Figure 0 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Immigrants’ Health Care: Issues Related to Coverage and Access Dataspeak Audioconference Maternal and Child Health Bureau June 13, 2002 Julie Hudman, PhD Associate Director Kaiser Commission on Medicaid and the Uninsured

Figure 1 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Who Are the Immigrants in the United States?

Figure 2 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Immigrants as a Percent of Total U.S. Population, % 14.8% 4.7% 11.2% Note: Immigrant is defined as a person who is not a U.S. citizen who enters the U.S. with the intent to remain for an indefinite period of time. Total U.S. population in 2000 was 273 million. SOURCE: U.S. Census Bureau, 2001

Figure 3 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured U.S. Immigrant Population, by Region of Birth, million 14.2 million 9.7 million 14.1 million 19.8 million 28.4 million Europe Canada Latin America Asia Other Note: For the 2000 data Canada was included in the other category. SOURCE: Schmidley and Gibson, 1999, Profile of the Foreign-Born Population in the U.S.: 1997, U.S. Census Bureau ;and Lollock, Lisa, 2001, The Foreign-Born Population in the U.S.: March 2000, U.S. Census Bureau. 9.6 million

Figure 4 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Geographical Distribution of Immigrants, 2000 Note: An immigrant is a person who is not a U.S. citizen who enters the U.S. with the intent to remain for an indefinite period of time. SOURCE: Passel, Urban Institute from the March 2000 CPS. Total Immigrants=28.4 million

Figure 5 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Legal Status of Immigrants, 2000 Total: 30.7 million immigrants SOURCE: Passel,Urban Institute preliminary estimates based on Census 2000, March CPS 2000, and analytic estimates.

Figure 6 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Selected Employment Characteristics by Citizenship Status, 2000 SOURCE: Urban Institute estimates based on March 2001 CPS data prepared for the Kaiser Commission on Medicaid and the Uninsured. Poor Full-time Worker in Family Work In Agricultural, Labor/Cleaning or Craft/ Repair Percent of Population Work for Small Business (<25) Work In Managerial, Sales, Tech or Administration Type of Work

Figure 7 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured What are the Programs and Policies that Affect Immigrants’ Health Care Coverage?

Figure 8 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Medicaid’s Role in the Health System Covers the Low-Income Population –Covers 1 in 10 nonelderly Americans –Covers 1 in 5 children (22 million) –Pays for nearly 40% of births –The State Children’s Health Insurance Programs (CHIP) covers an additional 3.5 million children Provides a Comprehensive Benefit Package –Mandatory services include inpatient hospital care, physician services, lab/x-ray services, immunizations and EPSDT services, and family planning services –Optional services include prescription drugs, dental care and vision care Improves Access to care –Improves access to physician services and preventive care –Facilitates access to prenatal care

Figure 9 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Welfare Reform’s Effects on Medicaid for Non-Citizens Before PRWORA Most persons who are legal immigrants and permanent U.S. residents are are entitled to full Medicaid coverage. Coverage for undocumented persons is restricted to emergency coverage only. After PRWORA “Qualified immigrants” (legal permanent residents and others) who enter the country after August 22, 1996 are barred from receiving federal funding for Medicaid and CHIP for five years. After the five years, the sponsor’s income is “deemed” before determining eligibility. States may choose to deny Medicaid or CHIP to these immigrants after the five year ban. Coverage for undocumented persons is restricted to emergency coverage only. Refugees/asylees are exempt from these provisions for seven years after receiving their status. Note: PWRORA is the Personal Responsibility and Work Opportunity Reconciliation Act of 1996.

Figure 10 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured State-Only Funding of Legal Immigrants arriving after August 22, 1996 Number of States NOTE: State policies as of May Some states cover services in addition to prenatal care such as primary and preventative care for children (MA), long-term care (CA) or full Medicaid benefits (RI). SOURCE: National Immigration Law Center, Children Pregnant Women Families/ Elderly/Disabled Pregnant Women Separate CHIP Program Medicaid Prenatal Care Regardless of Immigrant Status

Figure 11 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured How Does Immigrant Status Affect Health Coverage?

