1. Immigrants Access to Health Care: Emerging 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