Immigrants’ Access to Health Care:

Emerging Trends and Issues

Gabrielle Lessard

National Immigration Law Center

January 27, 2005

Federal Issues

• Medicaid block grants

• Women Immigrants Safe Harbor Act (WISH)– Eliminate restrictions on battered immigrant

women’s access to essential services, including Medicaid and SCHIP

– Violence Against Women Act (VAWA) reauthorization

WISH• Eliminates 5 year bar

• Eliminates restrictions on SSI eligibility

• Clarifies eligibility for federal housing programs

• Exempts DV, trafficking and crime survivors with U visas from the public charge test

• Exempts DV, trafficking and crime survivors from sponsor deeming and liability

Undocumented Immigrants• Arizona Prop. 200

– Voter registration requires proof of citizenship

– Agencies that administer state and local public benefits (not mandated by federal law) must verify applicant’s immigration status and share immigration status information with other agencies

– Agency employees required to report violations of immigration law

– Failure to report is a misdemeanor (also applies to supervisors)

Prop 200 – AG Opinion• Scope limited to state and local public

benefits as defined in 8 USC 1621– AZ Title 46 programs, including TANF, Food

Stamps, general assistance, crisis assistance– Medicaid not included– Benefits defined in federal law as available

regardless of status not included Enforcement of immigration law is an

exclusively federal power

After Prop 200

• Legal challenge pending – TRO denied

• “me too” effect in other states– According to AZ Republic, “experts” are

linking trend to rapid growth in Latino population in states such as Arkansas, Colorado and Georgia

Increased Concerns about Reporting

• Rohrabacher bill, HR 3722, would have required hospitals to report undocumented patients to U.S. Border Patrol– Bill defeated but concerns remain

• Potential for ‘proxy’ questions about immigration status in implementation of Section 1011 reimbursement provisions

Section 1011 (of MMA)

• Limited funding to reimburse hospitals, physicians and emergency transportation providers for uncompensated emergency services to:– undocumented persons,

– holders of border crossing cards, and

– persons paroled into the U.S. for the purpose of receiving emergency medical treatment

• $250M per year FY 2005-2008

Section 1011

• Money allocated to states based on number of undocumented persons (determined by DHS)

• Additional money for 6 states with highest rates of apprehensions – AZ, CA, FL, NM, NY, TX

• Statute provides for direct payment to providers, but does not specify process

Section 1011 Reimbursement• Advocates and health care providers express

concern about deterrent effect of asking patients about their immigration status, urge statistical method

• CMS releases proposed guidance through web site; uses individual claims-based method

• CMS issues letter to hospital and provider groups stating that it will not require questions about “citizenship” status, implying that it will use other individual inquires (such as questions about SSN)

Section 1011- other issues

• Coverage includes services required by EMTALA and related inpatient, outpatient and emergency transportation services– Coverage ends with patient discharge

• Providers may ‘balance bill’

• Claims will be aggregated at state level, and providers paid a pro-rata share if state allotment is exceeded