The Trump administration on Monday proposed giving immigration officers the authority to deny permanent residency to lawfully present immigrants who use Medicaid or other food and housing assistance programs. Officials argue that “government benefits should not incentivize immigration” and that immigrants should be “self-reliant.”

This marks a revision of the so-called public charge rule from Trump’s first term, which the Biden administration halted in 2021 and officially rescinded in 2022.

The new proposal, issued by the Department of Homeland Security’s Citizenship and Immigration Services (USCIS), would repeal the Biden-era rule. Instead of reinstating the exact public charge rule from the first Trump term, the agency said it will release guidance at an unspecified future date, effectively giving USCIS officers more discretion to determine who might become a “public charge.”

While the U.S. has long restricted immigrants considered a burden on taxpayers, the Trump administration was the first to classify public health insurance as a form of welfare.

The Department of Homeland Security will accept public comments on the proposal over the next 30 days and review the feedback before issuing a final decision.

Health policy experts and immigrant rights advocates warn that the change, if implemented, could harm both individuals and the broader population. They say it may strain hospitals if immigrants avoid preventive care for fear of jeopardizing their immigration status, leading to more emergency room visits. The policy could also make it harder to control infectious disease outbreaks and manage chronic health conditions.

“Immigrants don’t live in isolation. Many of them live in mixed-status families,” said Adriana Cadena, executive director of Protecting Immigrant Families. “Out of fear of jeopardizing their immigration status, they’re avoiding public benefits. We are already seeing a drop in patients attending appointments.”

The Trump administration estimated that the policy could save the government $8.97 billion annually, as people may drop out of Medicaid and other benefit programs, including “aliens as well as U.S. citizens who are members of mixed-status households.”

However, the announcement acknowledges that the policy could reduce revenues for healthcare providers, such as hospitals and nonprofit organizations participating in Medicaid, and negatively affect companies that manufacture medical supplies or pharmaceuticals.

A 2021 study found that the original public charge rule caused many low-income immigrants, including over a quarter of legal permanent residents, to avoid using health services. Another study by George Washington University that year found the rule worsened racial disparities in illness and death during the COVID-19 pandemic by discouraging immigrants from seeking testing and treatment.

The new proposal follows another recent Trump administration initiative to deny visas to immigrants with chronic health conditions, including cancer and obesity, based on the assumption that these individuals could later rely on taxpayer-funded health programs.