Immigrants and Public Benefits in Texas

1 Immigrants and Public Benefits in Texas Immigration and Border Security Hearing House Committee on State Affairs House Committee on Border and International Affairs. Presented March 28, 2007, rev. 10/24/07 Anne Dunkelberg, Associate Director (dunkelberg@cppp.org) 900 Lydia Street - Austin, Texas 78702 Phone (512) 320-0222 fax (512) 320-0227 -

The Numbers Texas Population now ~ 22.5-23 million About 1.1 million naturalized US citizens who were born abroad (U.S. Census) U.S. Census does NOT provide information on immigration STATUS, only citizenship status. About 1.4-1.6 million 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 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 also #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 (<200% FPL) are in mixed families (Census 2001 CPS, CBPP) 2

Basic Immigration Status Vocabulary 3 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 25-40% 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.

4 Immigrant Eligibility for Public Benefits: A Short Review Before 1996 Welfare Reform law (PRWORA), most legally present immigrants treated same as 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 8/22/96 (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.

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). 5 Persons with 10 years (40 quarters) 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)

New Categories Related to Public Benefit Eligibility Qualified Non-qualified 6 Legal Permanent Residents Refugees, Asylees Withholding of Deportation Granted Conditional Entry Parolees Domestic Violence VAWA petitioners (must have US citiz. Or LPR spouse) Undocumented persons Legally present Non-qualified Employment Visas (incl. Ag.) Temporary Protected Status In US since 1/72 (not LPR) Lawful Temporary Residents Family Unity Status Certain Voluntary Departure Victims Of Trafficking (not technically qualified, but but eligible for all federal benefits Certain Stays, Suspensions of Deportation Non-immigrants (tourists, students)

The Big Picture: 7 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.

The Big Picture: 8 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.

Some Programs MUST be Available to ALL PERSONS in Need; MAY NOT exclude undocumented 9 Public programs, whether federal, state or local, MUST NOT restrict access based on Immigration status if they do any of the following: Emergency Medicaid, immunizations, diagnosis (testing) and treatment of communicable disease Non-cash assistance needed to protect life & safety and not income-conditional (e.g., shelters, soup kitchens, crisis intervention) as specified by U.S. Atty. 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.

U.S. Attorney General s List Of Programs Necessary To Protect Life Or Safety Which Must Be Open To All In Need 10 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 & safety of workers, children & youths, or community residents Other services necessary for the protection of life or safety

Texas CHIP: Coverage of non-u.s. Citizens Undocumented persons are not eligible for either Medicaid or CHIP 11 Federal law REQUIRES Texas to include Legal Immigrant children (who qualify by income) IF they have been in U.S. 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.

Texas CHIP: Coverage of non-u.s. Citizens Undocumented persons are not eligible for either Medicaid or CHIP 12 HHSC reports about 16,000 legal immigrant children per month were enrolled in FY 2006, but 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.

Texas CHIP: Coverage of non-u.s. Citizens Undocumented persons are not eligible for either Medicaid or CHIP 13 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 federallyfunded 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, and 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.

Texas Medicaid: Coverage of non-u.s. Citizens Undocumented persons are not eligible for either Medicaid or CHIP 14 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 ER care for every immigrant: ONLY those who meet every other Medicaid requirement except immigration/citizenship status Example: undocumented 25 year-old single construction worker construction worker cannot get covered

Texans and Health Insurance 15 US Census Bureau Statistics (March 2007 CPS): Approximately 5.7 million Texans uninsured in 2006 24.5% of Texans of all ages were uninsured (versus 15.8% U.S.) Ages 0-18: 22% uninsured Ages 19-64: 29.8% uninsured Ages 65: 3.2% uninsured Another three million Texans covered by Medicaid or CHIP (i.e., generally not insured through private coverage) The BIG difference: Texas has far lower coverage through work ( ESI ) than U.S. (52.2% of Texans have ESI, vs. 59.7% in US) even though Texas has very high rates of employment. Even large firms (100-499 workers) have 19% uninsured!

