刚才有人在微信上问我：「Derek 你好！请问你知不知道给美宝申请 Medicaid/CHIP 会不会影响以后申请绿卡？谢谢！」
Medicaid 属于 Public Assistance
以 AOS 为例，I-485 第13页 “Public Assistance” 包含两个问题：
- 你是否接受过 public assistance？
- 你将来是否可能要接受 public assistance？
若申请过 Medicaid / CHIP，第1个问题应回答 “Yes”（第2个问题视个人情况而定）。然而，接受过 public assistance 并不会导致绿卡申请被拒。
Medicaid 官网表示，申请 Medicaid/CHIP “will not affect someone's chances of becoming an LPR or US citizen; the one exception is for indviduals receiving long-term care in an institution at government expense”，它还同时表示，申请 Medicaid/CHIP 不属于“Public Charge”，我们接下来会讨论。
Medicaid 通常不属于 Public Charge
“Public charge” 指你将来可能成为美国纳税人／政府的负担；USCIS 解释如下：
Q. What is a public charge and when does it apply?
A. For purposes of determining inadmissibility, “public charge” means an individual who is likely to become primarily dependent on the government for subsistence, as demonstrated by either the receipt of public cash assistance for income maintenance or institutionalization for long-term care at government expense.
A number of factors must be considered when making a determination that a person is likely to become a public charge.
Under Section 212(a)(4) of the Immigration and Nationality Act (INA), an individual seeking admission to the United States or seeking to adjust status to that of an individual lawfully admitted for permanent residence (green card) is inadmissible if the individual, "at the time of application for admission or adjustment of status, is likely at any time to become a public charge." Public charge does not apply in naturalization proceedings. If an individual is inadmissible, admission to the United States or adjustment of status is not granted.
Public charge 属于 “inadmissible” 的情形，不能申请绿卡（境外或境内都不行）。若接受过政府现金资助、或花纳税人／政府的钱 long-term care，可能被视为 public charge。
Food stamps、public housing、emergency treatment、常规的 Medicare、Medicaid、ER 等并不属于现金资助，参见 8 CFR 210.1, Title 8 - Aliens and Nationality：“It [public cash assistance] does not include assistance in kind, such as food stamps, public housing, or other non-cash benefits, nor does it include work-related compensation or certain types of medical assistance (Medicare, Medicaid, emergency treatment, services to pregnant women or children under 18 years of age, or treatment in the interest of public health.”
USCIS 的 “Public Charge Fact Sheet” 对此也有清楚说明：
Benefits Subject to Public Charge Consideration
[...] public assistance, including Medicaid, that is used to support aliens who reside in an institution for long-term care – such as a nursing home or mental health institution – may also be considered as an adverse factor in the totality of the circumstances for purposes of public charge determinations. Short-term institutionalization for rehabilitation is not subject to public charge consideration.
Benefits Not Subject to Public Charge Consideration
[...] Medicaid and other health insurance and health services (including public assistance for immunizations and for testing and treatment of symptoms of communicable diseases, use of health clinics, short-term rehabilitation services, prenatal care and emergency medical services) other than support for long-term institutional care.
Medicaid/Medicare 虽然是 public assistance，但并不属于 public charge，理论上来说并不会影响绿卡申请。然而，若使用 Medicaid/Medicare 来负担长期看护（如住 nursing home 或精神病院），则可能被视为 public charge、绿卡申请可能因此被拒绝。