Center for Public Policy Priorities 1 Immigrants and Public Benefits in Texas Immigrants and Public Benefits in Texas Immigration and Border Security Hearing House Committee on State Affairs House Committee on Border and International Affairs March 28, 2007 Anne Dunkelberg, Associate Director 900 Lydia Street - Austin, Texas Phone (512) – fax (512)

Center for Public Policy Priorities 2 The Numbers Texas Population now ~ million –About 1.1 million are naturalized US citizens who were born abroad (U.S. Census) U.S. Census does NOT provide information on immigration STATUS, only citizenship status. –About million are “Unauthorized” (Pew Hispanic Center) Some persons in this estimate have legal authorization to live and work in the United States on a temporary basis. These include migrants with temporary protected status (TPS) and some migrants with unresolved asylum claims. Together they may account for as much as 10% of the estimate. –About 1.2 million are Legal Immigrants, mostly Legal Permanent Residents LPRs are foreign nationals who have been granted the right to reside permanently in the United States. LPRs are often referred to simply as “legal immigrants," but they are also known as “permanent resident aliens” and “green card holders.” –Texas #3 or #4 in the number of newly arrived Legal Immigrants for the last several years; tied for #3 in adoptions from overseas in recent years. –23 percent of ALL Texas' children live in "mixed families" (one or more parent is non-citizen) –34 percent of Texas' children in low-income families (below 200% of the federal poverty line) are in mixed families (Census 2001 CPS, CBPP)

Center for Public Policy Priorities 3 Basic Immigration Status Vocabulary “Alien” is a term used in many laws to refer to immigrants (both legally present and undocumented). “Undocumented” Immigrants include 2 groups -- –EWIs (Entries Without Inspection) –Overstays (came with a legal visa, but stayed after it expired; these make up % of all undocumented) –Other terms: “not lawfully present”, “illegal aliens” “Legal” immigrants include many different legal statuses –Some are permanent or long-term statuses, that is, the immigrant can reside in the U.S. indefinitely as long as they do not commit crimes: e.g., LPRs (lawful permanent residents), Refugees, Asylees –Others are temporary, or transitional statuses, which may be indefinite in length (e.g., the spouse, child or fiancée of a US citizen waiting to get LPR status may have a “K” Visa), or they may be required to get approval for renewal of status at regular intervals (e.g., “Temporary Protected Status). –MOST LPRs in the US are family-based immigrants. All legal immigrants are NOT treated equally with regard to federal benefits.

Center for Public Policy Priorities 4 Immigrant Eligibility for Public Benefits: A Short Review Before 1996 “Welfare Reform” law (PRWORA), most legally present immigrants were treated the same as U.S. citizens for purposes of federal benefit eligibility. PRWORA created new terms: “Qualified”, “Not Qualified.” “Not qualified” now includes undocumented, plus some legally present immigrants. These are NOT immigration law terms, just public benefit classifications. Despite term “qualified,” PRWORA reduced eligibility of qualified immigrants for benefits. Also, big differences in eligibility depend on whether in US prior to Aug. 22, 1996 (date PRWORA signed). Congress has, over time, restored portions of the Legal (Qualified) Immigrant cuts proposed in PRWORA, especially for Food Stamps. Also, access to critical health and crisis services for “Not Qualified” is protected under federal law and regulation.

Center for Public Policy Priorities 5 Certain Legal Immigrants are Exempt From Any Benefit Limits: These persons are eligible for SSI, Food Stamps, Medicaid, TANF, or CHIP on same basis as U.S. citizens: Refugees, asylees, withholding of deportation, Cuban & Haitian, may collect during first 7 years in U.S. (EXCEPT: TANF window is 5 years, Amerasians may only get 5 years Medicaid, SSI). Persons with 10 years (40 quarters) of U.S. work history –immigrants with date of arrival 8/22/96 or later must have 40 quarters AND have been in US more than 5 years) –families “share” quarters (married couples and their minor children) Active-duty U.S. military and veterans (& spouse, dependent children)

Center for Public Policy Priorities 6 New Categories Related to Public Benefit Eligibility QualifiedNon-qualified Legal Permanent Residents Undocumented persons Refugees, AsyleesLegally present Non-qualified Withholding of DeportationEmployment Visas (incl. Ag.) Granted Conditional EntryTemporary Protected Status ParoleesIn US since 1/72 (not LPR) Domestic Violence “VAWA” petitioners (must have US citiz. or LPR spouse) Lawful Temporary Residents Family Unity Status Certain Voluntary Departure Certain Stays, Suspensions of Deportation Victims Of Trafficking (not technically “qualified”, but eligible for all federal benefits Non-immigrants (tourists, students)

Center for Public Policy Priorities 7 The Big Picture: Undocumented Immigrants are not eligible for Medicaid, CHIP SSI, Food Stamps, or TANF (cash assistance). –This is NOT a new policy for undocumented persons; these programs never included the undocumented. State and local programs that use federal funds MUST abide by the federal policy regarding immigrants—legal and undocumented—related to those funds (i.e., they cannot impose stricter rules). Many Legal Immigrants are still eligible for benefits from federally funded programs, including many programs the state administers.

