Center for Public Policy Priorities 1 Immigrants and Public Benefits in Texas Immigrants and Public...

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Immigrants and Public Benefits in TexasImmigrants and Public Benefits in Texas

Immigration and Border Security Hearing House Committee on State Affairs

House Committee on Border and International Affairs

March 28, 2007

Anne Dunkelberg, Associate Director

[email protected] 900 Lydia Street - Austin, Texas 78702

Phone (512) 320-0222 – fax (512) 320-0227 - www.cppp.org


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The NumbersTexas Population now ~ 22.5 - 23 million

– About 1.1 million are naturalized US citizens who were born abroad (U.S. Census)

• U.S. Census does NOT provide information on immigration STATUS, only citizenship status.

– About 1.4-1.6 million are “Unauthorized” (Pew Hispanic Center)• Some persons in this estimate have legal authorization to live and work in the United

States on a temporary basis. These include migrants with temporary protected status (TPS) and some migrants with unresolved asylum claims. Together they may account for as much as 10% of the estimate.

– About 1.2 million are Legal Immigrants, mostly Legal Permanent Residents

• LPRs are foreign nationals who have been granted the right to reside permanently in the United States. LPRs are often referred to simply as “legal immigrants," but they are also known as “permanent resident aliens” and “green card holders.”

– Texas #3 or #4 in the number of newly arrived Legal Immigrants for the last several years; tied for #3 in adoptions from overseas in recent years.

– 23 percent of ALL Texas' children live in "mixed families" (one or more parent is non-citizen)

– 34 percent of Texas' children in low-income families (below 200% of the federal poverty line) are in mixed families (Census 2001 CPS, CBPP)


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Basic Immigration Status Vocabulary• “Alien” is a term used in many laws to refer to immigrants (both legally present

and undocumented).• “Undocumented” Immigrants include 2 groups --

– EWIs (Entries Without Inspection)– Overstays (came with a legal visa, but stayed after it expired; these make up 25-

40% of all undocumented)– Other terms: “not lawfully present”, “illegal aliens”

• “Legal” immigrants include many different legal statuses– Some are permanent or long-term statuses, that is, the immigrant can reside in the

U.S. indefinitely as long as they do not commit crimes: e.g., LPRs (lawful permanent residents), Refugees, Asylees

– Others are temporary, or transitional statuses, which may be indefinite in length (e.g., the spouse, child or fiancée of a US citizen waiting to get LPR status may have a “K” Visa), or they may be required to get approval for renewal of status at regular intervals (e.g., “Temporary Protected Status).

– MOST LPRs in the US are family-based immigrants.

• All legal immigrants are NOT treated equally with regard to federal benefits.


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Immigrant Eligibility for Public Benefits: A Short Review

• Before 1996 “Welfare Reform” law (PRWORA), most legally present immigrants were treated the same as U.S. citizens for purposes of federal benefit eligibility.

• PRWORA created new terms: “Qualified”, “Not Qualified.” “Not qualified” now includes undocumented, plus some legally present immigrants. These are NOT immigration law terms, just public benefit classifications.

• Despite term “qualified,” PRWORA reduced eligibility of qualified immigrants for benefits. Also, big differences in eligibility depend on whether in US prior to Aug. 22, 1996 (date PRWORA signed).

• Congress has, over time, restored portions of the Legal (Qualified) Immigrant cuts proposed in PRWORA, especially for Food Stamps.

• Also, access to critical health and crisis services for “Not Qualified” is protected under federal law and regulation.


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Certain Legal Immigrants are Exempt From Any Benefit Limits:

These persons are eligible for SSI, Food Stamps, Medicaid, TANF, or CHIP on same basis as U.S. citizens:

• Refugees, asylees, withholding of deportation, Cuban & Haitian, may collect during first 7 years in U.S. (EXCEPT: TANF window is 5 years, Amerasians may only get 5 years Medicaid, SSI).

• Persons with 10 years (40 quarters) of U.S. work history

– immigrants with date of arrival 8/22/96 or later must have 40 quarters AND have been in US more than 5 years)

– families “share” quarters (married couples and their minor children)

• Active-duty U.S. military and veterans (& spouse, dependent children)


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New Categories Related to Public Benefit Eligibility

Qualified Non-qualified

Legal Permanent Residents Undocumented persons

Refugees, Asylees Legally present Non-qualified

Withholding of Deportation Employment Visas (incl. Ag.)

