1. "Making a Case for Social Justice - Opening the Door of Access and Opportunity for Everyone"Alabamas Immigration LawImpacts on Health and Social Care By John R. Wible General Counsel (retired)Alabama Department of Public Health John R. Wible, 2012 All Rights Reserved 1

2. Acknowledgement/Caveat Based upon analysis of GregLocklier, Assistant General Counsel, ADPH Mr. Locklier is not responsible for my additions andthey do not necessarily represent his opinion Caveat: the author has elaborated and updated The author is not your lawyer, therefore this may notbe relied upon as legal advice No representation is made that this presentationrepresents the opinion of the Alabama Department ofPublic Health, its OGC, officers, agents or employees John R. Wible, 2012 All Rights Reserved 2 3. We Are All Immigrants! Were all very differentpeople Were not Watusi Were not Spartans Were Americans with aCapital A USA is the Great SaladBowl John R. Wible, 2012 All Rights Reserved 3 4. Inmigracin History 101Historically, American immigration historycan be viewed in four periods: the colonial period, the mid-nineteenth century, the turn of the twentiethEllis Islandcentury, and Post-1965.John R. Wible, 2012 All Rights Reserved 4 5. Inmigracin Laws Act of 1790 Chinese Exclusion Act 1882 Acts of the 1920s Mexican Deportation Acts of 1930s Immigration and Nationality Act of 1952 Operation Wetback Immigration and Nationality Act of 1965 Act of 1990 John R. Wible, 2012 All Rights Reserved 5 6. A Strictly Federal PowerStates have no power to pass immigration laws because its an attribute of foreign affairs. Just as states cant have their own foreign policies or enter into treaties, they cant have their own immigration laws either.-Karl Manheim, Program for Law & Technology,Cal Tech and Loyola Law School.John R. Wible, 2012 All Rights Reserved 6 7. The Arizona Law on Appeal Arizona Sheriff Joe Arpaio The Support Our Law Enforcement and Safe Neighborhoods Act Police to check nationality of reasonably suspicious person in traffic or other arrest Requires everyone to carry citizenship docs Police to stop any reasonably suspicious vehicle to check for human smuggling On appeal to U.S. Supreme Court John R. Wible, 2012 All Rights Reserved7 8. The Alabama Law The Beason-HammondAlabama Taxpayer and CitizenProtection Act, HB 56, (Act 2011-535)was signed into law on June 9, 2011. Purpose: To discourage illegalimmigration, according to Section 2 ofthe text and statements by the sponsor* Sponsor, Rep. Scott Beason wore a wire inthe statehouse corruption case and ranunsuccessfully for Congress. John R. Wible, 2012 All Rights Reserved 8 9. The Act Dec & Def Declares unlawfully present aliens to beineligible to receive public benefits or to obtainlicenses/permits from state or local agencies. Requires employers to verify citizenship/lawfulpresence of its employees. Makes it illegal to enter into a contract with anunlawfully present alien. Proclaims it Illegal to assist such personsJohn R. Wible, 2012 All Rights Reserved 9 10. Attitude Many believe this is not a good law Many believe it addresses serious issues A very wise man once said, render, thereforeunto Caesar that which is Caesars * This fits that category, therefore . . . * Matthew 22:21 John R. Wible, 2012 All Rights Reserved 10 11. LitigationSoon after the legislation was signed intolaw, the U.S. Department of Justice and acoalition of individuals and private interestgroups filed lawsuits which are pending.Status of Federal LitigationStatus of State LitigationJohn R. Wible, 2012 All Rights Reserved 11 12. Hispanic Coalition of Ala. et al. v. Governor, et al. October 14, the 11th Circuit appeals court approved the U.S.Justice Departments request to temporarily block parts ofAlabamas law pending the outcome of an appeal. Among them: Requirement that public schools determine the immigration status of their students. But they did have to report back to the state information about which students didnt have birth certificates or other documents showing that they are here legally. The court is blocking enforcement a provision that makes it acrime not to have documents proving you are in the countrylegally. In other words, everybody had to have their papers onthem or they could be