Immigrants

1
Immigrants Health CareIssues Related to
Coverage and AccessDataspeak
AudioconferenceMaternal and Child Health
BureauJune 13, 2002

• Julie Hudman, PhD
• Associate Director
• Kaiser Commission on Medicaid and the Uninsured

2
Who Are the Immigrants in the United States?
3
Immigrants as a Percent of Total U.S. Population,
1850-2000
14.8
11.2
9.7
4.7
Note Immigrant is defined as a person who is not
a U.S. citizen who enters the U.S. with the
intent to remain for an indefinite period of
time. Total U.S. population in 2000 was 273
million. SOURCE U.S. Census Bureau, 2001
4
U.S. Immigrant Population,by Region of Birth,
1900-2000
Other
Asia
Latin America
Canada
Europe
10.3 million
14.2 million
9.7 million
14.1 million
19.8 million
28.4 million
9.6 million
Note For the 2000 data Canada was included in
the other category. SOURCE Schmidley and Gibson,
1999, Profile of the Foreign-Born Population in
the U.S. 1997, U.S. Census Bureau and Lollock,
Lisa, 2001, The Foreign-Born Population in the
U.S. March 2000, U.S. Census Bureau.
5
Geographical Distribution of Immigrants, 2000
Total Immigrants28.4 million

Note An immigrant is a person who is not a U.S.
citizen who enters the U.S. with the intent to
remain for an indefinite period of time. SOURCE
Passel , Urban Institute from the March 2000 CPS.

6
Legal Status of Immigrants, 2000
Total 30.7 million immigrants
SOURCE Passel ,Urban Institute preliminary
estimates based on Census 2000, March CPS 2000,
and analytic estimates.
7
Selected Employment Characteristics by
Citizenship Status, 2000
Percent of Population
Full-time Worker in Family
Poor
Type of Work
Work for Small Business (lt25)
Work In Agricultural, Labor/Cleaning or Craft/
Repair
Work In Managerial, Sales, Tech or Administration
SOURCE Urban Institute estimates based on March
2001 CPS data prepared for the Kaiser Commission
on Medicaid and the Uninsured.
8
What are the Programs and Policies that Affect
Immigrants Health Care Coverage?
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Medicaids Role in the Health System

• Covers the Low-Income Population
• Covers 1 in 10 nonelderly Americans
• Covers 1 in 5 children (22 million)
• Pays for nearly 40 of births
• The State Childrens Health Insurance Programs
  (CHIP) covers an additional 3.5 million children
• Provides a Comprehensive Benefit Package
• Mandatory services include inpatient hospital
  care, physician services, lab/x-ray services,
  immunizations and EPSDT services, and family
  planning services
• Optional services include prescription drugs,
  dental care and vision care
• Improves Access to care
• Improves access to physician services and
  preventive care
• Facilitates access to prenatal care

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Welfare Reforms Effects on Medicaidfor
Non-Citizens

• After PRWORA
• Qualified immigrants (legal permanent residents
  and others) who enter the country after August
  22, 1996 are barred from receiving federal
  funding for Medicaid and CHIP for five years.
  After the five years, the sponsors income is
  deemed before determining eligibility. States
  may choose to deny Medicaid or CHIP to these
  immigrants after the five year ban.
• Coverage for undocumented persons is restricted
  to emergency coverage only.
• Refugees/asylees are exempt from these provisions
  for seven years after receiving their status.

• Before PRWORA
• Most persons who are legal immigrants and
  permanent U.S. residents are are entitled to full
  Medicaid coverage.
• Coverage for undocumented persons is restricted
  to emergency coverage only.

