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Health Care and Public Health Care and Public Benefits for Immigrant Benefits for Immigrant

Families*Families*Immigration Challenges Impacting Children and Immigration Challenges Impacting Children and

Families in the Child Welfare SystemFamilies in the Child Welfare SystemSeptember 2013September 2013

NC Administrative Office of the CourtsNC Administrative Office of the Courts

North Carolina Justice CenterNorth Carolina Justice Center www.ncjustice.org

* Originally drafted in part by NILC and YLC* Originally drafted in part by NILC and YLC

Immigrant Families in Immigrant Families in America TodayAmerica Today

Immigrant families: “mixed status”Immigrant families: “mixed status” Most immigrant families (85%) include Most immigrant families (85%) include

at least one citizen, usually a child. at least one citizen, usually a child.

Immigrant families with children Immigrant families with children experience greater povertyexperience greater poverty 50% have incomes below 200% FPL 50% have incomes below 200% FPL

(compared with 35% of citizen families)(compared with 35% of citizen families)

Issues Affecting Access to Issues Affecting Access to ServicesServices

Immigrant eligibility rulesImmigrant eligibility rules

State residency and other eligibility rulesState residency and other eligibility rules

Privacy, Confidentiality and VerificationPrivacy, Confidentiality and Verification

Concerns about Sponsors & “Public charge” Concerns about Sponsors & “Public charge”

Fear about being reported to ICEFear about being reported to ICE

Language Barriers and Cultural CompetenceLanguage Barriers and Cultural Competence

Lack of TransportationLack of Transportation

The “Climate” The “Climate”

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Immigrant Benefit Immigrant Benefit ClassificationsClassifications

1996 Federal Welfare Law:1996 Federal Welfare Law:

CitizensCitizens

““Qualified”Qualified” Immigrants Immigrants entered US before Aug. 22, 1996entered US before Aug. 22, 1996 entered US on or after Aug. 22, 1996entered US on or after Aug. 22, 1996

““Not Qualified”Not Qualified” Immigrants Immigrants

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Qualified ImmigrantsQualified Immigrants

Lawful Permanent Residents (LPR)Lawful Permanent Residents (LPR)

Refugees, Persons Granted Asylum, Refugees, Persons Granted Asylum, Withholding of Deportation/Removal, Withholding of Deportation/Removal, Conditional Entrant statusConditional Entrant status

Paroled into U.S. for at least 1 YearParoled into U.S. for at least 1 Year

Cuban and Haitian EntrantsCuban and Haitian Entrants

Certain Battered Spouse and Children Certain Battered Spouse and Children

Certain Victims of TraffickingCertain Victims of Trafficking

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Qualified Battered Qualified Battered ImmigrantsImmigrants

With With prima facie caseprima facie case or approved: or approved:

Visa petitionVisa petition filed by US citizen or LPR filed by US citizen or LPR spouse/parent spouse/parent

Self-petitionSelf-petition under VAWAunder VAWA, or, or Application for cancellation of Application for cancellation of

removal/suspension of deportation removal/suspension of deportation under VAWA under VAWA

ParentParent of battered child and of battered child and childchild of of battered spouse also considered battered spouse also considered “qualified”“qualified”

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Victim of Severe Form of Victim of Severe Form of TraffickingTrafficking

If 18 or over, must be certified by HHSIf 18 or over, must be certified by HHS

Children under 18 need HHS “eligibility letter”Children under 18 need HHS “eligibility letter”

Eligible for federal benefits to the same Eligible for federal benefits to the same extent as refugeesextent as refugees. .

Derivative beneficiaries of “T” visas are also Derivative beneficiaries of “T” visas are also eligible for federal benefitseligible for federal benefits

Victims with approved T visa petitions or prima Victims with approved T visa petitions or prima facie determinations are “qualified”-- but facie determinations are “qualified”-- but other trafficking victims may also be eligible other trafficking victims may also be eligible for benefits.for benefits.

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Not Qualified ImmigrantsNot Qualified Immigrants

ALLALL Other Non-citizens Other Non-citizens

… … even if have work authorization even if have work authorization and are lawfully present in U.S.and are lawfully present in U.S.