subjected to a misdemeanor charge. John R. Wible, 2012 All Rights Reserved12 13. United States v. AlabamaOn appeal, 11th Circuit Court of Appeals holds: Enjoined Sections 10 and 28, which permit law enforcementto charge immigrants, unable to demonstrate lawful presencein the United States, with a misdemeanor and requireschools to check new students immigration status. However, the court denied injunction on Sections 12, 18, 27and 30, provisions that: Allow police to check immigration status during trafficstops, based on reasonable suspicion. Bar Alabama courts from enforcing contracts involving anillegal immigrant party. Make it a felony for an illegal immigrant to apply for a driverslicense, license plate or nondriver identification card. John R. Wible, 2012 All Rights Reserved13 14. U.S. v. Alabama (cont.) The court refused to halt a provision that wouldrequire police in Alabama to do immigrationstatus checks under certain circumstances. Did not deal with section 13 giving assistanceto undocumented persons (lower court deniedinjunction as moot for want of standing On Appeal, enjoined 27 and 30 Awaiting S. Ct. decision in Arizona case.John R. Wible, 2012 All Rights Reserved 14 15. Enjoined Sections 10 Need to carry ID 27 Inability to make contracts 28 School reporting requirements 30 Inability to obtain state permitsThere are also less important state court actions pending. See paper.John R. Wible, 2012 All Rights Reserved 15 16. Recent Developments German born Manager of Mercedes-Benz plantarrested in Tuscaloosa for having no drivers license.Case dismissed. Japanese-born employee of Honda plant arrested inNorth Alabama. Case dismissed, employee had a validinternational D/L Governor has apologized to Germany andJapan and stated we want your business. No one yet arrested for giving assistance toundocumented person John R. Wible, 2012 All Rights Reserved 16 17. General Effects on Public Health"I dont want to spread fear, but any timepeople are afraid to get medical care thereare potential complications. - Dr. JimMcVay, ADPH. Children may not get required immunizations. Communicable diseases may spread Mothers may not get adequate prenatal careJohn R. Wible, 2012 All Rights Reserved 17 18. More Detrimental Effects Citizen children and those in lawfulstatus may not get adequate health care Water may be less safe Restaurants may be unable to getpermits and food may be less safe Public health costs may increase The people of Alabama may suffernegative health consequences John R. Wible, 2012 All Rights Reserved 18 19. Sections of the Act ImpactingHealth Care & Social Work Section 7: Public Benefits Section 9: Contracts Section 15: E-verification of Employees(effective 4/1/12) Section 29: Birth Certificates Section 30: Business Transactions w/State John R. Wible, 2012 All Rights Reserved 19 20. Health Care & Social Services An alien not legally present in the U.S. is notentitled to receive certain public benefits. An alien is a person who is not a U.S. citizen ornational. The term public benefits includes certainhealthcare services Many services/programs are excluded orexempt from the citizenship/lawful presenceverification requirements pursuant to state orfederal law/rules/guidance.John R. Wible, 2012 All Rights Reserved 20 21. Exempt Programs/ServicesAct 2011-535 expressly exempts the followingprograms/services from citizenship/lawful presenceverification requirements: WIC Immunizations In kind disaster relief Communicable disease Pre-natal care Emergency medical treatment Child or adult protective services John R. Wible, 2012 All Rights Reserved 21 22. Excluded Federal Benefit ProgramsThe following services/programs are federalpublic benefits and excluded from thecitizenship/lawful presence verificationrequirements by federal law/rules/guidance:Family planningCancer DetectionTobacco CessationHere, there is a direct conflict between Stateand Federal law.John R. Wible, 2012 All Rights Reserved 22 23. Medicaid Programs Verification of U.S. Citizenship and lawfulpresence of aliens participating in thefollowing programs is also NOT required as theAlabama Medicaid Agency determineseligibility to receive the services: Patient First Plan First EPSDT Dental (Medicaid clients) Home Health (Medicaid/Medicare clients).John