Entitled to Nothing: The Struggle for Immigrant Health Care in the Age of Welfare Reform

Appendix B: Summary of Provisions of Federal Welfare and Immigration Reform Affecting Health Care Access

159 Appendix B Summary of Provisions of Federal Welfare and Immigration Reform Affecting Health Care Access The 1996 Personal Responsibility and Work Opportunities Act (PRWORA) created two categories of immigrant eligibility for means-tested programs: “qualified” and “not qualified.” Those considered qualified include: Lawful permanent residents (LPRs) Refugees, persons granted asylum or withholding of deportation/removal, and conditional entrants Persons granted parole by the Department of Homeland Security for a period of at least one year Cuban and Haitian entrants Certain abused immigrants, their children, and/or their parents. In addition, these qualified immigrants must have arrived prior to August 22, 1996 (when PRWORA was enacted) in order to be eligible. All other immigrants , both documented and undocumented, are considered “not qualified .” Those arriving after August 22, 1996 are ineligible for nonemergency Medicaid for the first five years in the United States. In years six through ten, the sponsor’s resources are counted, or “deemed,” in the eligibility review . Also, those states choosing to provide state or local public benefits to “not qualified” immigrants must enact new laws to do so. The 1996 Illegal Immigration Reform and Immigrant Responsibility Act (IIRIRA) required sponsors to demonstrate their ability to maintain the sponsored immigrant at a minimum annual income of 125 percent of the federal poverty level. This policy also made the affidavits of support legally enforceable for the costs of certain means-tested programs. In addition , it required states requesting reimbursement for emergency Medicaid services to unqualified immigrants to verify the immigration status 160 Appendix B of patients for whom the payment was made. However, it also amended PRWORA to extend nonemergency public benefits to a group of battered or abused spouses and required the Attorney General and the Secretary of the Department of Health and Human Services to establish procedures to provide proof of citizenship in a “nondiscriminatory manner.” Despite all these changes, labor and delivery remains available for all immigrants, regardless of documentation status and time of arrival, as a form of emergency health care. Table Appendix B Immigrant Eligibility for Federal Medicaid Benefits Program Qualified Immigrants (before 8/22/1996) Qualified Immigrants (after 8/22/1996) Not Qualified Immigrants Emergency Medicaid (includes labor and delivery) Eligible Eligible Eligible Medicaid(full scope) Eligible Restricted* Restricted** *Eligible only if: 1) Were granted asylum or refugee status or withholding of deportation/removal, Cuban/ Haitian entrant, Amerasian, or Iraqi or Afghan special immigrant status; 2) Veteran, active duty military, including spouse, unremarried surviving spouse, or child; 3) Receiving federal Foster Care; 4) Have been in “qualified” immigrant status for 5 years or more; 5) Children under 21 (state option); and 6) Pregnant women (state option). **Eligible only if: 1) Were receiving SSI on 8/22/96 (in states that link Medicaid to SSI eligibility); 2) Certain American Indians born abroad; 3) Victims of trafficking and their derivative beneficiaries; 4) Lawfully residing children under 21 (state option); and 5) Lawfully residing pregnant women (state option). Source: National Immigration Law Center, April 2010. ...