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Not Qualified Not Qualified Immigrants: Federal Immigrants: Federal

Program BarProgram Bar Bar on “Federal Public Benefits”Bar on “Federal Public Benefits” to be defined by agencies (only HHS, FEMA and a to be defined by agencies (only HHS, FEMA and a

few others have done so)few others have done so)

Examples of “Public Benefit” in lawExamples of “Public Benefit” in law: : grants, contracts, loans, professional/commercial grants, contracts, loans, professional/commercial

licenses by government; retirement, welfare, licenses by government; retirement, welfare, health & disability, housing, post-secondary health & disability, housing, post-secondary education, food, unemployment, FEMA, education, food, unemployment, FEMA, oror any any “similar benefit” “similar benefit” which iswhich is

provided to individual, household, or family provided to individual, household, or family unitunit, by agency/funds of federal government, by agency/funds of federal government

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Examples of HHS Examples of HHS Federal Public BenefitsFederal Public Benefits

Adoption AssistanceAdoption Assistance Child Care and Development FundChild Care and Development Fund Foster CareFoster Care Independent Living Independent Living Low Income Home Energy Assistance Program Low Income Home Energy Assistance Program

(LIHEAP)(weatherization for single units only)(LIHEAP)(weatherization for single units only) MedicareMedicare MedicaidMedicaid (except emergency medical) (except emergency medical) Refugee benefits (cash, medical, social services) Refugee benefits (cash, medical, social services) Social Services Block Grant (SSBG) Social Services Block Grant (SSBG) Children’s Health Insurance Program/CHIP (NC Children’s Health Insurance Program/CHIP (NC

Health Choice)Health Choice) TANF/Work First andTANF/Work First and Food Stamps (USDA)Food Stamps (USDA)

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Programs That Can Be Programs That Can Be Provided to All Provided to All

ImmigrantsImmigrants Emergency MedicaidEmergency Medicaid and other emergency and other emergency

medical medical Immunizations, testing and treatment for Immunizations, testing and treatment for

symptoms of communicable diseases (outside of symptoms of communicable diseases (outside of Medicaid)Medicaid)

Short-term non-cash disaster reliefShort-term non-cash disaster relief Certain housing assistance if receiving on 8/22/96 Certain housing assistance if receiving on 8/22/96 School Lunch and School BreakfastSchool Lunch and School Breakfast State Option to ProvideState Option to Provide WIC WIC

AND AND programs programs 1.1. Delivered at the community level, that are:Delivered at the community level, that are:2.2. Not conditioned on income or resources and Not conditioned on income or resources and 3.3. Necessary to protect life or safety Necessary to protect life or safety

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AG’s List of ProgramsAG’s List of Programs“Necessary to Protect “Necessary to Protect

Life or Safety”Life or Safety”

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Child and adult protective services Violence and abuse prevention, domestic violence Mental illness, substance abuse treatment Short-term shelter or housing assistance Programs for adverse weather conditions

Soup kitchens, food banks, senior nutrition programs Medical & public health, mental health, disability or substance abuse services Programs to protect life & safety of workers, children

& youth, or community

Other services necessary to protect life or safety

Non-Profit AgenciesNon-Profit Agencies

Non-profit charitable organizations are Non-profit charitable organizations are not required to determine, verify or not required to determine, verify or otherwise ask for proof of an immigrant’s otherwise ask for proof of an immigrant’s statusstatus applies to immigrant restrictions in the applies to immigrant restrictions in the

1996 welfare and immigration la1996 welfare and immigration lawsws

Non-profits can create a safe environment Non-profits can create a safe environment for immigrants and their family members for immigrants and their family members who are seeking serviceswho are seeking services

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Barrier to Access: Fear Barrier to Access: Fear of ICE Reportingof ICE Reporting

Concern: “If I go to the government Concern: “If I go to the government office to get help for my child, will office to get help for my child, will they deport me or my husband?”they deport me or my husband?”

Agency threats of ICE reporting - Agency threats of ICE reporting - frighten immigrants, discourage frighten immigrants, discourage participation participation

Barriers: ICE ReportingBarriers: ICE ReportingGeneral RulesGeneral Rules

Immigration enforcement is theImmigration enforcement is the responsibility responsibility of Immigration and Customs Enforcement/DHSof Immigration and Customs Enforcement/DHS

Benefits agencies are Benefits agencies are notnot responsible for responsible for enforcing immigration laws, with limited enforcing immigration laws, with limited exceptionsexceptions Certain government entities (SSI, TANF, FS, public Certain government entities (SSI, TANF, FS, public

housing) required to notify ICE of any immigrant housing) required to notify ICE of any immigrant the entity the entity “knows”“knows” is not lawfully present in the is not lawfully present in the U.S.U.S.