R. Wible, 2012 All Rights Reserved 23 24. Private Providers Programs that do not received federalassistance are not subject to the Act and mayoffer services without carding or verifying. However, after April 1, they must E-verify theiremployees John R. Wible, 2012 All Rights Reserved 24 25. Verification of U.S. citizenshipand lawful presence IS REQUIRED for:Non-Medicaid dental services Private pay or indigent Home Health services Prostate screenings Non-Medicaid covered services provided towalk-in clients. Example: blood pressurecheck; administration of patient carriedmedication prescribed by outside provider. John R. Wible, 2012 All Rights Reserved 25 26. Childrens Health Insurance Program (CHIP)CHIP is already required to verifycitizenship or lawful presence of aliens butis authorized by Act 2011-535 to utilizeother means approved by the FederalgovernmentCHIP already has an account with SAVEJohn R. Wible, 2012 All Rights Reserved 26 27. John R. Wible, 2012 All Rights Reserved 27 28. Means of Verifying U.S. Citizen- ship or Lawful Presence Completion of a declaration form byclient/applicant. Provision of documents demonstrating U.S.citizenship. Provision of documents demonstrating lawfulpresence of an alien AND verification of lawfulpresence through the federal governmentsSystematic Alien Verification for Entitlements(SAVE) Program. John R. Wible, 2012 All Rights Reserved 28 29. Means of Verifying Citizenship or Lawful Presence of an Alien Must rely on documents provided byclient/applicant and determinations madeby SAVE. Determinations of U.S. citizenshipcannot be made based upon race, color, ornational origin. Imagine a Green Card John R. Wible, 2012 All Rights Reserved29 30. ALABAMA DEPARTMENT OF PUBLIC HEALTH DECLARATION OF CITIZENSHIP AND LAWFUL PRESENCE OF ANALIEN FOR PUBLIC BENEFITS AND LICENSING/PERMITTING PROGRAMSTitle IV of the federal Personal Responsibility and Work Opportunity Reconciliation Act of 1996,8 U.S.C. 1621, provides that, with certain exceptions, only United States citizens, United States non -citizen nationals,non-exempt qualified aliens (and sometimes only particular categories of qualified aliens), nonimmigrants, and certainaliens paroled into the United States are eligible to receive covered state or local public benefits.With certain exceptions, Alabama Act 2011-535 prohibits aliens unlawfully present in the U.S. from receiving state or localbenefits. Every U.S. Citizen applying for a state or local public benefit must sign a declaration of Citizenship, and thelawful presence of an alien in the U.S. must be verified by the Federal Government.Act 2011-535 also requires every individual applying for a permit or license to demonstrate his/her U.S. citizenship or if theapplicant is an alien, he/she must demonstrate his/her lawful presence in the United States.Directions: This form must be completed and submitted by applicants for health care benefits/services that are notexempt or excluded from citizenship/lawful presence verification requirements. Medicaid/Medicare clients are notrequired to complete this form as eligibility to receive services has already been determined by Medicaid/Medicare.This form must also be completed by individuals applying for licenses or permits. An individual includes a soleproprietorship, but does not include other business entities such as corporations.SECTION 1 --- APPLICANT INFORMATIONNAME: ___________________________________________________________________________________________(Print or Type) (Last) (First) (M.I.)DATE OF BIRTH: ______________________________________________________________________________ SECTION II --- U.S. CITIZENSHIP OR NATIONAL STATUSAre you a citizen or national of the United States (check one) ___ Yes ___ NoIf you answered YES: (1) Provide an original or legible copy of document from attached List A or other document thatdemonstrates U.S. citizenship or nationality and (2) Complete Section IV.If you answered No: Complete Sections III and IV.Name of document provided: __________________________________________________________________ SECTION III ALIEN STATUSAre you an alien lawfully present in the United States? ___ Yes ___ NoIf you answered Yes: (1) Provide an original or legible copy of the front and back (if any) of a document from attachedList B or other document that demonstrates lawful presence in the United States. (2) Complete Section IV. Informationfrom the documentation provided will be used to verify lawful presence through the United States Government.If you answered No: Complete Section IV.Name of document provided: _________________________________________________________________. SECTION IV -- DECLARATIONI declare under penalty of perjury under the laws of the State of Alabama that the answers and evidence I provided are trueand correct to the best of my knowledge._________________________________________________________________APPLICANTS/ LEGAL REPRESENTATIVES SIGNATURE DATE______________________________________________ _________________________________If signed by legal representative, Relationship to Patient Health Dept. EmployeeJohn R. Wible, 2012 All Rights Reserved 30 31. John R. Wible, 2012 All Rights Reserved 31 32. John R. Wible, 2012 All Rights Reserved 32 33. Licensing and Permitting Programs Alien not lawfully presentin U.S. may not enter intobusiness transaction with the state. Every person entering into a businesstransaction shall be required to demonstrateU.S. citizenship or lawful presence in the U.S. A business transaction includes licenses/permits issued to individuals by ADPH However, AG Opinion 2011-01 enforce onlywhen SAVEd and ADPH is still lost Enjoined and on appeal awaiting S. Ct. John R. Wible, 2012 All Rights Reserved 33 34. Licensing and Permitting Programs Act 2011-535 only impacts the licensing andpermitting of individuals It does not impact the licensing or permittingof business entities, other than soleproprietorships Thus, partnership or Inc.Restaurant, licensed day care orother potential permitee not = SAVing Enjoined and on appeal.John R. Wible, 2012 All Rights Reserved 34 35. Licensing and Permitting Programs For purposes of implementing Act 2011-535, anapplicant for a license/permit is the individual towhom a permit/license is issued, not necessarilythe person signing or submitting the application. Thus, agents do not need to be SAVEd The applicants citizenship/lawful presencemust be determined.John R. Wible, 2012 All Rights Reserved 35 36. How to determine if an applicantis a business entity other thansole proprietorship? Check the application for the name of thebusiness to which the permit/license is issued- Inc., LLC, and LLP indicate types of businessentities other than sole proprietorships. Require applicant to provide the legal nameof the business on the application and thetype of business entity. John R. Wible, 2012 All Rights Reserved 36 37. Section 15 Employment Verify Beginning in April, 2012, all employers,including state agencies must E-verify all newhires. The next section deal with how to do that This section is not before the court and is OKJohn R. Wible, 2012 All Rights Reserved 37 38. Means of Verifying U.S. Citizenship or Lawful Presence of an Alien Completion of a declaration form byclient/applicant. Provision of documents demonstrating U.S.citizenship. Provision of documents demonstrating lawfulpresence of an alien AND verification of lawfulpresence through the SAVE Program. Must rely on documents provided byclient/applicant and determinationsmade by SAVE.John R. Wible, 2012 All Rights Reserved 38 39. Means of Verifying U.S. Citizenship or Lawful Presence of an AlienDeterminations of U.S. citizenship/lawfulpresence cannot be made based upon race,color, or national origin.* Duh, of course! John R. Wible, 2012 All Rights Reserved 39 40. The Declaration Form When implemented, form Must besubmitted when initially presenting forservices & applying for or renewing permits orlicenses. Ensure that all sections are completed. The application process is incomplete without aproperly completed declaration form. Do notissue license or provide service if incomplete. Again, this is subject to SAVE implementation John R. Wible, 2012 All Rights Reserved 40 41. U.S. Citizen Declaration/VerificationIf applicant declares to be U.S. citizen, he/she must present a document demonstrating such from List A.A valid Alabama drivers license is acceptable. A valid drivers license from another state may not be Legislation may change thisA legible copy of a