Immigrants Access to Health Care: Emerging Trends and Issues

1
Immigrants Access to Health CareEmerging
Trends and Issues

• Gabrielle Lessard
• National Immigration Law Center
• January 27, 2005

2
Federal Issues

• Medicaid block grants
• Women Immigrants Safe Harbor Act (WISH)
• Eliminate restrictions on battered immigrant
  womens access to essential services, including
  Medicaid and SCHIP
  
• Violence Against Women Act (VAWA) reauthorization

3
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
  

4
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 applicants 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)

5
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
  

6
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

7
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

8
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

9
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

10
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)

11
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