Public Charge Rule Will Undermine the Direct Care Workforce
Last month, the Department of Homeland Security (DHS) finalized a “public charge” rule that puts immigrant direct care workers—and the older adults and people with disabilities who depend on them—at risk. The rule allows immigration officials to count immigrants’ lawful use of safety-net programs, like Medicaid and SNAP, against them when they apply to enter the U.S., obtain a green card, or renew their work authorization. PHI condemns this rule, which we urged DHS to withdraw in formal comments last December.
Immigrants constitute at least 28 percent of the direct care workforce—the nearly 5.4 million people who provide daily care and support to older adults and people with disabilities. Because median annual earnings in direct care are just under $26,000, nearly half of these essential workers rely on public benefits such as Medicaid and SNAP to meet their basic needs. By turning the lawful use of benefits into an immigration risk,, this rule will push immigrant workers out of direct care, deter others from entering the field, and force families to forgo food, health coverage, and housing support.
These harms will reverberate across the entire long-term care system. Providers already report chronic vacancies, high turnover, and reduced capacity. Coming on the heels of other punitive immigration policy changes, nearly $1 trillion in planned Medicaid cuts, and rollbacks of direct care labor rights, this rule further destabilizes the workforce that older adults, people with disabilities, and family caregivers depend on every day.
Congress designed programs like Medicaid and SNAP to support low-wage workers, but this rule undercuts that goal by targeting immigrant direct care workers who provide essential care while working in jobs that have long been undervalued and underpaid. PHI will continue working alongside our partners across the aging, disability, and immigration communities to oppose this rule’s implementation and to advance policies (like the Careworker Visa Act) that strengthen the direct care workforce.