Medicaid & SCHIP agencies under no duty to Medicaid & SCHIP agencies under no duty to “report”“report”

Interagency NoticeInteragency Noticeon Reportingon Reporting

SSI, TANF, Food Stamps, Public Housing:SSI, TANF, Food Stamps, Public Housing:

Agency will appropriately Agency will appropriately “know”“know” the the immigration status only of an immigration status only of an applicantapplicant

An agency can only KNOW status is unlawful via An agency can only KNOW status is unlawful via a a formal ICE documentformal ICE document (Order of Deportation) (Order of Deportation)

““Know” determination must be a formal Know” determination must be a formal determination subject to administrative review. determination subject to administrative review.

DHHS and the “SAVE” DHHS and the “SAVE” programprogram

NC DHHS uses the federal “SAVE” program to determine NC DHHS uses the federal “SAVE” program to determine immigrants’ eligibility for benefits.immigrants’ eligibility for benefits.

NC DHHS signed an agreement with USCIS in 2010 NC DHHS signed an agreement with USCIS in 2010 stating in part that NC DHHS will:stating in part that NC DHHS will:

““Use any information provided by DHS-USCIS under this Use any information provided by DHS-USCIS under this [agreement] [agreement] solely for the purpose of determining the solely for the purpose of determining the eligibility of persons applying for the benefit issued by eligibility of persons applying for the benefit issued by [DHHS]…[DHHS]…  

““Safeguard such information andSafeguard such information and access methods to access methods to ensure that it is not used for any other purpose than ensure that it is not used for any other purpose than described in this [agreement] and described in this [agreement] and protect its protect its confidentialityconfidentiality; including ensuring that it is not ; including ensuring that it is not disclosed to any unauthorized person(s) without the disclosed to any unauthorized person(s) without the prior written consent of DHS-USCIS.”prior written consent of DHS-USCIS.”

Angie and NadiaAngie and Nadia

Angie works in a health clinic, a non-profit organization that receives federal funds. Patients can be treated at the clinic, regardless of their income. Nadia, an undocumented teenager, seeks treatment at the clinic.

1. 1. Does the clinic provide a federal public Does the clinic provide a federal public benefit?benefit?

2.2. Is Nadia eligible for treatment?Is Nadia eligible for treatment?3. Is Angie required to verify Nadia’s 3. Is Angie required to verify Nadia’s

immigration immigration status?status?4. Is Angie required to report Nadia to the 4. Is Angie required to report Nadia to the

Department of Homeland Security/DHS?Department of Homeland Security/DHS?18

Foster Care and Child Foster Care and Child Welfare: Child Welfare Welfare: Child Welfare

ServicesServices Title IV-B Child Welfare ServicesTitle IV-B Child Welfare Services

Child Abuse Prevention and Child Abuse Prevention and Treatment Act (CAPTA) Treatment Act (CAPTA)

Title XX Social ServicesTitle XX Social Services

Foster Care and Child Foster Care and Child Welfare: Cash BenefitsWelfare: Cash Benefits

Title IV-E Title IV-E Foster Care Maintenance PaymentsFoster Care Maintenance Payments

Title IV-E Adoption AssistanceTitle IV-E Adoption Assistance

SSI SSI

Non federal cash benefits Non federal cash benefits

Foster Care and Child Foster Care and Child WelfareWelfare

Whose immigration status matters?Whose immigration status matters? ChildChild ParentParent CaregiverCaregiver

Is it necessary for the protection of Is it necessary for the protection of life or safety? life or safety? Child protectionChild protection Abuse preventionAbuse prevention

Foster Care and Child Foster Care and Child WelfareWelfare

Is it a public benefit?Is it a public benefit? Title IV-B vs. Title IV-ETitle IV-B vs. Title IV-E Eligibility for payment vs. qualified for Eligibility for payment vs. qualified for

placementplacement

What program are we talking about? What program are we talking about? State Foster Care vs. Unaccompanied State Foster Care vs. Unaccompanied