Center for Public Policy Priorities 8 The Big Picture: Undocumented immigrants must be provided access to many federally funded programs, especially health care programs, short-term emergency and intervention services, WIC, and school meals. –Access to emergency and crisis services is ALSO mandated under federal law even when a program is funded entirely with state or local funds. U.S. citizen children (i.e., all children born in U.S.) can be eligible for public benefits, regardless of the immigration status of the parents. Federal policy protects these children’s rights. –Only the applicant's status is relevant to his eligibility; for example, the parent's immigration status is irrelevant to a U.S. citizen child's eligibility for public benefits.

Center for Public Policy Priorities 9 Some Programs MUST be Available to ALL PERSONS in Need; MAY NOT exclude undocumented Public programs, whether federal, state or local, MUST NOT restrict access based on immigration status if they provide any of the following: –Emergency Medicaid, immunizations, diagnosis (testing) and treatment of communicable disease –Non-cash assistance needed to protect life and safety and not income-conditional (e.g., shelters, soup kitchens, crisis intervention) as specified by U.S. Attorney General (see next slide) –Short-term, in-kind emergency disaster relief – WIC, school meals, child nutrition programs, and elderly nutrition IMPORTANT: when they provide the benefits listed above, service providers –are not required to verify citizenship or immigration status (exception: Emergency Medicaid), and –MAY NOT EXCLUDE UNDOCUMENTED PERSONS.

Center for Public Policy Priorities 10 U.S. Attorney General’s List Of Programs “Necessary To Protect Life Or Safety” Which Must Be Open To All In Need Child protection & adult protective services Violence and abuse prevention, including domestic violence Mental illness or substance abuse treatment Short-term shelter or housing assistance (e.g. battered women’s shelters, homeless, disaster shelters) Programs during adverse weather conditions Soup kitchens, food banks, senior nutrition programs Medical & public health services & mental health, disability or substance abuse services necessary to protect life or safety Programs to protect the life and safety of workers, children & youths, or community residents Other services necessary for the protection of life or safety

Center for Public Policy Priorities 11 Texas CHIP: Coverage of non-U.S. Citizens Undocumented persons are not eligible for either Medicaid or CHIP Federal law REQUIRES Texas to include Legal Immigrant children (who qualify by income) IF they have been in the U.S. for 5 years or more. –Texas has CHOSEN since creation of CHIP to also cover the small group of Legal Immigrant children who are in their first 5 years in U.S. –Legal Immigrant kids in CHIP already have to provide their immigration documents to get CHIP. –All CHIP policies (premiums, asset test, etc.) for these children identical to those for U.S.-citizen children; state tracks their expenses separately.

Center for Public Policy Priorities 12 Texas CHIP: Coverage of non-U.S. Citizens Undocumented persons are not eligible for either Medicaid or CHIP HHSC reports about 16,000 legal immigrant children per month were enrolled in fiscal year 2006; it is assumed that this group’s caseload has declined along with the rest of CHIP enrollment. Combined child Medicaid and CHIP enrollment in Texas in February 2007 is 2.09 million, so the immigrant CHIP children made up less than 1% of enrollment (0.79%). NOTE: Because Texas has not exercised its option under federal law* to provide Medicaid to otherwise-eligible Legal Immigrants who arrived after 8/22/96, LPR children at Medicaid incomes are eligible for Texas CHIP. In other words, the immigrant portion of CHIP is serving children who otherwise would be served in Medicaid.

