NYHealth submitted the following comments in opposition to HHS’ proposed reinterpretation of the term “federal public benefit” under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) and the direct threat to community health centers (CHCs), funded through the federal Health Center Program.
August 13, 2025
The Honorable Robert F. Kennedy, Jr.
Secretary
U.S. Department of Health and Human Services
200 Independence Avenue SW
Washington, DC 20201
Subject: Public Comment on HHS Reinterpretation of “Federal Public Benefit” Under PRWORA
Docket ID: AHRQ-2025-0002
Submitted via: regulations.gov
Re: Notice: Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA); Interpretation of “Federal Public Benefit”
The New York Health Foundation (NYHealth) submits this comment in strong opposition to the Department of Health and Human Services (HHS) proposed reinterpretation of the term “federal public benefit” under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA).
NYHealth is a private foundation committed to improving the health of all New Yorkers and strengthening primary care and public health across New York State. As such, we are deeply concerned about the negative health consequences and the implementation issues that this notice would trigger. While the notice of policy change implicates a broad range of critical programs, this comment focuses on the direct threat to community health centers (CHCs), funded through the federal Health Center Program.
Background
HHS’s revised interpretation of PRWORA is a sharp departure from nearly 30 years of legal interpretation and precedent. Since 1998, HHS has excluded the Health Center Program and other safety-net programs from being considered a “federal public benefit” on the grounds that they serve the broader community and should be widely accessible. This longstanding interpretation recognized the role CHCs and other safety-net programs play in promoting population health by serving entire communities, regardless of individuals’ immigration status.
The proposed notice undoes this policy. Specifically, the notice adds federally funded CHCs to the list of programs that are considered a “federal public benefit.” They would be newly prohibited from providing care to individuals deemed “unqualified aliens” lacking “qualified” immigration status. This will include undocumented individuals, but also several categories of people lawfully in the United States, such as holders of H1B and J-1 visas, as well as some lawful permanent residents.
The proposed notice will affect the ability of millions of immigrants and their families to access critical health and other safety-net programs and will impose burdensome new requirements on state and local governments and service providers.
The notice conflicts with the Health Center Program’s mandate to provide accessible, high-quality care to all residents
The U.S. Department of Health Resources and Services Administration Health Center Program—which funds more than 1,400 CHCs across the country—was founded with a clear mandate: provide access to all residents of the area served by the center, regardless of their background, immigration status, or ability to pay. This new notice strikes at the heart of that mission. Healthy communities depend on unobstructed access to primary care.
CHCs are a cornerstone of the U.S. primary care health system. In New York alone, CHCs provide high-quality, cost-effective care to 2.4 million patients each year—many of whom would otherwise have no options for primary or preventive care. Restricting this ability would directly conflict with their mandate and jeopardize services essential to managing chronic conditions like diabetes and heart disease, reducing avoidable high-cost care like emergency room visits, and preventing the spread of communicable diseases.
The notice cannot be implemented in a practical or realistic manner
CHCs may now be required to assess immigration status as a condition of service delivery; something they have never done before. CHCs—already stretched thin—do not have the administrative capacity or verification systems in place. Diverting limited personnel and funding to implement a new verification process will compromise their ability to deliver timely, essential services.
Furthermore, CHCs have built a foundation of trust with their communities and patients, which is essential to the patient-provider relationship. Asking these providers to collect data from patients that has no bearing on their care will undermine and erode this trust.
The notice raises significant legal questions
In 1996, Title 8 of the Aliens and Nationality Act (8 U.S.C. § 1642(d)), mandated there to be no verification requirement for charitable organizations, which include CHCs, when providing federal public benefits.[1] The new notice’s implication that CHCs would now be required to screen patients for immigration status directly conflicts with this existing statute and with CHC’s statutory mandate to provide care to all residents of the area served by the center.[2]
The notice will harm public health with unintended consequences
The notice’s restriction on CHCs from providing care to everyone in their service areas will result in troubling consequences for access and utilization. It will deter people from seeking timely medical care—including patients managing chronic conditions, such as diabetes and asthma—increasing the likelihood that preventable conditions worsen and result in costlier care, including emergency room visits.
The chilling effect of the notice will reverberate beyond its intended population. Confusion and fear would spread across patient populations, including among mixed-status families and lawfully present immigrants, who may avoid or forego care altogether due to uncertainty about their eligibility and eroding trust in the system. Delays and disruptions in care will result in public health harm to entire communities over the short and long term. When access to prevention, diagnosis, and immunizations is restricted, outbreaks of communicable diseases such as influenza, COVID-19, and tuberculosis will increase.
The combined effect will add additional strain on health systems and budgets, including operational burdens on already stretched systems; higher administrative costs for local and state health care systems; and increased uncompensated care costs as patients delay and avoid care.
Recommendations
We respectfully urge HHS to:
- Rescind this reinterpretation and exempt CHCs and other essential primary and preventive care services and social safety-net services from restrictions. HHS should continue to rely on the longstanding 1998 Notice.
- Extend the public comment period to allow meaningful input from patients, providers, and public health experts. HHS makes this notice effective immediately and only provides 30 days for comments. For a revision of nearly 30 years of precedent, this lack of time for public input is deeply inadequate.
The notice directly contradicts the federal administration’s stated priorities to prevent chronic illness, lower health care costs, and strengthen primary care and public health infrastructure. This policy will undermine progress toward a more accessible, affordable, and accountable health care system. We urge the administration to withdraw the notice entirely.
We appreciate the opportunity to provide comments. HHS should uphold public health, community trust, and the wellbeing of children and families in implementing federal law. For any questions regarding this comment please contact Program Officer, Ali Foti at foti@nyhealthfoundation.org or 212-584-7679.
Respectfully,
David Sandman, Ph.D.
President and CEO
New York Health Foundation
[1] Verification of Eligibility for Federal Public Benefits, 8 U.S.C. § 1642 (1996). https://codes.findlaw.com/us/title-8-aliens-and-nationality/8-usc-sect-1642/
[2] Primary Health Care, 42 U.S.C. §§ 254b–254t (1978). https://uscode.house.gov/view.xhtml?path=/prelim@title42/chapter6A/subchapter2/partD&edition=prelim
