Health Care and Public Benefits for Immigrant Families*

1. Health Care and Public Benefits for Immigrant Families* Immigration Challenges Impacting Children and Families in the Child Welfare System September 2013 NC Administrative Office of the Courts North Carolina Justice Center www.ncjustice.org * Originally drafted in part by NILC and YLC

2. Immigrant Families in America Today Immigrant families: “mixed status” Most immigrant families (85%) include at least one citizen, usually a child. Immigrant families with children experience greater poverty 50% have incomes below 200% FPL (compared with 35% of citizen families)

3. Issues Affecting Access to Services • Immigrant eligibility rules • State residency and other eligibility rules • Privacy, Confidentiality and Verification • Concerns about Sponsors & “Public charge” • Fear about being reported to ICE • Language Barriers and Cultural Competence • Lack of Transportation • The “Climate”

4. Immigrant Benefit Classifications 1996 Federal Welfare Law: Citizens • “Qualified” Immigrants • entered US before Aug. 22, 1996 • entered US on or after Aug. 22, 1996 • “Not Qualified” Immigrants

5. Qualified Immigrants • Lawful Permanent Residents (LPR) • Refugees, Persons Granted Asylum, Withholding of Deportation/Removal, Conditional Entrant status • Paroled into U.S. for at least 1 Year • Cuban and Haitian Entrants • Certain Battered Spouse and Children • Certain Victims of Trafficking

6. Qualified Battered Immigrants With prima facie case or approved: • Visa petition filed by US citizen or LPR spouse/parent • Self-petitionunder VAWA, or • Application for cancellation of removal/suspension of deportation under VAWA Parent of battered child and child of battered spouse also considered “qualified”

7. Victim of Severe Form of Trafficking • If 18 or over, must be certified by HHS • Children under 18 need HHS “eligibility letter” • Eligible for federal benefits to the same extent as refugees. • Derivative beneficiaries of “T” visas are also eligible for federal benefits  Victims with approved T visa petitions or prima facie determinations are “qualified”-- but other trafficking victims may also be eligible for benefits.

8. Not Qualified Immigrants ALL Other Non-citizens … even if have work authorization and are lawfully present in U.S.

9. Not Qualified Immigrants: Federal Program Bar • Bar on “Federal Public Benefits” • to be defined by agencies (only HHS, FEMA and a few others have done so) • Examples of “Public Benefit” in law: • grants, contracts, loans, professional/commercial licenses by government; retirement, welfare, health & disability, housing, post-secondary education, food, unemployment, FEMA, orany “similar benefit” which is • provided to individual, household, or family unit, by agency/funds of federal government

10. Examples of HHS Federal Public Benefits • Adoption Assistance • Child Care and Development Fund • Foster Care • Independent Living • Low Income Home Energy Assistance Program (LIHEAP)(weatherization for single units only) • Medicare • Medicaid (except emergency medical) • Refugee benefits (cash, medical, social services) • Social Services Block Grant (SSBG) • Children’s Health Insurance Program/CHIP (NC Health Choice) • TANF/Work First andFood Stamps (USDA)

11. Programs That Can Be Provided to All Immigrants • Emergency Medicaid and other emergency medical • Immunizations, testing and treatment for symptoms of communicable diseases (outside of Medicaid) • Short-term non-cash disaster relief • Certain housing assistance if receiving on 8/22/96 • School Lunch and School Breakfast • State Option to Provide WIC AND programs 1. Delivered at the community level, that are: 2. Not conditioned on income or resources and 3. Necessary to protect life or safety

12. AG’s List of Programs“Necessary to Protect Life or Safety” • Child and adult protective services • Violence and abuse prevention, domestic violence • Mental illness, substance abuse treatment • Short-term shelter or housing assistance • Programs for adverse weather conditions • Soup kitchens, food banks, senior nutrition programs • Medical & public health, mental health, disability or substance abuse services • Programs to protect life & safety of workers, children & youth, or community • Other services necessary to protect life or safety

