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Immigrants’ Access to Public Benefits: Post 1996 Welfare Reform. Leslie Helmcamp, Health Care Finance, Professor David Warner November 30, 2009. Agenda. Definitions Background: Trends in Immigrants’ Health Care Coverage Overview: Immigrants and public benefits
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Immigrants’ Access to Public Benefits: Post 1996 Welfare Reform Leslie Helmcamp, Health Care Finance, Professor David Warner November 30, 2009
Agenda • Definitions • Background: Trends in Immigrants’ Health Care Coverage • Overview: Immigrants and public benefits • Policy recommendations and rationale
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
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%
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
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)
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
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)
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
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
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
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
Impact of PRWORA (cont’d) An estimated 4.1 million LPR adults are currently affected by the five-year waiting period
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
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)
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
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
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…
Questions and Answers CONFIDENTIAL