Title IV of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) restricts the eligibility of non-U.S. nationals (aliens) for many federal benefit programs. Under PRWORA’s baseline rule for federal benefits, only “qualified aliens” are eligible for benefits that fall within the statute’s definition of “federal public benefit.” In 1998, HHS published a Federal Register Notice (FRN) interpreting the statutory definition of “federal public benefit” in a way that expanded the number of programs exempted from the ban. That FRN listed HHS programs that were subject to the ban, and the Health Center program was not listed.
On July 10, 2025, the Department of Health and Human Services (HHS) formally rescinded the 1998 interpretation and presented a new interpretation that adds over a dozen new programs to the list of those that must comply with the ban, including the Health Center program. The new interpretation goes into effect immediately upon publication in the Federal Register, simultaneous with the start of a 30-day comment period. The FRN has not yet been officially published, however the text of the notice has been released, and in order to be proactive, this notice is to inform you of what we know and what may be coming
What This Means for FQHCs
As of publication of the FRN, FQHCs are expected to halt provision of services to all nonqualified aliens. The text of the notice states that verification requirements are a “practical effectuation” of the ban and the press release accompanying the notice indicates that HHS will issue further guidance to affected programs to ensure full implementation. It is possible that not for profit FQHCs may be excepted from the verification requirements, however, until further guidance is provided, FQHCs should begin creating policies that the meet the verification requirements of other federal public benefits.
Under the Interim Guidance on Verification of Citizenship published in 1997, federal public benefits should have in place procedures that include (1) asking for a declaration of status of the individual seeking the benefit and (2) verifying that status. Verifying the status should include asking for a document or declaration made under penalty of perjury or utilizing a program created for such purpose, which we suspect HHS will provide greater access to following implementation. It is important to note that the Emergency Medical Treatment and Labor Act (EMTALA) will still provide a basis for emergent care of any individual, regardless of immigration status and that Emergency Medicaid is an exempted benefits program.
The list of “Qualified aliens” who are not subject to the ban is included below:
- Lawful Permanent Residents (LPRs/green card holders)
- Refugees
- Asylees
- Cuban/ Haitian Entrants
- Certain Battered Immigrants
- Parolees (for >1 year)
- Special Immigrant Juveniles (SJIs)
- Afghan/ Iraqi Special Immigrants
- Victims of trafficking (T visa holders)
Anyone not in one of these categories, such as undocumented immigrants, those with pending applications, or individuals with Temporary Protected Status (TPS), will be ineligible for most services at FQHCs.
What to Do
Here's what you need to do now:
- Understand the change: FQHCs may soon be required to verify immigration status and limit services accordingly. Know who qualifies and who does not.
- Begin compliance planning: Develop protocols for status declarations and document collection in anticipation of official HHS verification requirements.
Our Healthcare group is here to help you navigate the new guidance. Please feel free to reach out with any questions.
YES! PLEASE SIGN ME UP TO RECEIVE EMAIL ALERTS FROM OTHER GUNSTER PRACTICE AREAS.
This publication is for general information only. It is not legal advice, and legal counsel should be contacted before any action is taken that might be influenced by this publication.
About Gunster
Gunster, Florida’s law firm for business, provides full-service legal counsel to leading organizations and individuals from its 13 offices statewide. Established in 1925, the firm has expanded, diversified and evolved, but always with a singular focus: Florida and its clients’ stake in it. A magnet for business-savvy attorneys who embrace collaboration for the greatest advantage of clients, Gunster’s growth has not been at the expense of personalized service but because of it. The firm serves clients from its offices in Boca Raton, Coral Gables, Fort Lauderdale, Jacksonville, Miami, Naples, Orlando, Palm Beach, Stuart, Tallahassee, Tampa, Vero Beach, and its headquarters in West Palm Beach. With more than 320 attorneys and consultants, and 300 committed support staff, Gunster is ranked among the top 200 largest law firms by the National Law Journal and has been recognized as one of the Top 100 Diverse Law Firms by Law360. More information about its practices, industries, offices and news is available at www.gunster.com.