Note PWRORA is the Personal Responsibility and
Work Opportunity Reconciliation Act of 1996.
11
State-Only Funding of Legal Immigrants arriving
after August 22, 1996
Number of States
Families/ Elderly/Disabled
Pregnant Women
Pregnant Women
Children
Separate CHIP Program
Medicaid
Medicaid
Medicaid
Prenatal Care Regardless of Immigrant Status
NOTE State policies as of May 2002. Some states
cover services in addition to prenatal care such
as primary and preventative care for children
(MA), long-term care (CA) or full Medicaid
benefits (RI). SOURCE National Immigration Law
Center, 2002.
12
How Does Immigrant Status Affect Health Coverage?
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Health Insurance Coverage of the Low-Income
Population by Citizenship Status, 2000
Non-Citizens
Total in group (millions)
70.0
9.4
1.9
3.8
3.7
Note Low-income is less than 200 of poverty.
Incomes less than 200 of federal poverty level
would be less than 27, 476 for a family of three
in 2000. Includes non-elderly only. SOURCE
Urban Institute estimates based on March 2000 CPS
data prepared for the Kaiser Commission on
Medicaid and the Uninsured.
14
Health Insurance Coverage ofLow-Income
Immigrants, 1995-2000
Uninsured
Medicaid
Note Low-income is less than 200 of poverty
(27,476) for a family of three. SOURCE Urban
Institute analysis of March 1996-2001 CPS
15
Low-Income Uninsured Population by Citizenship
Status, 2000
Total 24.5 million low-income uninsured
Note Low-income is less than 200 of poverty
(27,476) for a family of three in 2000. SOURCE
Urban Institute estimates based on March 2001 CPS
data.
16
Health Insurance, Access and Health Status of
Children, by Parents Immigrant Status, 1999
Note Children of immigrants are defined as those
with one or more foreign-born parents. 78 of
children born to immigrants are U.S. born
citizens. Low-income is less than 200 of FPL or
26,760 for a family of three. Data The 1999
National Survey of Americas Families, Urban
Institute. SOURCE Capps, 2001.
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Percentage of Uninsured Low-Income Children, by
Family Citizenship Status and Language, 1999
Parents Primary Language
Citizen Family
White, Citizen Family
Families with Mixed Citizenship Status
Non-Citizen Families
Hispanic
Data The 1999 National Survey of Americas
Families, Urban Institute. SOURCE Source Ku and
Waidman, How Race, Immigration Status and English
Proficiency Affect Insurance Coverage and Access
to Care, Forthcoming Report for the Kaiser
Commission on Medicaid and the Uninsured
18
Barriers to Medicaid/CHIP Coverage for Immigrants

• Eligibility
• Legal immigrants arriving after August 1996 are
  barred from Medicaid/CHIP federal funds for five
  years,
• Eligibility for Medicaid/CHIP has limits
  regardless of immigrant status,
• Undocumented immigrants are ineligible for any
  federal public coverage except emergency care.
• Enrollment
• Immigrants face barriers to enrollment, such as
• Language not spoken by Medicaid workers or
  providers,
• Discrimination by caseworkers or providers,
• Fear/misinformation about consequences of
  enrolling in coverage.

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How Does Immigrant Status Affect Access to Health
Care Services?
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Usual Source of Care for Low-Income Adults by
Citizenship Status, 1997
Note Low-income is less than 200 of poverty or
26,660 for a family of three in 1997. Data
National Survey of Americas Families, Urban
Institute. Source Ku and Matani, 2000.
21
Health Care Utilization for Low-Income Children,
by Citizenship Status, 1997
Average Number of Visits Per Year
Mental Health Visits
Dental Visits
Emergency Room Visits
Provider Visits
Note Low-income is less than 200 of poverty or
26,660 for a family of three in 1997. Data
National Survey of Americas Families, Urban
Institute. Source Ku and Matani, 2000.
22
Low-Income Children with a Doctor Visit in the
Last Year, by Family Citizenship Status and
Language, 1999
Parents Primary Language
Citizen Family
White, Citizen Family
Families with Mixed Citizenship Status
Non-Citizen Families
Hispanic
Data The 1999 National Survey of Americas
Families, Urban Institute. SOURCE Source Ku and
Waidman, How Race, Immigration Status and English
Proficiency Affect Insurance Coverage and Access
to Care, Forthcoming Report for the Kaiser
Commission on Medicaid and the Uninsured
23
Key Issues Facing Immigrant Populations

• Changes in where immigrants come from and where
  they settle
• Lack of health care coverage
• Barriers to accessing health care services
• Policies treating new immigrants differently
• Constantly changing political environment and
  economy.