13. Non-Profit Agencies • Non-profit charitable organizations are not required to determine, verify or otherwise ask for proof of an immigrant’s status • applies to immigrant restrictions in the 1996 welfare and immigration laws • Non-profits can create a safe environment for immigrants and their family members who are seeking services

14. Barrier to Access: Fear of ICE Reporting Concern: “If I go to the government office to get help for my child, will they deport me or my husband?” Agency threats of ICE reporting - frighten immigrants, discourage participation

15. Barriers: ICE ReportingGeneral Rules Immigration enforcement is theresponsibility of Immigration and Customs Enforcement/DHS Benefits agencies are not responsible for enforcing immigration laws, with limited exceptions Certain government entities (SSI, TANF, FS, public housing) required to notify ICE of any immigrant the entity “knows” is not lawfully present in the U.S. Medicaid & SCHIP agencies under no duty to “report”

16. Interagency Noticeon Reporting SSI, TANF, Food Stamps, Public Housing: Agency will appropriately “know” the immigration status only of an applicant An agency can only KNOW status is unlawful via a formal ICE document (Order of Deportation) “Know” determination must be a formal determination subject to administrative review.

17. DHHS and the “SAVE” program NC DHHS uses the federal “SAVE” program to determine immigrants’ eligibility for benefits. NC DHHS signed an agreement with USCIS in 2010 stating in part that NC DHHS will: “Use any information provided by DHS-USCIS under this [agreement] solely for the purpose of determining the eligibility of persons applying for the benefit issued by [DHHS]… “Safeguard such information and access methods to ensure that it is not used for any other purpose than described in this [agreement] and protect its confidentiality; including ensuring that it is not disclosed to any unauthorized person(s) without the prior written consent of DHS-USCIS.”

18. Angie and Nadia Angie works in a health clinic, a non-profit organization that receives federal funds. Patients can be treated at the clinic, regardless of their income. Nadia, an undocumented teenager, seeks treatment at the clinic. 1. Does the clinic provide a federal public benefit? 2. Is Nadia eligible for treatment? 3. Is Angie required to verify Nadia’s immigration status? 4. Is Angie required to report Nadia to the Department of Homeland Security/DHS?

19. Foster Care and Child Welfare: Child Welfare Services Title IV-B Child Welfare Services Child Abuse Prevention and Treatment Act (CAPTA) Title XX Social Services

20. Foster Care and Child Welfare: Cash Benefits • Title IV-E • Foster Care Maintenance Payments • Title IV-E Adoption Assistance • SSI • Non federal cash benefits

21. Foster Care and Child Welfare • Whose immigration status matters? • Child • Parent • Caregiver • Is it necessary for the protection of life or safety? • Child protection • Abuse prevention

22. Foster Care and Child Welfare • Is it a public benefit? • Title IV-B vs. Title IV-E • Eligibility for payment vs. qualified for placement • What program are we talking about? • State Foster Care vs. Unaccompanied Refugee Minor or Unaccompanied Alien Minor

23. Special Immigrant Juvenile Status • Individuals placed by court order in physical custody of a state agency, individual or entity appointed by a state or court, • Whose reunification with one or both parents is not viable due to abuse, neglect, abandonment or a similar basis, • Judicial or administrative finding that it is not in best interest of child to be returned to the child’s or parent’s previous country of residence.

24. Julia and Nora • Julia, a 10 year old, was born in the U.S. Her 14 year old sister, Nora, is undocumented. They live with their father who is abusive. Nora called the police to report the violence, and the police contacted child protective services. • Can CPS conduct a child abuse investigation? • Can Julia and Nora be placed in foster care? • Can they be placed with their aunt, who is undocumented? • Can they receive foster care benefits to pay for their care?

25. Qualified Immigrants: Major Federal Programs • Supplemental Security Income (SSI) severely restricted for immigrants • 5 year bar on federal TANF, Medicaid (non-emergency), CHIP for qualified immigrants who entered U.S. on or after 8/22/96, with exceptions • Restriction on Foster Care for caretakers of recently qualified immigrant children • 5 year bar on SNAP/Food Stamps for qualified immigrant adults, with exceptions.