Uninsured Texans by Age Group, 2006 16 57% are below 200% FPL 19-64 2/3 are below 200% FPL 0-18 Rate: 22% of 0-18 are uninsured 0-18 19-64 65+ Rate: 30% of 19-64 are Uninsured

Uninsured Texas Children: We CAN Cut the Number in Half by Enrolling Kids Who are Eligible Right Now 17 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)). Texas Children who are Uninsured, 2004-05 U.S. Census All incomes, under age 19 (0-18*; 2-year average 2004-05 Census CPS) < 200% FPL; under age 19 (0-18; 2-year average 2004-05 Census CPS) 20.4% 28% of <200%; 13.4% of all kids 1.367 million 919,000

How Does Immigration Factor In Uninsured Rate? 18 Immigrants are NOT the primary cause of Texas last-place ranking Census Bureau reported 2.48 million non-citizens (includes both legal residents and undocumented persons); 1.5 million of them are uninsured (61% of noncitizens) BUT! If you removed non-citizens from the equation, Texas would still have the worst uninsured rate at 20% uninsured (4.2 million), even if you left the non-citizens in the other state s counts. So, immigrants are only part of the problem, not the cause, and only about 1/5 of Texas uninsured.

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Texas Medicaid: Who it Helps 20 Disabled, 359,937 July 2007, HHSC data. Elderly, 368,135 Poor Parents, 91,838 TANF Parent, 23,263 Maternity, 96,036 Children, 1,845,159 Total enrolled 7/1/2007: 2.79 million

CHIP and Medicaid: Helping Texas Kids 21 As of September 1, 2007: 1.84 million Texas children (under age 19) were enrolled in Medicaid about 105,000 of these children get Medicaid because of a serious disability About 117,000 in TANF cash assistance families (6% of the kids, 4% of Medicaid) About 12,700 pregnant teens (less than 1% of the children, 12% of maternity) Other 1.6 MILLION predominantly in WORKING poor families 327,379 Texas children were enrolled in CHIP. CHIP stands on the broad shoulders of Medicaid That s 2.2 million Texas children nearly one-third of all our kids.

Medicaid in Texas: Who it Helps 22 Medicaid: As of July 2.8 million Texans were enrolled in Medicaid: 940,000 were adults: 728,000 (77% of the adults) were elderly or disabled. Adults on SSI account for 58.5% of the aged and disabled recipients Other adults: 96,000 maternity coverage; 23,263 TANF cash assistance parents (less than 1.0% of total caseload); NOTE: there are about 115,000 total poor parents on Texas Medicaid. 92,000 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 September 1, 2007 327,379 (drop of -179,880, or 35.5%

23 Income Caps for Texas Medicaid and CHIP, 2007 250% 200% 150% 100% 50% 0% $31,765/yr Pregnant Women $31,765/yr $22,836/yr 185% 185% 133% $17,170 100% Newborns Age 1-6 Age 6-18 TANF parent of 2, no income Working Parent of 2 $7,716 $2,256 $3,696 13.1% 21.5% 74% SSI (aged or disabled) $22,428 222% Long Term Care $34,3400 200% CHIP Mandatory Optional 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

Texas CHIP Enrollment (May 2000-September 2007) 24 600,000 Highest, 5/02: 529,271 9/03: 507,259 400,000 200,000 0 May-00 Sep-00 Jan-01 May-01 Sep-01 Jan-02 May-02 Sep-02 Jan-03 May-03 Sep-03 Jan-04 May-04 Sep-04 Jan-05 May-05 Sep-05 Jan-06 May-06 Sep-06 Jan-07 May-07 Sep-07 Source: All figures from Texas Health and Human Services Commission; Compares most recent month with September 2003 9/07: 327,379

2,200,000 Texas Child Medicaid Enrollment Simplified Enrollment begins under SB 43 (February 2001-August 2007) Old High: 1,838,239 August 2007: 1,836,498 25 1,900,000 1,600,000 1,300,000 1,000,000 Feb-01 Jun-01 Oct-01 Feb-02 Jun-02 Oct-02 2006 low: 1,720,025 Feb-03 Jun-03 Oct-03 Feb-04 Jun-04 Oct-05 Feb-05 Jun-05 Oct-05 Feb-06 Jun-06 Oct-06 Source: Texas Health and Human Services Commission 1/2007 to present include perinates Feb-07 Jun-07

26 Texas Child Medicaid and CHIP Enrollment 3.0 6.5 Enrollment (millions) 2.5 2.0 1.5 Jan 02 Apr 02 Jul 02 Sept. 03: 2,150,543 Estimated child population growth of almost 70,000 per year Combined CHIP/Child Medicaid Enrollment Oct 02 Jan 03 Apr 03 Jul 03 Oct 03 Jan 04 Apr 04 Jul 04 Oct 04 Jan 05 Apr 05 Jul 05 Oct 05 Jan 06 September 07: 2,163,877 Apr 06 Jul 06 Oct 06 Jan 07 Apr 07 Jul 07 Sources: Enrollment from Texas Health and Human Services Commission; Texas State Demographer's 0-17 Population Estimates 5.5 4.5 3.5 2.5 1.5 0.5 Child population (millions)