A new federal rule takes effect on September 18, 2026. It changes what an immigration officer is allowed to hold against someone applying for a green card.

Under the rule, the officer can count the family's use of Medicaid, the Children's Health Insurance Program, and food stamps.

Federal law has long said that someone likely to become a "public charge" — dependent on government support — can be refused entry or refused lawful permanent residency. The fight has always been over what counts. In 2022 the Biden administration wrote regulations barring officers from weighing non-cash benefits: health coverage, housing help, food assistance. The new Homeland Security rule, published on July 20 and effective September 18, throws those out and puts those benefits back on the table.

Who it reaches

The people subject to public charge review are not an abstract category. They are, in large part, the immediate families of American citizens.

The rule applies to immigrants seeking to adjust their status to lawful permanent residency — including the spouses, siblings, parents and children of U.S. citizens, widows and widowers, graduates of foreign medical schools, members of the U.S. armed forces, and certain workers with advanced degrees.

Some groups are exempt. USCIS lists asylees and refugees, Afghan and Iraqi interpreters and others who worked for the U.S. government, people seeking temporary protected status, victims of human trafficking, and people self-petitioning under the Violence Against Women Act, among others.

The part that does the damage is the part nobody has to enforce

Here is how this rule actually works, and it is worth being precise about it.

Very few people will be denied a green card because their child is on CHIP. What will happen instead is that families will take their children off.

In a mixed-status household — one parent without lawful status, children who are U.S. citizens — the safe move is to drop the benefit rather than risk the application. The child is entitled to the coverage. The parent cannot afford to find out whether claiming it costs them their status.

That is not a prediction from an advocacy group. It is what happened last time. Studies of the first Trump administration's public charge rules found families became less likely to apply for food assistance or to seek health care at all.

And it is what the government itself expects. The Department of Homeland Security says the people who will drop off "include aliens as well as U.S. citizens who are members of mixed-status households," and it has put a number on the result. When it proposed the rule in November 2025 that number was $8.97 billion a year. In the final rule it went up: federal and state spending could fall by $13.05 billion a year "due to disenrollment or forgone enrollment in public benefits programs by members of households that include aliens who may be receiving public benefits," affecting an estimated 1,265,993 people. DHS says the increase came partly from expanding the analysis "to include child enrollment within the Medicaid estimates."

Read that sentence again. The savings are not from catching anyone. The savings are from people who are eligible deciding not to enroll.

The health research group KFF estimated this summer that between 1.4 million and 4.1 million people enrolled in Medicaid or CHIP who live in a household with a noncitizen could drop coverage because of the public charge rule or related fear — "including about 560,000 to about 1.7 million citizen children."

DHS listed who else loses, in its own filing

The same agency analysis went on to describe what happens downstream when $13 billion leaves those programs. It named the businesses that absorb it:

"For example, the rule might result in reduced revenues for healthcare providers, such as hospitals and nonprofits, participating in Medicaid, companies that manufacture medical supplies or pharmaceuticals, grocery retailers participating in SNAP, agricultural producers who grow foods that are eligible for purchase using SNAP benefits, or landlords participating in federally funded housing programs."

Hospitals. Grocery stores. Farmers. Landlords. A rural hospital does not get to distinguish between an uninsured citizen child and an uninsured noncitizen child; it treats both and eats both bills.

What it does to the children

Dr. Sural Shah chairs the American Academy of Pediatrics' Council on Immigrant Child and Family Health. At a news conference on September 10, she described what the pediatric consequence of a family dropping coverage looks like.

"When a child is hungry, it can affect every aspect of their development and lead to chronic conditions like heart disease and diabetes, even into adulthood."

"Without accessing WIC, babies and young children will miss out on critical nutrition supports that are important for brain development in the first 1,000 days of life. Medicaid and CHIP are lifeline programs."

Clinicians also report that immigration activity has already been producing delayed care, with illnesses advancing in children whose families are afraid to come in. They say people with disabilities and complex needs will be among those hit hardest. The Autism Self Advocacy Network says immigrants with disabilities will be disproportionately affected, because they tend to use public benefits more than other immigrants do.

The stated purpose and the measured effect point opposite ways

A month after his inauguration, President Trump signed an executive order framing the policy this way: his administration would "uphold the rule of law, defend against the waste of hard-earned taxpayer resources, and protect benefits for American citizens in need, including individuals with disabilities and veterans."

Set that against the government's own figures. The $13.05 billion in savings comes, by DHS's own description, from households that include U.S. citizens forgoing benefits. Between 1.4 and 4.1 million Medicaid and CHIP enrollees in such households may disenroll. Disability advocates say immigrants with disabilities are disproportionately affected. Members of the U.S. armed forces are on the list of people subject to public charge review.

An order that promises to protect benefits for American citizens in need is scheduled to produce its savings by removing American citizens from benefits.

The rhetoric has been running ahead of the facts for a while

The political version of this argument has been that immigrants in the country illegally are drawing federal benefits. They are, for the most part, already barred from them.

Ohio Senator Jon Husted told Fox News this year that his opponent had backed "Social Security payments for illegals." PolitiFact rated the claim false: none of the three votes his campaign pointed to would have given a single federal benefit to anyone in the country illegally.

The rule taking effect on September 18 does not go after a benefit that immigrants without status are collecting. It goes after the benefits their citizen children are entitled to, by making the parents afraid to claim them.

What the record shows

A Department of Homeland Security final rule effective September 18, 2026 rescinds the 2022 public charge regulations and allows immigration officers to weigh enrollment in Medicaid, CHIP and SNAP when deciding applications for lawful permanent residency, including applications from the spouses, parents and children of U.S. citizens and from members of the U.S. armed forces. The Department of Homeland Security's own analysis projects $13.05 billion in annual federal and state savings from "disenrollment or forgone enrollment" by households that include noncitizens, and lists reduced revenue for hospitals, pharmaceutical manufacturers, grocery retailers, farmers and landlords as downstream effects. KFF estimates 1.4 million to 4.1 million Medicaid and CHIP enrollees living with a noncitizen could drop coverage, including about 560,000 to 1.7 million citizen children. The executive order behind the policy says its purpose is to "protect benefits for American citizens in need, including individuals with disabilities and veterans."

Source

Nada Hassanein, Mixed-status immigrant households expected to lose benefits under new public charge rule, Stateline, via the Pennsylvania Capital-Star, September 11, 2026. Photo by John Moore / Getty Images.