Granted Conditional Entry Temporary Protected Status

Parolees In US since 1/72 (not LPR)

Domestic Violence “VAWA” petitioners

(must have US citiz. or LPR spouse)

Lawful Temporary Residents

Family Unity Status

Certain Voluntary Departure

Certain Stays, Suspensions of Deportation

Victims Of Trafficking (not technically “qualified”, but eligible for all federal

benefits

Non-immigrants (tourists, students)


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The Big Picture:

• Undocumented Immigrants are not eligible for Medicaid, CHIP SSI, Food Stamps, or TANF (cash assistance).

– This is NOT a new policy for undocumented persons; these programs never included the undocumented.

• State and local programs that use federal funds MUST abide by the federal policy regarding immigrants—legal and undocumented—related to those funds (i.e., they cannot impose stricter rules).

• Many Legal Immigrants are still eligible for benefits from federally funded programs, including many programs the state administers.


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The Big Picture:

• Undocumented immigrants must be provided access to many federally funded programs, especially health care programs, short-term emergency and intervention services, WIC, and school meals.

– Access to emergency and crisis services is ALSO mandated under federal law even when a program is funded entirely with state or local funds.

• U.S. citizen children (i.e., all children born in U.S.) can be eligible for public benefits, regardless of the immigration status of the parents. Federal policy protects these children’s rights. – Only the applicant's status is relevant to his eligibility; for

example, the parent's immigration status is irrelevant to a U.S. citizen child's eligibility for public benefits.


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Some Programs MUST be Available to ALL PERSONS in Need; MAY NOT exclude undocumented

Public programs, whether federal, state or local, MUST NOT restrict access based on immigration status if they provide any of the following: – Emergency Medicaid, immunizations, diagnosis (testing) and

treatment of communicable disease

– Non-cash assistance needed to protect life and safety and not income-conditional (e.g., shelters, soup kitchens, crisis intervention) as specified by U.S. Attorney General (see next slide)

– Short-term, in-kind emergency disaster relief

– WIC, school meals, child nutrition programs, and elderly nutrition

• IMPORTANT: when they provide the benefits listed above, service providers – are not required to verify citizenship or immigration status

(exception: Emergency Medicaid), and

– MAY NOT EXCLUDE UNDOCUMENTED PERSONS.


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U.S. Attorney General’sList Of Programs “Necessary To Protect Life Or

Safety” Which Must Be Open To All In Need• Child protection & adult protective services • Violence and abuse prevention, including domestic violence • Mental illness or substance abuse treatment• Short-term shelter or housing assistance (e.g. battered

women’s shelters, homeless, disaster shelters)• Programs during adverse weather conditions• Soup kitchens, food banks, senior nutrition programs • Medical & public health services & mental health, disability or

substance abuse services necessary to protect life or safety• Programs to protect the life and safety of workers, children &

youths, or community residents• Other services necessary for the protection of life or safety


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Texas CHIP: Coverage of non-U.S. CitizensUndocumented persons are not eligible for either Medicaid or CHIP

Federal law REQUIRES Texas to include Legal Immigrant children (who qualify by income) IF they have been in the U.S. for 5 years or more.

– Texas has CHOSEN since creation of CHIP to also cover the small group of Legal Immigrant children who are in their first 5 years in U.S.

– Legal Immigrant kids in CHIP already have to provide their immigration documents to get CHIP.

– All CHIP policies (premiums, asset test, etc.) for these children identical to those for U.S.-citizen children; state tracks their expenses separately.


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• HHSC reports about 16,000 legal immigrant children per month were enrolled in fiscal year 2006; it is assumed that this group’s caseload has declined along with the rest of CHIP enrollment.

• Combined child Medicaid and CHIP enrollment in Texas in February 2007 is 2.09 million, so the immigrant CHIP children made up less than 1% of enrollment (0.79%).

NOTE: Because Texas has not exercised its option under federal law* to provide Medicaid to otherwise-eligible Legal Immigrants who arrived after 8/22/96, LPR children at Medicaid incomes are eligible for Texas CHIP. In other words, the immigrant portion of CHIP is serving children who otherwise would be served in Medicaid.


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– Vast majority of these children will eventually naturalize to become U.S. citizens. Texas’ modest investment today helps give these future citizens a healthy start.

– Because legal immigrant children become eligible for federally-funded CHIP after 5 years, the program is self-limiting in size: children are “aging out” of the program at the same rate new children become eligible.

– Opponents imply that eliminating coverage will result in savings to Texas taxpayers, but costs of care for these children will be shifted to Texas' charity care providers: public and nonprofit hospitals, cities, counties, community health centers, and others who care for the uninsured.

– Eighteen other states have similar programs for their legal immigrant children: California, Connecticut, Delaware, District of Columbia, Hawaii, Illinois, Maine, Massachusetts, Minnesota, Nebraska, New Jersey, New Mexico, New York, Oklahoma, Pennsylvania, Rhode Island, Virginia, Washington and Wyoming.


