Here’s a question I get frequently from I-864 sponsors: if the person I sponsors gets into a serious accident, am I going to have to pay the medical bill? Short answer: probably not.
There are two different financial promises made by a person who signs a Form I-864, Affidavit of Support. The first is to ensure the beneficiary has income at or above 125% of the Federal Poverty Guideline. There is a lot of information about the obligation available on this site (start here to learn more).
The second promise is the one that creates concern about medical bills. Here’s the language in the Form I-864 itself:
If a Federal, State or local agency, or a private agency provides any covered means-tested public benefit to the person who becomes a permanent resident based on the Form I-864 that you signed, the agency may ask you to reimburse them for the amount of the benefits they provided. If you do not make the reimbursement, the agency may sue you for the amount that the agency believes you owe.
In other words, if the I-864 beneficiary receives certain public benefits, the sponsor can be sued for the cost of those benefits. Let’s take a closer look at how this works.
What is meant by means-tested public benefits?
“Means-tested public benefits” is a legal term of art. Generally, these are a type of federally-funded public benefit programs, loosely referred to sometimes as “welfare”. (The term welfare is so broad it really doesn’t mean anything, and it’s not a legal term). According to the Department of State’s description of means-tested benefits, they include:
- Food stamps;
- Supplemental Security Income (SSI);
- Medicaid;
- Temporary Assistance for Needy Families (TANF); and
- State Child Health Insurance Program (CHIP).
Importantly, notice what’s not on that list: general debt. So let’s say the I-864 beneficiary goes out and buys a flat screen TV on credit, then doesn’t pay the bill. The government isn’t going to swoop in and sue the sponsor, because the TV debt has absolutely nothing to do with a means-tested public benefits program.
What about medical debt? That really depends on how the medical care was delivered. The government can come after the I-864 sponsor only if there was a means-tested public benefit. If an I-864 beneficiary is enrolled in Medicaid and has a car accident, definitely the I-864 sponsor could be sued for a huge amount of money.
But the government cannot sue the sponsor merely because a hospital provided expensive services to the I-864 beneficiary. Again, if the beneficiary didn’t receive a means-tested benefit, the government cannot come after the sponsor.
Could a medical provider sue the sponsor directly?
So far we’ve been talking about the government getting involved to seek repayment of benefits. Can a medical provider sue an I-864 sponsor if the beneficiary has medical debt?
Remember there are two promises in the I-864: (1) ensuring income to the beneficiary; and (2) repaying means-tested public benefits. Looking at the first promise, a hospital could say that the sponsor’s income should be available to the beneficiary to repay medical bills.
First off, I have never heard of a medical provider suing an I-864 sponsor. Moreover, it is unlikely that such a lawsuit would succeed. The I-864 is a contract between the sponsor and the United States government. In contract law terms, the immigrant is a “third-party beneficiary” of the I-864. This means that she has the ability to enforce rights under the contract even though she isn’t a party to the contract (meaning she wasn’t one of the parties entering into the agreement… it was just made for her benefit).
The I-864 makes very clear that the immigrant is a third-party beneficiary with rights to enforce the contract. So does the federal statute that creates the I-864. But there are no similar provisions for medical providers. It would take some very creative arguments by a hospital to explain why they have the legal ability to enforce rights under the I-864 contact.
I won’t go on the record saying this sort of lawsuit is completely impossible, but success seems unlikely. If you’ve heard of such a suit, please let me know!
Bottom line.
Here’s the bottom line:
- The government gets involved only if there are means-tested public benefits. The government can’t sue the I-864 sponsor just because the I-864 beneficiary has general debt, including medical debt.
- There is no obvious way that a medical provider could sue the I-864 sponsor directly, since the I-864 doesn’t say that such third-parties can enforce the contract.
Footnote: government suits against sponsors seem to be rare.
Even in cases where an I-864 beneficiary does receive public benefits, it is rare for the sponsor to be sued. I’m not aware of a single case in my home state of Washington where an I-864 sponsor has been sued by government agencies. In the recent past there were some efforts made to collect the cost of benefits from I-864 sponsors on the East Coast, including New York. But I haven’t heard any reports of such cases in the past year.
Certainly a sponsor cannot assume he won’t be sued. Government agencies have the right to seek repayment of means-tested public benefits, so sponsors shouldn’t rest too easily just because this doesn’t happen all the time. The point is only that it appears to be relatively rare that this happens.
Photo credit: hywards of http://www.freedigitalphotos.net/.
Under Means Tested Benefits, only non-energency Medicaid is included. Emergency Medicaid is not a Means Tested Benefit. Car accident is fully covered under Emergency Medicaid and the Government cannot seek for reimbursement from the sponsor.
What about Medicaid for pregnancy? Could that affect citizenship application of an immigrant who was sponsored under i864?
Our firm focuses on the rights of new immigrants to recover support form their sponsors. But yes – receipt of Medicaid can potentially be considered with respect to "public charge" determinations for residency applications, though public charge determinations do not apply for citizenship (N-400) applications.
Can a sponsor, who is US citizen, receive Means Tested Benefits such as Medicaid? Let’s say if the sponsor gets pregnant and qualifies for Medicaid.
Can you apply for medicaid if a sponsored immigrant is under 18? Will the sponsor have to repay for that?
Thank you for the great content! What about Obamacare? If I sponsor someone and they receive subsidies through Obamacare (not Medicare) will the government ask me to repay those subsidies?
Hi, Andrew. Nope – there’s no obligation to repay ACA Healthcare costs or any private healthcare. Medicaid is a different story, but ACA Healthcare is "safe."
hi, am a wife to a US citizen with low income so his sister is my co sponsor. I was entered to emergency and now I receive medical bills from Swedish medical hospital but I don’t work and my husband can’t afford too. he and his sister fought and now she refuses to pay the bill. will we be charged for that?