Figure 12 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Health Insurance Coverage of the Low-Income Population by Citizenship Status, Note: Low-income is less than 200% of poverty. Incomes less than 200% of federal poverty level would be less than $27, 476 for a family of three in Includes non-elderly only. SOURCE: Urban Institute estimates based on March 2000 CPS data prepared for the Kaiser Commission on Medicaid and the Uninsured. Non-Citizens 1.9 Total # in group (millions):

Figure 13 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Health Insurance Coverage of Low-Income Immigrants, Note: Low-income is less than 200% of poverty ($27,476) for a family of three. SOURCE: Urban Institute analysis of March CPS Uninsured Medicaid

Figure 14 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Low-Income Uninsured Population by Citizenship Status, 2000 Total= 24.5 million low-income uninsured Note: Low-income is less than 200% of poverty ($27,476) for a family of three in SOURCE: Urban Institute estimates based on March 2001 CPS data.

Figure 15 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Health Insurance, Access and Health Status of Children, by Parents’ Immigrant Status, 1999 Note: Children of immigrants are defined as those with one or more foreign-born parents. 78% of children born to immigrants are U.S. born citizens. Low-income is less than 200% of FPL or $26,760 for a family of three. Data: The 1999 National Survey of America’s Families, Urban Institute. SOURCE: Capps, 2001.

Figure 16 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Percentage of Uninsured Low-Income Children, by Family Citizenship Status and Language, 1999 Hispanic Citizen Family EnglishSpanish White, Citizen Family Families with Mixed Citizenship Status Non-Citizen Families Parents’ Primary Language Data: The 1999 National Survey of America’s Families, Urban Institute. SOURCE: Source: Ku and Waidman, How Race, Immigration Status and English Proficiency Affect Insurance Coverage and Access to Care, Forthcoming Report for the Kaiser Commission on Medicaid and the Uninsured

Figure 17 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Barriers to Medicaid/CHIP Coverage for Immigrants Eligibility : Legal immigrants arriving after August 1996 are barred from Medicaid/CHIP federal funds for five years, Eligibility for Medicaid/CHIP has limits regardless of immigrant status, Undocumented immigrants are ineligible for any federal public coverage except emergency care. Enrollment : Immigrants face barriers to enrollment, such as: –Language not spoken by Medicaid workers or providers, –Discrimination by caseworkers or providers, –Fear/misinformation about consequences of enrolling in coverage.

Figure 18 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured How Does Immigrant Status Affect Access to Health Care Services?

Figure 19 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Usual Source of Care for Low-Income Adults by Citizenship Status, 1997 Note: Low-income is less than 200% of poverty or $26,660 for a family of three in Data: National Survey of America’s Families, Urban Institute. Source: Ku and Matani, 2000.

Figure 20 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Health Care Utilization for Low-Income Children, by Citizenship Status, 1997 Note: Low-income is less than 200% of poverty or $26,660 for a family of three in Data: National Survey of America’s Families, Urban Institute. Source: Ku and Matani, Provider Visits Emergency Room Visits Dental Visits Mental Health Visits Average Number of Visits Per Year

Figure 21 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Low-Income Children with a Doctor Visit in the Last Year, by Family Citizenship Status and Language, 1999 Hispanic Citizen Family EnglishSpanish White, Citizen Family Families with Mixed Citizenship Status Non-Citizen Families Parents’ Primary Language Data: The 1999 National Survey of America’s Families, Urban Institute. SOURCE: Source: Ku and Waidman, How Race, Immigration Status and English Proficiency Affect Insurance Coverage and Access to Care, Forthcoming Report for the Kaiser Commission on Medicaid and the Uninsured

Figure 22 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Key Issues Facing Immigrant Populations Changes in where immigrants come from and where they settle; Lack of health care coverage; Barriers to accessing health care services; Policies treating new immigrants differently; Constantly changing political environment and economy.