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Texas Medicaid: Coverage of non-U.S. CitizensUndocumented persons are not eligible for either Medicaid or CHIP

Full Medicaid Coverage• Legal Immigrants who came to US before 8/96 treated same as U.S.

Citizens• Texas has chosen (federal law option) NOT to provide Medicaid to

Legal Immigrants who arrived after 8/96– Example: Lawful permanent resident of U.S. who entered U.S. in 1998

cannot get coverage, even if severely disabled

“Emergency” Medicaid• Nearly half the persons whose care is covered under this category

are LEGAL immigrants, because we exclude them from full Medicaid• NOT available to pay for E.R. care for every immigrant: ONLY those

who meet every other Medicaid requirement except immigration/ citizenship status– Example: undocumented 25 year-old single construction worker cannot

get covered


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How Does Immigration Factor In Uninsured Rate?

• Immigrants are NOT the primary cause of Texas’ last-place ranking – Census Bureau reported 1.3 million uninsured non-

citizens (includes both legal residents and undocumented persons); (54.5% of non-citizens)

– BUT, if you remove non-citizens from the equation, Texas would still be tied with New Mexico for the worst uninsured rate at 20.6% uninsured (4.2 million), even if you left the non-citizens in the other state’s counts

• Without immigrants, New Mexico’s rate would drop to 18.9%


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Uninsured Texas Children:We CAN Cut the Number in Half by Enrolling

Kids Who are Eligible Right Now

Texas Children who are Uninsured, 2004-05 – U.S. Census CPS

All incomes, under age 19 (0-18*; 2-year average 2004-05)

20.4% 1.367 million

Below 200% FPL; under age 19

(0-18; 2-year average 2004-05)

28% of <200%; 13.4% of all

kids

919,000

•Texas is home to nearly 1.4 million uninsured children.

• 2/3 of these uninsured Texas children are below 200% of the federal poverty line, despite Medicaid and CHIP.

•More than HALF our uninsured Texas Kids Could be enrolled in Medicaid or CHIP today! (Adjusting for ~230,000 undocumented kids; another 160,000 legal immigrant (LPR) children can participate in CHIP (Pew Hispanic Center)).


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The Center for Public Policy Priorities encourages you to reproduce and distribute these slides, which were developed

for use in making public presentations.

If you reproduce these slides, please give appropriate credit to CPPP.

The data presented here may become outdated. For the most recent information, or to sign up for our free

e-mail updates, visit www.cppp.org

© CPPP


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Texas Medicaid: Who it Helps

Children, 1,769,244

Disabled, 353,390

Elderly, 367,672

Poor Parents, 55,901

TANF Parent, 24,288

Maternity, 93,063

February 2007, HHSC data.

Total enrolled 2/1/2007: 2.66 million


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CHIP and Medicaid: Helping Texas Kids

As of February 2007:

� 1.77 million Texas children (under age 19) were enrolled in Medicaid• about 100,700 of these children get Medicaid because of a serious disability • About 122,000 in TANF cash assistance families (7% of the kids)• About 12,700 pregnant teens (less than 1% of the children)• Other 1.53 MILLION predominantly in WORKING poor families

• 325,479 Texas children were enrolled in CHIP.

“CHIP stands on the broad shoulders of Medicaid”

That’s 2.09 million Texas children – nearly one-third of all our kids.


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Medicaid in Texas: Who it HelpsMedicaid: As of February, 2.7 million Texans were enrolled in Medicaid:895,000 were adults:

– 721,000 (80.5% of the adults) were elderly or disabled. Adults on SSI account for 60% of the aged and disabled recipients

– Other adults: 93,000 maternity coverage;

– 24,288 TANF cash assistance parents (less than 1% of total caseload);

• NOTE: there are fewer than 81,000 total poor parents on Texas Medicaid. 55,901 are parents who are at or below TANF income, but not receiving TANF cash assistance

Children’s Health Insurance Program (CHIP):• as of September 1, 2003 — 507,259 children • as of March 1, 2007 — 325,090 (drop of 182,169, or 36%)


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Income Caps for Texas Medicaid and CHIP, 2006

0%

50%

100%

150%

200%

250%

PregnantWomen

Newborns Age 1-6 Age 6-18 TANFparent of 2,no income

WorkingParent of 2

SSI (agedor

disabled)

Long TermCare

CHIP

Mandatory Optional

$22,078

$30,710/yr $30,710

185% 185%

133%

$16,600

100%$2,256 $3,696

13.6% 22.3%

74%

$7,476

222%

$21,708$33,200

200%

Income Limit as Percentage of Federal Poverty IncomeAnnual Income is for a family of 3,

except Individual Incomes shown for SSI and Long Term Care

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