Proposed Immigration Rule Threatens to Further Challenge U.S. Direct Care Workforce
A proposed Department of Homeland Security (DHS) regulation is likely to bring significant challenges to immigrants, the direct care workforce, our nation’s care systems, and state and local economies.
To gain admission to the United States, immigrants are subjected to a public charge test, which assesses whether an individual seeking entry is likely to become dependent on the government for subsistence. In late 2025, PHI submitted formal comments to DHS regarding the Department’s Notice of Proposed Rulemaking (NPRM) on the Public Charge Ground of Inadmissibility. This proposed rule seeks to replace a 2022 public charge regulation with a punitive approach that treats the use of legally available safety-net programs—such as Medicaid and SNAP—as strong evidence against an immigrant’s admissibility and future status in the U.S.
PHI strongly urges DHS to withdraw this proposal, which will have devastating consequences for the nation’s direct care workforce and for the older adults and people with disabilities who rely on direct care workers for daily care and support.
A Devastating Impact on an Essential Workforce
Immigrants constitute at least 29 percent of the direct care workforce—with much higher proportions in some U.S. regions, where they are indispensable to maintaining access to care.
The current DHS proposal discards the clear, evidence-informed framework adopted in 2022 with an expansive, vague, and punitive approach that treats the use of legally available safety-net programs as strong evidence against an immigrant’s admissibility and future status. This will be particularly harmful to the direct care sector. Nearly half of direct care workers rely on some form of public assistance to meet their basic needs. By injecting immigration risk into any decision to use benefits for which they are lawfully eligible, this rule will force many immigrant direct care workers to forego necessary food, shelter, and health care.
Undermining the Long-Term Care System
Direct care jobs represent our nation’s largest occupation, and the one with the most anticipated growth in the years ahead. However, providers across the long-term services and supports (LTSS) sector already report chronic vacancies and reduced capacity.
The predictable result of the DHS’s proposed rule is a chilling effect that will worsen economic insecurity for workers. Specifically, workers and their families will disenroll from or forego benefits, including health coverage for themselves and their children, food assistance, and housing support. This will lead to higher stress, greater instability in housing and transportation, and increased difficulty in meeting basic needs, which, in turn, will translate into increased absenteeism, turnover, and burnout. Any policy that makes it riskier for immigrants to enter or remain in the direct care workforce will significantly undermine the stability and capacity of our LTSS system and drag down our economy.
Compounding the Harm
The negative effects of this NPRM would amplify the harm caused by recent Medicaid, labor law, and other immigration policy changes. These changes fall disproportionately on direct care workers. In this context, the proposed rule would serve as an untenable blow to the direct care workforce.
“The DHS’s proposed rule ignores the reality that public charge-induced disenrollment in public benefits will shift costs, not eliminate them,” said PHI’s CEO, Jodi M. Sturgeon. “This rule will place the burden of these costs onto our nation’s healthcare and LTSS systems, provider employers, and state and local governments, while bringing greater instability and harm to the very workers who provide an essential contribution to our nation’s care.”
An effective economic analysis must grapple with the real-world conditions of the direct care labor market. The proposed rule fails to do that, and should be rescinded in the interest of fairness, efficiency, and the day-to-day sustainability of our nation’s care systems.
PHI urges DHS to prioritize policies that strengthen, rather than undermine, this critical workforce. Read our full comments to the DHS here.