document indicating U.S. citizenship is acceptable.John R. Wible, 2012 All Rights Reserved 41 42. U.S. Citizen Declaration/VerificationIf the form is properly completed and acceptable documentation provided, services may be provided or permit issued to the U.S. citizen.Maintain the declaration form and a copy of the document presented in the clients fileJohn R. Wible, 2012 All Rights Reserved 42 43. Alien Declaration/Verification If applicant declares to be a lawfully presentalien, he/she must present a documentdemonstrating such. Federal law requires non-citizens 18 yearsor older to have immigrationdocumentation in their possession at alltimes. Acceptable forms of documentation arefound in List B and include green cards.John R. Wible, 2012 All Rights Reserved 43 44. AcceptableDocumentationNot AcceptableDocumentationJohn R. Wible, 2012 All Rights Reserved 44 45. Alien Declaration/Verification If the applicant declares to be a lawfullypresent alien and provides supportingdocumentation from List B, provideinformation from the document to thedesignated SAVE user for your office to verifylawful presence through SAVE The SAVE response is generally instantaneous John R. Wible, 2012 All Rights Reserved 45 46. Alien Declaration/Verification If for any reason the verification throughSAVE is delayed or is inconclusive, the alienis eligible to receive health services orother public benefits in the interim periodif the alien signs the declaration indicatingthat he or she is an alien lawfully present inthe U.SJohn R. Wible, 2012 All Rights Reserved 46 47. SAVE The SAVE Program uses electronic and paperrecords for accessing information to verify anapplicants immigration status. ADPH is in the process of registering to useSAVE. The process may take 60-90 days. Only designated users may access the SAVEProgram. John R. Wible, 2012 All Rights Reserved 47 48. Nondiscrimination The eligibility of an applicantcannot be based upon an applicants race,color, or national origin. Do not single out individuals who look orsound foreign for closer scrutiny or requirethem to provide more documentation ofcitizenship or immigration status than whatis required. Decisions about U.S. citizenship shall only bebased upon documentation provided.John R. Wible, 2012 All Rights Reserved 48 49. Conflict with EMTALA Duties under EMTALA Emergency screening examination EMC until the condition is resolved orstabilized and the patient is able to provideself-care following discharge, or if unable,can receive needed continual care Must transfer if unable to care for the pt.John R. Wible, 2012 All Rights Reserved 49 50. Conflict with EMTALA Emergency exception hospital may not turnaway any person regardless of nationality orimmigration status if such person needsemergency care May not discharge such person until stable,though law enforcement may be used to keepthem secure Also applies to hospital-based clinics/services(EMS) EMTALA does not apply to other H/C providers HB 56 excludes emergency treatment John R. Wible, 2012 All Rights Reserved 50 51. HIPAA Consequences Covered Entity may, but is not required to disclose under HIPAA w/o pt. consent if required by law to: Follow court order or comply with subpoena Locate a fugitive or suspect Alert LE of a crime taking place on premises (I.E.violating Alabama Immigration Law) HIPAA, itself does not require disclosure, permissive only Disclose only minimum necessary PHI John R. Wible, 2012 All Rights Reserved 51 52. Required Reporters State employees, only, are required reporters Required reporters have a legal duty to inform theauthorities of violations of the law. 13A-10-2, Code of Alabama 1975, misdemeanor This does not apply to private citizens John R. Wible, 2012 All Rights Reserved 52 53. For A Copy of Presentation and a PaperSee Alabamas Immigration Law Impacts on Health and Social CareSee several presentations & documents also: http://www.slideshare.net/jwibleBlog: http://www.johnwible.blogspot.comAlso on FacebookJRW, 201253 54. For a Video See:November 15, 2011 Rock Center with Brian Williamshttp://www.bing.com/videos/watch/video/help-not-wanted-alabama-immigration-law-sparks-feud/60bci5hJohn R. Wible, 2012 All Rights Reserved 54 55. QUESTIONS OR COMMENTS?John R. Wible, 2012 All Rights Reserved 55