Immigrants’ Access to Public Benefits: Post 1996 Welfare Reform

1. Immigrants’ Access to Public Benefits: Post 1996 Welfare Reform Leslie Helmcamp, Health Care Finance, Professor David Warner November 30, 2009

2. Agenda • Definitions • Background: Trends in Immigrants’ Health Care Coverage • Overview: Immigrants and public benefits • Policy recommendations and rationale

3. Definitions • U.S. Citizen (USC) – by birth or naturalization • LPR – Legal Permanent Resident or “Green Card” holder • Undocumented Immigrant – Entry without inspection (EWI)/permission or “visa overstay” • Nonimmigrant – valid visa holder (tourist, business, employer-sponsored) • Noncitizen – foreign-born person that is not a U.S. citizen

4. Legal Permanent Resident • Residency is granted through the following categories : • Family-sponsored immigration (U.S. Citizen or LPR petitioner) -65% • Employer-sponsored immigration – High-skilled workers- 15% • Refugees and Asylees -15% • Other special immigrants – 5%

5. Background • 46.3 million uninsured in United States • 21% or 9.5 million uninsured noncitizens • 12 million LPRs • 3.1 million working-age adults below 150% FPL • 4.1 million working-age adults between 150%-400% FPL • 3.4 million working-age adults below 400% are uninsured

6. Background • Noncitizen health insurance coverage varies by: • Time in the United States • Employment & Socioeconomic status • Legal status • Immigrants ≠ majority of uninsured • Not all legal immigrants have equal access public health insurance (Medicaid and SCHIP)

7. Overview: Immigrants & Public Benefits • 1996 Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) • Imposed a ban on public benefits use for LPRs during their first five years • This law extended to the State Children’s Health Insurance Program (SCHIP) when it was enacted one year later • Defined new categories of immigrants for purposes of public benefits eligibility • Qualified vs. Non-Qualified

8. Overview: Immigrants & Public Benefits • Qualified Immigrants • Legal Permanent Residents (entry before 8/22/96), • Refugees, Asylees, • Cancellation of Removal • Parolees, and • Survivors of Domestic Violence “VAWA” petitioners • (Victims Of Trafficking – are not qualified; however, they are eligible for federal funds)

9. Overview: Immigrants & Public Benefits • Non-Qualified Immigrants • Undocumented immigrants • Legal Immigrants, but ineligible: • Employment Visas, • Temporary Protected Status, • Lawful Temporary Residents (entry after 8/22/96), • Family Unity Status, • Voluntary Departure, • Stays, Suspensions of Deportation, and • Non-immigrants (tourists, students, work visas) CONFIDENTIAL

10. Overview: Immigrants & Public Benefits Low-income Legal Immigrants Eligible for Medicaid and CHIP • Refugees and asylees • Cancellation of removal/withholding of deportation • Cuban and Haitian entrants (7 year limit) • Immigrants who have obtained 40 qualifying quarters of work = 10 years • Active-duty U.S. military and veterans

11. Overview: Immigrants & Public Benefits Public Health Benefits Available to All Persons Regardless of Immigration Status • Emergency Medicaid • Immunizations • Screening and treatment of communicable diseases • WIC • School meals • Child nutrition programs & nutrition for seniors

12. Impact of PRWORA • 935,000 immigrants lost Medicaid coverage under PRWORA • Confusion regarding eligibility • Spill over effects on U.S. born children • Patchwork of state-level policies • Food insecurity in states withholding state funds for public benefits such as food stamps

13. Impact of PRWORA (cont’d)

14. Impact of PRWORA (cont’d) An estimated 4.1 million LPR adults are currently affected by the five-year waiting period

15. Policies Post PRWORA • 2009 Children’s Health Insurance Program Reauthorization Act (CHIPRA) • Extends federal match for Medicaid and CHIP coverage to LPR children and pregnant women within the 5 year period

16. Policies Post PRWORA • State-funded coverage for Medicaid, CHIP or state-based health programs for noncitizens • 25 states- all LPRs who are ineligible for Medicaid or CHIP due to the five year bar. • 17 states -LPR children and pregnant women • 22 states - prenatal option regardless of immigration status (7 states provided to undocumented immigrants)

17. Policy Recommendations • Eliminate the 5-year federal ban on Medicaid and/or CHIP to LPRs • Enact new provisions to insure low-income single adults under Medicaid and/or CHIP (provision would help both USCs and LPRs) • Ensure that all low-income LPRs have access to health care subsidies under health reform • Commission study on immigrants and public benefits, as well as their financial contribution in the United States

18. Rationale • PRWORA’s restrictions have not reduced healthcare spending • Restrictions negatively affect U.S. Citizen Children • Will insure more people without waiting periods • Reforms will bring cash assistance to states already providing care

19. Rationale (cont’d) • New LPRs still need care, but lack coverage due to affordable options • Results in delayed care • Federal waiting periods shift costs from the federal government to tax payers and local and state governments • Higher costs of loss in productivity due to poor health • LPRs (and noncitizens in general) pay taxes – Every kind of tax you can think of…

20. Questions and Answers CONFIDENTIAL