Immigrant Access to Health and Human Services: Final Report

R E S E A R C H R E P O R T Immigrant Access to Health and Human Services Final Report Edited by Julia Gelatt and Heather Koball October 2014 I M M I G R A N T S A N D I M M I GR A T I O N A B O U T T H E U R B A N I N S T I T U T E The nonprofit Urban Institute is dedicated to elevating the debate on social and economic policy. For nearly five decades, Urban scholars have conducted research and offered evidence-based solutions that improve lives and strengthen communities across a rapidly urbanizing world. Their objective research helps expand opportunities for all, reduce hardship among the most vulnerable, and strengthen the effectiveness of the public sector. The Urban Institute is a nonprofit policy research organization. It has been incorporated and is operated as a public charity. It has received official IRS recognition of its tax-exempt status under section 501(c)(3) of the Internal Revenue Code. The Institute’s federal ID number is 52-0880375. Donations will be tax deductible and may be disclosed to the IRS and the public, unless given anonymously. We are committed to transparent accounting of the resources we receive. In addition to required tax filings, a copy of the Urban Institute’s audited financial statement is available to anyone who requests it. Copyright © October 2014. Urban Institute. Permission is granted for reproduction of this file, with attribution to the Urban Institute. Cover image from AP Photo/John Raoux. Contents Acknowledgments iv Introduction 1 Immigrant Eligibility for Federally Funded SNAP, TANF, Medicaid, and CHIP 2 State Policies on Immigrant Eligibility for Health and Human Services 3 Rates of Program Use 7 Changes to Health Insurance Policy under the Affordable Care Act 8 Promising Practices and Remaining Challenges for Connecting Immigrant Families to Health Insurance in California 9 Barriers and Promising Practices in Four States 11 Methods and Context within the States 11 Barriers to Accessing Health and Human Services 12 Promising Practices for Increasing Immigrants’ Access to Services 14 The Role of CBOs in Facilitating Access to Benefits 16 Conclusions 17 Appendix A. Definitions 19 Appendix B. Methods 21 Notes 23 References 24 About the Editors 25 Figures 1. Availability of Federally Funded and State-Funded Medicaid and CHIP to Pregnant Women and Children during First Five Years of Lawfully Present Status, 2011 4 2. States Providing State-Funded Health Coverage to Nonqualified Immigrants, 2011 5 3. States Providing State-Funded Food Assistance to Immigrants Ineligible for Federally Funded SNAP, 2011 6 4. States Providing State-Funded Cash Assistance to Immigrants during Five-Year Ban, 2009 6 IV A C K N O W L E D G M E N T S Acknowledgments This study was conducted by the Urban Institute under contract number HHSP23320095654WC, task order number HHSP2333014T, with the US Department of Health and Human Services’ (DHHS) Office of the Assistant Secretary for Planning and Evaluation (ASPE). The authors take full responsibility for the accuracy of material presented herein. The views expressed are those of the authors and should not be attributed to ASPE or DHHS. This report includes material drawn from the seven briefs and one policy report produced as part of the Immigrant Access to Health and Human Services project, which maps and describes the legal and policy contexts that govern and affect immigrant access to health and human services. Through a synthesis of existing information, supplemented by in-depth visits to purposively selected sites, the study aims to identify and describe federal, state, and local program eligibility provisions related to immigrants; major barriers (such as language and family structure) to immigrants’ access to health and human services for which they are legally eligible; and innovative or promising practices that can help states manage their programs. The information presented here was gathered by the following team of researchers: Robert Crosnoe, Karina Fortuny, Julia Gelatt, Devlin Hanson, Michael Huntress, Genevieve M. Kenney, Heather Koball, Juan Manuel Pedroza, Krista M. Perreira, Kelly Purtell, Kjersti Ulvestad, Christina Weiland, Hirokazu Yoshikawa, and Ajay Chaudry, who contributed to this work while at the Urban Institute. This final report was prepared by Julia Gelatt and Heather Koball. We are grateful to our many colleagues at the Urban Institute who provided assistance and feedback throughout this project and to David Nielsen from the Office of the Assistant Secretary for Planning and Evaluation at the Department of Health and Human Services for his thoughtful comments and guidance on the prior products in this series and on this final report. We appreciate the editorial assistance of Ashleigh Rich and Fiona Blackshaw, and the production assistance of Scott Forrey, David Connell, and Leigh Franke. Urban strives for the highest standards of integrity and quality in its research, analyses, and p