Nusheen Ameenuddin, MD, MPH, MPA


Assistant Professor, Department of Pediatrics, Mayo Clinic, Rochester, MN

Dr. Nusheen Ameenuddin is currently an Assistant Professor and Consultant (tenured staff physician) in the Division of Community Pediatric and Adolescent Medicine, Department of Pediatrics, at the Mayo Clinic, Rochester, MN.  Previously, she was a pediatrician at MeritCare Clinic and a full-time active medical staff in pediatrics at North Country Regional Hospital, Bemidji, MN.  She is most passionate about advocating for underserved populations and immigrant populations who face significant barriers to healthcare, including language, health literacy and transportation.  In response to the recent measles outbreak in Minnesota, Dr. Ameenuddin participated in a vaccine education outreach as part of a joint effort between the Minnesota Department of Health and the state’s chapter of the American Academy of Pediatrics, traveling to Somali mosques to educate and vaccinate.  These efforts halted the spread of measles before any deaths occurred.  She has also taken to social media with the #KeepKidsCovered Twitter video campaign she helped spearhead in response to efforts to repeal the Affordable Care Act.  Dr. Ameenuddin received her medical degree in 2002 and her MPH degree in 1998 from the University of Kansas Medical Center, Kansas City, KS.  She completed a residency in pediatric and adolescent medicine at Mayo School of Graduate Medical Education, Mayo Clinic, in 2005. 


Public Charge: A Threat to Public Health


The public charge rule was conceived of centuries ago in an effort to limit immigration of “undesirables” to the US. It evolved into its more current form after the passage of welfare reform in 1996, limiting benefits that legal immigrants could access upon arrival and eliminating some benefits for undocumented immigrants. The impetus for public charge stemmed from the idea that new immigrants should be able to prove self-sufficiency in the US rather than relying on welfare and other public benefits.  In October 2018, DHS proposed expanding the current form of public charge to make non-cash benefits like Medicaid and food stamps potential factors that could weigh negatively in immigrants’ green card and citizenship applications. Before a rule can go into effect as law, there must be a 60-day comment period for the public to share individual comments and selected organizations to provide formal analytical statements.  The proposed rule forces immigrants to make a choice between accessing public benefits that they are entitled to and having a less complicated path to citizenship. However, forgoing medical, food or housing benefits can exacerbate financial insecurity, which erodes the safety net that limits children and families in need from falling through the cracks, which is poor policy for public health.

The purpose of this project is to examine both potential direct and indirect effects of the proposed expansion of public charge by looking at historical precedent, estimates using the Manatt Tool and a completing a literature review.


1.  To examine the impact of proposed public charge rule expansion on immigrants in the US.
2.  To contribute to Health Law Advocates’ (HLA) formal analysis and official submission of the impact to the Department of Homeland Security (DHS).


1. Performed a literature review and examine historical precedent to analyze direct and indirect impacts of public charge rule expansion
2. Applied and compared projections of indirect impacts of using the Manatt Tool
3. Prepared a document summarizing the literature and projections of indirect impacts that was incorporated into a formal submission by HLA to DHS.


The creation of a formal analysis by HLA that was submitted to DHS during the public comment period. Among over 200,000 individual comments, selected advocacy organizations were also tasked with providing formal comments. HLA submitted an analysis to DHS, which is currently reviewing all comments and analyses before determining how to proceed with the proposed rule expansion.

Future Directions:

1. Publish educational material on impacts of public charge to educate and engage the public in advocacy for immigrants
2. Work closely with immigrant rights groups to look at alternative ways to meet needs

Preceptor: Justin Lowe, JD, Health Law Advocates, Boston, MA