Refugee Minor or Unaccompanied Alien Refugee Minor or Unaccompanied Alien Minor Minor

Special Immigrant Juvenile Special Immigrant Juvenile StatusStatus

Individuals placed by court order in physical Individuals placed by court order in physical custody of a state agency, individual or entity custody of a state agency, individual or entity appointed by a state or court, appointed by a state or court,

Whose reunification with one or both parents Whose reunification with one or both parents is not viable due to abuse, neglect, is not viable due to abuse, neglect, abandonment or a similar basis, abandonment or a similar basis,

Judicial or administrative finding that it is not Judicial or administrative finding that it is not in best interest of child to be returned to the in best interest of child to be returned to the child’s or parent’s previous country of child’s or parent’s previous country of residence.residence.

Julia and NoraJulia and Nora Julia, a 10 year old, was born in the U.S. Her 14

year old sister, Nora, is undocumented. They live with their father who is abusive. Nora called the police to report the violence, and the police contacted child protective services.

Can CPS conduct a child abuse investigation?

Can Julia and Nora be placed in foster care?

Can they be placed with their aunt, who is undocumented?

Can they receive foster care benefits to pay for their care?

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Qualified Immigrants: Qualified Immigrants: Major Federal ProgramsMajor Federal Programs Supplemental Security Income (SSI)

severely restricted for immigrants 5 year bar on federal TANF,

Medicaid (non-emergency), CHIP for qualified immigrants who entered U.S. on or after 8/22/96, with exceptions

Restriction on Foster Care for caretakers of recently qualified immigrant children

5 year bar on SNAP/Food Stamps for qualified immigrant adults, with exceptions.

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Medicaid, CHIP, TANFMedicaid, CHIP, TANFFederal funds available for:Federal funds available for:

Qualified immigrantsQualified immigrants who entered U.S. before who entered U.S. before 8/22/96, or who complete the 5 year bar8/22/96, or who complete the 5 year bar

RefugeeRefugee groups, trafficking victims groups, trafficking victims

VeteransVeterans, active duty military & family, active duty military & family

““Lawfully residing” immigrant children & Lawfully residing” immigrant children & pregnant women in Medicaid/CHIPpregnant women in Medicaid/CHIP (NC state (NC state option)option)

MedicaidMedicaid: federal: federal Foster Care Foster Care children, SSI children, SSI recipients in most states, Native Americansrecipients in most states, Native Americans

CHIP optionCHIP option: prenatal regardless of status : prenatal regardless of status

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New Provisions for Pregnant Women and

Children under CHIPRA A new provision in 2010 made Medicaid available to

pregnant women and children (under age 19) w/o 5 yr Bar in a variety of lawful immigrant categories, including:

Legal Permanent Residents (LPR) VAWA prima facie determination or approved petitions Temporary Protected Status (TPS) Family Unity beneficiaries Temporary resident status under 210 or 245 of the Immigration and

Nationality Act Deferred Enforced Departure Spouses or children of U.S. citizens whose visa petitions are approved and who

have pending applications for adjustment of status Victims of crime (“U” visa holders)* ( *It is not yet clear whether this applies to

all U visa holders or only those who are DV victims) Fiancées of citizens (K visa) Religious workers (R visa) Individuals assisting in criminal prosecutions (S visa) Individuals with a pending petition for 3 years or more (V visa) Parents or children of individuals with special immigrant status (N visa)

SSISSI Receiving SSI or application pending on 8/22/96

Qualified immigrants with disabilities, who were lawfully present in the U.S. on 8/22/96

LPRs with credit for 40 quarters of work history. Post 8/22/96 entrants only after in qualified status for 5 years.

Refugees, granted asylum, withholding of deportation or removal, Cuban/Haitian entrants, Amerasian immigrants, Iraqi and Afghan Special Immigrants, trafficking victims, during first 7 years after obtaining status

Veterans, active duty military, spouses, surviving spouses & children

Members of federally recognized Indian tribes or American Indians born in Canada

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Federal Law: Federal Law: Immigration Status, SSNImmigration Status, SSN

As a general rule, States must establish As a general rule, States must establish citizenship or eligible immigration status, and citizenship or eligible immigration status, and SSNs of SSNs of applicantsapplicants for many federal programs for many federal programs

““Applicant”Applicant” = Person for whom benefits are = Person for whom benefits are sought (or household/ family unit defined by benefit sought (or household/ family unit defined by benefit granting authority)granting authority)

““Non-Applicant”Non-Applicant” = Member of the applicant’s = Member of the applicant’s family or household who is not seeking benefits.family or household who is not seeking benefits.

