Immigrants and Welfare: The Impact of Welfare Reform on America's Newcomers

Chapter 6Changes in Immigrants’ Use of Medicaid and Food Stamps: The Role of Eligibility and Other Factors

Chapter 6 Changes in Immigrants’ Use of Medicaid and Food Stamps: The Role of Eligibility and Other Factors Leighton Ku CONGRESS RESTRICTED the eligibility of legal immigrants for meanstested benefits by passing two laws in 1996, the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) and the Illegal Immigration Reform and Immigrant Responsibility Act (IIRIRA). These changes were designed to limit the use of means-tested federal benefits by immigrants, to shift responsibility for immigrants’ needs to their sponsors or to the states and to achieve federal cost savings (Fix and Passel 2002). In so doing, Congress altered the previous social contract, under which immigrants who were legally admitted as lawful permanent residents (LPRs)—and who were subject to civic responsibilities like paying taxes—were eligible for public benefits on terms similar to those of citizens. This chapter examines how the use of Medicaid and food stamps—the two most commonly used means-tested benefits— changed for noncitizen immigrants over the past decade. Part of the changes in participation can be attributed to the restrictions in the eligibility criteria established by Congress in 1996 or to changes made in subsequent years. But some of the changes were influenced by other economic, social, and programmatic factors over the years. I compare trends in Medicaid and Food 153 Stamp Program (recently renamed the Supplemental Nutrition Assistance Program, or SNAP) use by noncitizen immigrants with trends for citizens as well as for citizen children with U.S.-born versus noncitizen parents.1 I also review evidence regarding how changes in Medicaid or Food Stamp Program participation may have affected hardship levels among immigrants as measured by changes in uninsurance, medical care use, and food insecurity. INTERPLAY OF SOCIAL FACTORS Public benefits like Medicaid and food stamps are designed to reduce the hardships of poor families and individuals, immigrants and citizens alike. But immigrants often face higher barriers to such services. Immigrants’ access to and use of public benefits are governed by multiple factors. The most visible and easily identifiable of these from a public policy perspective are the eligibility criteria, that is, the formal federal or state rules that determine who qualifies. But there is typically a large gap between the number of people who are eligible and those who actually participate, and a number of social and policy factors may also affect participation . Numerous economic, social, and structural factors affect immigrants’ participation in public benefit programs and, more broadly, the use of services that meet their needs (see table 6.1). Eligibility Criteria Elements of eligibility rules established for public benefits include income limits, immigration status, categorical restrictions, and so on. The 1996 legislation modified immigrant-related eligibility criteria , but subsequent amendments eased some of those restrictions , restoring eligibility for some legal immigrants. Key provisions of the 1996 law and subsequent modifications for Medicaid and the Food Stamp Program (FSP)—including the 2002 restorations of FSP eligibility under the Farm Bill (Public Law 107-17) and 2009 restorations of Medicaid and the State Children’s Health Insurance Program (SCHIP) under the Children’s Health Insurance Program Reauthorization Act (Public Law 111-3)—are summarized in table 6.2. 154 Immigrants and Welfare Requirements that applicants submit certain types of documents or that their status be verified also affect who can be determined eligible. When specific documentation is mandated, those who are unable to provide the necessary paperwork may be barred. Thus, for example, under legislation enacted for Medicaid in 2006 (the Deficit Reduction Act, Public Law 109-171), citizens who could not prove their citizenship by submitting a passport, Changes in Immigrants’ Use of Medicaid and Food Stamps 155 Table 6.1 Types of Factors Affecting Immigrants’ Use of Public Benefits Eligibility criteria • Immigration-citizenship status (for example, citizen, lawful permanent resident (LPR), refugee, undocumented) • Income and assets • Category and family composition (for example, family, child, elderly person , person with disability) • Other special factors (for example, worked for ten years in qualified employment , military veteran) • Residence (duration, place) • Documentation-verification requirements Economic and social trends • Poverty or unemployment rates • Demographic trends • Immigration and naturalization rates (for example, growth in undocumented population) Social and community factors • Awareness of public benefit programs and understanding about immigrant eligibility • Social isolation and integration, including acculturation and time in the United States • Language barriers • Fears...