A Comprehensive Review of Immigrant Access to Health and Human Services

A COMPREHENSIVE REVIEW OF IMMIGRANT ACCESS TO HEALTH AND HUMAN SERVICES KARINA FORTUNY AJAY CHAUDRY Urban Institute June 2011 Report Submitted to Department of Health and Human Services Office of Assistant Secretary for Planning and Evaluation By Karina Fortuny Ajay Chaudry The Urban Institute June 2011 ii This study was conducted by the Urban Institute under Contract Number HHSP23320095654WC, Task Order Number HHSP2333014T with the U.S. Department of Health and Human Services’ (HHS) 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 HHS. The authors would like to thank Genevieve Kenney and Olivia Golden for their invaluable contributions to this report. The authors are grateful to Sarah Spector and Tanya Broder for their comprehensive review and helpful information and David Nielsen for his thoughtful comments and guidance. The Urban Institute is a nonprofit, nonpartisan policy research and educational organization that examines the social, economic, and governance challenges facing the nation. Views expressed in this report are those of the authors and do not necessarily reflect the views of the Institute, its trustees, or its funders. iii About the Project The Immigrant Access to Health and Human Services study maps and describes the policy context that can affect immigrant access to health and human services as well as the well-being of immigrants and their children. The study is funded by the Office of Assistant Secretary for Planning and Evaluation at the U.S. Department of Health and Human Services. Through synthesis of existing information, supplemented by in-depth visits to purposively selected sites, the project identifies and describes the eligibility criteria related to immigrants under major federal and federal/state health and human service programs, in particular TANF, SNAP, Medicaid, and CHIP; the major barriers to immigrants’ access to health and human services, including barriers due to program eligibility provisions, immigration enforcement initiatives, family composition, or other factors; the potential impact on immigrant families of new eligibility provisions being implemented under health care reform; and innovative or promising practices, program designs, or other strategies and initiatives that appear to facilitate or improve immigrant families’ access to health and human services. This paper summarizes the policy landscape affecting immigrants’ eligibility for, and access to, health and human services from a review of literature and existing information. It provides a building block for the fieldwork and in-depth analyses of immigrant access to health and human services. iv Acronyms CHIP Children’s Health Insurance Program CHIPRA Children’s Health Insurance Program Reauthorization Act of 2009 IIRIRA Illegal Immigration Reform and Immigrant Responsibility Act of 1996 PRWORA Personal Responsibility and Work Opportunity Reconciliation Act of 1996 SNAP Supplemental Nutrition Assistance Program (formerly known as the Food Stamp Program) SSI Supplemental Security Income TANF Temporary Assistance for Needy Families v Contents Tables and Figures .................................................................................................................................... v Introduction .............................................................................................................................................. 1 Overview of Federal Policy ....................................................................................................................... 3 Federal Programs and State Provisions .................................................................................................. 10 Immigration Enforcement and Policies .................................................................................................. 21 Data Sources ........................................................................................................................................... 25 Discussion ............................................................................................................................................... 28 References .............................................................................................................................................. 33 Tables and Figures Table 1. Immigrant Eligibility for Federally Funded SNAP, TANF, Medicaid, and CHIP ............................ 8 Table 2. State-Only-Funded Cash Assistance to Immigrants by State .................................................... 12 Table 3. Medicaid and CHIP Assistance and State-Only Health Covera