26. Medicaid, CHIP, TANF Federal funds available for: • Qualified immigrants who entered U.S. before 8/22/96, or who complete the 5 year bar • Refugee groups, trafficking victims • Veterans, active duty military & family • “Lawfully residing” immigrant children & pregnant women in Medicaid/CHIP(NC state option) • Medicaid: federal Foster Care children, SSI recipients in most states, Native Americans • CHIP option: prenatal regardless of status

27. New Provisions for Pregnant Women and Children under CHIPRA A new provision in 2010 made Medicaid available to pregnant women and children (under age 19) w/o 5 yr Bar in a variety of lawful immigrant categories, including: Legal Permanent Residents (LPR) VAWA prima facie determination or approved petitions Temporary Protected Status (TPS) Family Unity beneficiaries Temporary resident status under 210 or 245 of the Immigration and Nationality Act Deferred Enforced Departure Spouses or children of U.S. citizens whose visa petitions are approved and who have pending applications for adjustment of status Victims of crime (“U” visa holders)* ( *It is not yet clear whether this applies to all U visa holders or only those who are DV victims) Fiancées of citizens (K visa) Religious workers (R visa) Individuals assisting in criminal prosecutions (S visa) Individuals with a pending petition for 3 years or more (V visa) Parents or children of individuals with special immigrant status (N visa)

28. SSI • Receiving SSI or application pending on 8/22/96 • Qualified immigrants with disabilities, whowere lawfully present in the U.S. on 8/22/96 • LPRs with credit for 40 quarters of work history. Post 8/22/96 entrants only after in qualified status for 5 years. • Refugees, granted asylum, withholding of deportation or removal, Cuban/Haitian entrants, Amerasian immigrants, Iraqi and Afghan Special Immigrants, trafficking victims, during first 7 years after obtaining status • Veterans, active duty military, spouses, surviving spouses & children • Members of federally recognized Indian tribes or American Indians born in Canada

29. Federal Law: Immigration Status, SSN As a general rule, States must establish citizenship or eligible immigration status, and SSNs of applicants for many federal programs “Applicant” = Person for whom benefits are sought (or household/ family unit defined by benefit granting authority) “Non-Applicant” = Member of the applicant’s family or household who is not seeking benefits.

30. Federal Guidanceon SSN States may not deny benefits because a non-applicant in the family or household has not provided information on immigration status or his or her SSN.

31. Emergency Medicaid Citizenship/immigration status not required SSN notrequired

32. Clare and her Children • Clare, who is undocumented, has two children, Mike, an undocumented teenager, and Tyler, who was born in the U.S. Clare is pregnant. Which benefits can they receive?

33. Annie and Jude • Annie is an undocumented mother of a U.S. citizen child, Jude. Jude has a severe disability, and the family needs assistance. • Which benefits can Jude receive? • Can Annie seek these benefits on his behalf?

34. Kim and Hana • Kim is a 28-year-old mom with a child, Hana, age 12. Both are lawful permanent residents (LPRs) who entered the U.S. in 2009. Kim lost her job.  • Which benefits can they receive? • After Kim experiences some problems, Hana ends up in the child welfare system. Can Hana be placed with her undocumented aunt? Can federal foster care pay for this placement?

35. Victor Victor, a 14 year old who is undocumented, came to the U.S. from Honduras on his own, seeking his family. He could not find them, and began living on the streets. His school called child welfare staff at the local DSS. What are his options?

36. The Affordable Care Act • How are immigrants included under the comprehensive health care legislation that passed in 2010, and going into effect in stages over the next several years…

37. Resources on Public Benefits for Immigrant Families National Immigration Law Center:www.nilc.org Youth Law Center: www.ylc.org National Council of La Raza:www.nclr.org National Health Law Program:www.healthlaw.org

38. Contact Information Kate Woomer-Deters, attorney, (919) 861-2072/kate@ncjustice.org Jack Holtzman, attorney (919) 856-2165/jack@ncjustice.org North Carolina Justice Center P.O. Box 28068, Raleigh, North Carolina 27611