Federal GuidanceFederal Guidanceon SSNon SSN

States States may not denymay not deny benefits because a benefits because a non-applicantnon-applicant in the family or in the family or household has not provided household has not provided information on immigration status or information on immigration status or his or her SSN.his or her SSN.

Emergency MedicaidEmergency Medicaid

Citizenship/immigration status Citizenship/immigration status not not requiredrequired

SSN SSN notnot requiredrequired

Clare and her Children

Clare, who is undocumented, has two Clare, who is undocumented, has two children, Mike, an undocumented children, Mike, an undocumented teenager, and Tyler, who was born in the teenager, and Tyler, who was born in the U.S. Clare is pregnant.U.S. Clare is pregnant.

Which benefits can they receive?Which benefits can they receive?

Annie and JudeAnnie and Jude

Annie is an undocumented Annie is an undocumented mother of a U.S. citizen child, mother of a U.S. citizen child, Jude. Jude has a severe disability, Jude. Jude has a severe disability, and the family needs assistance. and the family needs assistance.

Which benefits can Jude receive? Which benefits can Jude receive?

Can Annie seek these benefits on Can Annie seek these benefits on his behalf?his behalf?

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Kim and HanaKim and Hana

Kim is a 28-year-old mom with a child, Hana, Kim is a 28-year-old mom with a child, Hana, age 12. Both are lawful permanent residents age 12. Both are lawful permanent residents (LPRs) who entered the U.S. in 2009. Kim (LPRs) who entered the U.S. in 2009. Kim lost her job. lost her job. 

Which benefits can they receive?Which benefits can they receive?

After Kim experiences some problems, Hana After Kim experiences some problems, Hana ends up in the child welfare system. Can ends up in the child welfare system. Can Hana be placed with her undocumented Hana be placed with her undocumented aunt? Can federal foster care pay for this aunt? Can federal foster care pay for this placement?placement?

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VictorVictor

Victor, a 14 year old who is Victor, a 14 year old who is undocumented, came to the U.S. undocumented, came to the U.S. from Honduras on his own, seeking from Honduras on his own, seeking his family. He could not find them, his family. He could not find them, and began living on the streets. His and began living on the streets. His school called child welfare staff at school called child welfare staff at the local DSS.the local DSS.

What are his options?What are his options?

The Affordable Care Act

How are immigrants included under the comprehensive health care legislation that passed in 2010, and going into effect in stages over the next several years…

“Lawfully residing” immigrants with more than 5 years presence in the U.S.

Are eligible for all the same benefits under the ACA as U.S. citizens: access to health insurance exchanges, subsidized health insurance, and expanded income-eligibility for Medicaid.

“Lawfully residing” immigrants with less than 5 years presence in the U.S.

May participate in the exchanges, and may receive subsidies for health insurance coverage, but are still not eligible for Medicaid.

Undocumented immigrants & immigrant youth with “Deferred Action for Childhood Arrivals”/DACA

Not eligible for any of the benefits of the ACA, including participation in the health insurance exchanges, receipt of subsidized insurance coverage, or the expanded Medicaid access.

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Resources on Public Benefits Resources on Public Benefits for Immigrant Familiesfor Immigrant Families

National Immigration Law Center:National Immigration Law Center: www.nilc.org

Youth Law Center:Youth Law Center: www.ylc.org

National Council of La Raza:National Council of La Raza: www.nclr.org

National Health Law Program:National Health Law Program: www.healthlaw.org

Contact InformationContact Information

Kate Woomer-DetersKate Woomer-Deters, attorney, , attorney, (919) 861-2072/kate@ncjustice.org(919) 861-2072/kate@ncjustice.org

Jack HoltzmanJack Holtzman, attorney, attorney (919) (919) 856-2165/jack@ncjustice.org

North Carolina Justice CenterNorth Carolina Justice CenterP.O. Box 28068, Raleigh, North P.O. Box 28068, Raleigh, North Carolina 27611 Carolina 27611