Center for Public Policy Priorities 13 Texas CHIP: Coverage of non-U.S. Citizens Undocumented persons are not eligible for either Medicaid or CHIP –Vast majority of these children will eventually naturalize to become U.S. citizens. Texas’ modest investment today helps give these future citizens a healthy start. –Because legal immigrant children become eligible for federally-funded CHIP after 5 years, the program is self- limiting in size: children are “aging out” of the program at the same rate new children become eligible. –Opponents imply that eliminating coverage will result in savings to Texas taxpayers, but costs of care for these children will be shifted to Texas' charity care providers: public and nonprofit hospitals, cities, counties, community health centers, and others who care for the uninsured. –Eighteen other states have similar programs for their legal immigrant children: California, Connecticut, Delaware, District of Columbia, Hawaii, Illinois, Maine, Massachusetts, Minnesota, Nebraska, New Jersey, New Mexico, New York, Oklahoma, Pennsylvania, Rhode Island, Virginia, Washington and Wyoming.

Center for Public Policy Priorities 14 Texas Medicaid: Coverage of non-U.S. Citizens Undocumented persons are not eligible for either Medicaid or CHIP Full Medicaid Coverage Legal Immigrants who came to US before 8/96 treated same as U.S. Citizens Texas has chosen (federal law option) NOT to provide Medicaid to Legal Immigrants who arrived after 8/96 –Example: Lawful permanent resident of U.S. who entered U.S. in 1998 cannot get coverage, even if severely disabled “Emergency” Medicaid Nearly half the persons whose care is covered under this category are LEGAL immigrants, because we exclude them from full Medicaid NOT available to pay for E.R. care for every immigrant: ONLY those who meet every other Medicaid requirement except immigration/ citizenship status –Example: undocumented 25 year-old single construction worker cannot get covered

Center for Public Policy Priorities 15 How Does Immigration Factor In Uninsured Rate? Immigrants are NOT the primary cause of Texas’ last-place ranking –Census Bureau reported 1.3 million uninsured non- citizens (includes both legal residents and undocumented persons); (54.5% of non-citizens) –BUT, if you remove non-citizens from the equation, Texas would still be tied with New Mexico for the worst uninsured rate at 20.6% uninsured (4.2 million), even if you left the non-citizens in the other state’s counts Without immigrants, New Mexico’s rate would drop to 18.9%

Center for Public Policy Priorities 16 Uninsured Texas Children: We CAN Cut the Number in Half by Enrolling Kids Who are Eligible Right Now Texas Children who are Uninsured, – U.S. Census CPS All incomes, under age 19 (0-18*; 2-year average ) 20.4%1.367 million Below 200% FPL; under age 19 (0-18; 2-year average ) 28% of <200%; 13.4% of all kids 919,000 Texas is home to nearly 1.4 million uninsured children. 2/3 of these uninsured Texas children are below 200% of the federal poverty line, despite Medicaid and CHIP. More than HALF our uninsured Texas Kids Could be enrolled in Medicaid or CHIP today! (Adjusting for ~230,000 undocumented kids; another 160,000 legal immigrant (LPR) children can participate in CHIP (Pew Hispanic Center)).

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Center for Public Policy Priorities 18 Texas Medicaid: Who it Helps February 2007, HHSC data. Total enrolled 2/1/2007: 2.66 million

Center for Public Policy Priorities 19 CHIP and Medicaid: Helping Texas Kids As of February 2007: 1.77 million Texas children (under age 19) were enrolled in Medicaid about 100,700 of these children get Medicaid because of a serious disability About 122,000 in TANF cash assistance families (7% of the kids) About 12,700 pregnant teens (less than 1% of the children) Other 1.53 MILLION predominantly in WORKING poor families 325,479 Texas children were enrolled in CHIP. “CHIP stands on the broad shoulders of Medicaid” That’s 2.09 million Texas children – nearly one-third of all our kids.

Center for Public Policy Priorities 20 Medicaid in Texas: Who it Helps Medicaid: As of February, 2.7 million Texans were enrolled in Medicaid: 895,000 were adults: –721,000 (80.5% of the adults) were elderly or disabled. Adults on SSI account for 60% of the aged and disabled recipients –Other adults: 93,000 maternity coverage; –24,288 TANF cash assistance parents (less than 1% of total caseload); NOTE: there are fewer than 81,000 total poor parents on Texas Medicaid. 55,901 are parents who are at or below TANF income, but not receiving TANF cash assistance Children’s Health Insurance Program (CHIP): as of September 1, 2003 — 507,259 children as of March 1, 2007 — 325,090 (drop of 182,169, or 36%)

Center for Public Policy Priorities 21 Income Caps for Texas Medicaid and CHIP, 2006 $22,078 $30,710/yr$30, % 133% $16, % $2,256$3, %22.3% 74% $7, % $21,708 $33, % Income Limit as Percentage of Federal Poverty Income Annual Income is for a family of 3, except Individual Incomes shown for SSI and Long Term Care