The Trump administration is moving to make it more difficult for immigrants with disabilities and their families to get a visa or attain permanent residency in the United States.

A proposal from the U.S. Citizenship and Immigration Services, part of the Department of Homeland Security, would alter how immigrants are evaluated as they seek the right to permanent residency — the step before citizenship. The use, or potential use, of public services by immigrants or their family members are considered “heavily weighted negative factors” in the draft document.

Some of the examples cited as negatives include high-cost medical conditions and many uses of social services, like food assistance, Medicaid, unemployment and disability benefits. The category “mental disorders” is on a list of the five most expensive health conditions contained in the draft regulations.

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Disability rights groups have raised concerns about the proposed changes and said that even though the proposal has yet to be adopted, it is already having an impact in the disability community.

“People are very scared,” said Michelle Garcia, the Latino community organizer for Access Living, a Chicago-based disability advocacy organization. “They’re scared of going to a hospital or getting support and services” because it may negatively impact their immigration status.

Garcia said she works with immigrant clients who have children with disabilities who are American citizens. However, they’re not seeking services for their children, out of fear it could lead to their own deportation or count against them in their efforts to stay in the country.

“Already people are being told that if their child seeks services, then they as a parent may not be able to fix their (residency) status later on,” Garcia said.

According to the draft document, the goal of the proposed changes would be to make sure those seeking a visa or residency would be self-sufficient and less likely to use public services. Those who may need such services are defined as a “public charge” in the proposal. The proposed changes would primarily impact immigrants who are applying for a green card through a family-based petition.

“This rule will have a disproportionate and discriminatory impact on people with disabilities,” said Julia Bascom, executive director at the Autistic Self Advocacy Network, in a statement. “Disability or need for supports and services should never impact someone’s immigration status.”

The proposal seeks to update existing federal guidance that’s been in place since 1999, said Gabrielle Lessard, senior policy attorney for the National Immigration Law Center. That guidance only considered two benefits as negatives, she said: cash assistance and long-term hospitalization care. The proposed regulations expand that list to a wide range of social services, including most government-funded health care, Lessard said.

“Everyone should be concerned about this,” Lessard said. “This is asking people to make cruel choices between getting assistance with health and nutrition and being able to join their family members.”

A spokeswoman for DHS’s Citizenship and Immigration Services office said she could not comment on the proposed rule because the rulemaking process is not complete. She noted that the proposed rule will soon be published in the Federal Register and public comments are encouraged.

At the same time the United States is pursuing this change, Canada is moving in the opposite direction. For decades, the Canadian government had rules in place that allowed the government to reject permanent resident applications from people with disabilities or medical conditions who would be likely to use government-funded social services, or with family members who fall into that category.

The Canadian government announced April 16 that it will update its definition of social services for immigration purposes to delete language referring to special education, social and vocational rehabilitation services and personal support services as services that would allow the government to reject a permanent residency petition.

The changes “are a major step forward in ensuring our immigration system is more inclusive of persons with disabilities, and reflects the values of Canadians,” Ahmed Hussen, the country’s minister of immigration, refugees and citizenship said in a statement.