Hi, Maha ~
This is a common misconception about the I-864. No, there is no open-ended responsibility to repay medical bills. The only related obligation under the I-864 is to repay the cost of "federally funded means-tested benefits" if demanded by the government. So if your sister-in-law received Medicaid, the government could potentially recover that from you. Note that some hospitals have tried to recover bills from sponsors, acting as though the sponsor is legally responsible for the bill. If that happens, contact me and we can discuss it – that could violate consumer protection law.
Best ~
Greg McLawsen
Hi Greg and thanks for the useful info…
I sponsored my 69 year old Mom and she has been a LPR for about 1 year. Her income is only $12,000USD and she acquired a good policy through covered California for $16/month.
However, now San Diego County has apparently blocked the renewal of the private insurance, insisting that because she is over 65, she must have Medi-cal instead.
Is this true?
I believe Medi-cal = California’s version of Medicaid… so I would become liable for any non-emergency care… no?
Thanks for your wise counsel,
David
David, great question and one that comes up often.
I’m based in Washington State and certainly no expert on MediCal. As a general rule under federal law, however, LPRs are eligible for Medicaid (of which MediCal is the California-administrated state counterpart) only after five years in LPR status. Moreover, I’m not aware of any reason – California or otherwise – why an individual can’t opt to purchase insurance on the private market. The usual situation is the opposite – folks are trying to get off private and onto Medicaid.
In terms of liability, you are correct that California could opt to recover from you the cost of any MediCal benefits paid to your mother. In practice I am not aware of any jurisdiction in the United States that actually does this. The Trump administration mandated that programs revise their guidance on enforcing the I-864, but stopped short of mandating enforcement.
This is a bizarre and unusual pickle to hear about (that they would make force your mother into MediCaid, imposing liability on you). I’d be interested in seeing a redacted copy of the letter they sent you, saying that she has to join Medicaid.
Best,
Greg McLawsen
Oh my, I am in the same exact situation!!!
I am also in San Diego and my 83 year old got automatically switched over from private insurance thru CoveredCA to Medi-Cal. I did not have to do anything. I just a phone call from the SD county asking me if she has income herself I said no, but I said she is a dependent of me. The rep on the phone said, that’s ok and I am going to approve her to Medi_Cal !!! And now she in need of surgery next month and I am panicking what if they sue me for what they paid for the hospitals for her consults, visits, and labs. This is Crazy!!!
My husband and I are the co-sponsors to my brother and his son due to his wife low income. My brother recently applied for Medi-Cal, not sure if it will be approved. Are we going to be responsible for his medical bill?
Hi, Bobo. Yes, a Form I-864 sponsor can be sued by – in this case – the State of California to recoup the cost of non-emergency Medicaid. In practice I am not aware of any jurisdiction in the country that actually does this, but it is a possibility.
Best,
Greg McLawsen
How long is a -864 Sponsor Liable for sponsored person?
Kathy, take a look at our post at the link below. In most cases a sponsor’s obligation ends when a person: (1) can be credited with 10 years of work; (2) becomes a citizen; or (3) gives up her green card and leaves the U.S.
https://i-864.net/how-long-does-the-i-864-support-last
If medicaid is paying the premium for Obamacare, can the sponsor be sued?
If medicaid is paying the premium for medicare, can the sponsor be sued?
Hi, Robert,
Any benefits provided under the auspices of Medicaid are theoretically recoverable under the I-864 (by the federal, state or local government – not by the immigrant). But to my knowledge there is no jurisdiction in the country routinely seeking such reimbursement. If you have heard of one, I’d be very interested to know.
Best,
Greg
Hi! I hope you can help.. My parents came here 16 years ago and received permanent resident status a few months later (due to the fact that I was a citizen). I was their sponsor. They worked and earned 40 credits to qualify for a small Social Security benefit and Medicare. They are now retired and have a very low income (about $1K a month). My mom just got diagnosed with Alzheimer’s, so trying to be proactive, I applied for Medicaid for them. I was told that I am still considered their sponsor and my income is included when their application was considered. I thought that after they earn 40 work credits, I am no longer their sponsor. They are not able to pass a citizenship test – due to mom’s condition and their age in general. I know that my mom’s condition is going to eventually wipe me out financially. What can I do?
Hi, Elena.
You are absolutely right: after your parents have worked (or can be "credited with") 40 qualifying quarters of work, your liability under the Form I-864 is concluded. Assessing quarters of work is relatively straight-forward, and they can request a statement on the Social Security website. The Government should not be imputing your income to your parents – called sponsorship deeming – if the contract is no longer in effect.
As a side note, your mother may qualify for a medical exemption to the testing requirements for citizenship. This is referred to by the form, the N-648, that is used to request an exception. I’m not sure if this link will post well, but here’s the governing provision in the USCIS Policy Manual: https://www.uscis.gov/policy-manual/volume-12-part-e-chapter-3#:~:text=Medical%20Disability%20Exception%20Requirements&text=The%20English%20and%20civics%20requirements%20do%20not%20apply%20to%20naturalization,last%2C%20at%20least%2012%20months.
Thank you so much for your response! I really appreciate that. Just a follow-up question.. Can states dictate Medicaid eligibility rules? We live in NV. I argued with the person on the phone stating exactly the point you made, but he kept insisting that the only two ways I will stop being my parents’ sponsor are if they become citizens or I die (his exact words). So what is my next step?
States have some authority to modify Medicaid rules, but the I-864 related provisions are governed by federal law. I would ask to apply for the benefit, and then appeal the denial if that’s the response you get.