charge case
- Benefit history — limited to the counted benefits listed above
An individual who uses Medicaid for routine care and has stable income, a sponsoring family member, and employment skills is very unlikely to fail the public charge test.
Why misinformation about public charge is harmful
Fear of public charge consequences has caused many immigrants to disenroll from Medicaid, stop taking children to the doctor, and avoid emergency care — all based on misunderstanding of the rule’s scope. Research consistently shows that fear of public charge has a “chilling effect” on benefit use that extends beyond the technically affected population, often including US citizen children.
Key points to internalize:
- Medicaid for non-long-term-care services is not counted.
- CHIP is not counted.
- Emergency Medicaid is not counted.
- Children’s benefits (citizen or otherwise) are separate from parents’ immigration cases.
- Naturalization applicants are not subject to public charge at all.
Getting accurate guidance for your specific case
The public charge rules are legal and policy-based, and individual circumstances vary. For an immigration application where public charge is relevant, consult:
- An immigration attorney licensed to practice in your state
- A Department of Justice accredited representative through a recognized nonprofit organization
- A legal aid organization with immigration law expertise — many provide free or low-cost services to low-income immigrants
Do not make decisions about disenrolling from medical coverage based on informal community information about public charge — the misinformation is widespread and the health consequences of forgoing care can be serious.
Key terms
| Term | Plain meaning | Glossary |
|---|---|---|
| Public charge | A legal standard used in certain immigration decisions — a determination that an individual is primarily dependent on government assistance for subsistence | → |
| Medicaid | Joint federal-state health insurance for low-income individuals; mostly not counted under the 2022 public charge rule | → |
| USCIS | US Citizenship and Immigration Services — the federal agency that adjudicates immigration benefits and applies the public charge test | → |
| Long-term institutional care | Medicaid-funded care in a nursing home, long-term care facility, or similar institution — the one component of Medicaid that is counted under the public charge rule | → |
| CHIP | Children's Health Insurance Program — not counted under the 2022 public charge rule | → |
Common questions
- Will using Medicaid affect my green card application?
- For most people and most Medicaid programs, no. The 2022 USCIS public charge rule specifies that Medicaid (with the exception of long-term institutional care in a nursing home or similar facility) is not counted as a negative factor in a public charge determination. CHIP, emergency Medicaid, and ACA Marketplace plans are also not counted.
- What benefits are counted under the public charge rule?
- The 2022 rule counts only two categories: certain cash assistance programs (Supplemental Security Income [SSI] and Temporary Assistance for Needy Families [TANF]) and Medicaid-funded long-term institutional care (such as long-term nursing home care). Most other commonly used benefits — regular Medicaid, SNAP, housing assistance, CHIP — are not counted.
- Who does the public charge test apply to?
- The public charge inadmissibility test applies to individuals applying for a green card (lawful permanent residence) and certain visa applicants seeking admission. It generally does not apply to refugees, asylees, VAWA petitioners, Special Immigrant Juveniles, U and T visa holders, individuals adjusting from some other protected statuses, or applicants for naturalization (citizenship).
- Can I use SNAP (food stamps) without it affecting my immigration case?
- Under the 2022 rule, SNAP (food stamps) is not counted in the public charge determination. Neither is housing assistance, school lunch programs, Medicaid (except long-term institutional care), CHIP, or most other public benefits. The rule is substantially narrower than many immigrants fear due to widely spread misinformation.
- Should I stop using Medicaid to be safe for immigration purposes?
- For most Medicaid programs, there is no reason to disenroll based on public charge concerns under the 2022 rule. Forgoing necessary medical care creates more serious risks to health and family stability than the public charge concern justifies in most cases. If you have a specific immigration case with unusual circumstances, consult an immigration attorney or accredited representative.
- Does using Medicaid affect my ability to become a US citizen?
- No. Naturalization (citizenship) applications are not subject to the public charge test at all. Medicaid use does not affect naturalization eligibility.
- What if I received cash assistance in the past?
- USCIS looks at the totality of circumstances in a public charge determination — it considers income, assets, health, family size, education, skills, and benefit history. Past use of non-counted benefits is not relevant. Past use of counted benefits (SSI, TANF, or long-term Medicaid institutional care) is one factor but not automatically disqualifying. USCIS will look at the individual's overall ability to support themselves.
- Where can I get reliable help understanding how this affects my specific case?
- Consult an immigration attorney, an accredited representative through a recognized organization, or a Department of Justice accredited legal services provider. Do not rely on informal advice from community members or non-legal sources for individual immigration decisions.
Sources
Last reviewed: September 2026