Access to Health Care and Public Benefits

​Immig​rant Child Health Toolkit​​

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​​​​Access to Health Care and Public Benefits​


Information on access to public benefits is subject to change. Please contact your local/state immigrant legal advocacy organization for the most up to date information on access to benefits, concerns about public charge, and guidance on enrollment.​

What health insurance options are available to immigrant children and families?


Children of immigrants are nearly twice as likely to be uninsured as are children in nonimmigrant families1. Access to health care insurance is dependent upon the child’s immigration status as well as federal and state level policies. Eligibility requirements and waiting periods can present barriers for immigrant families to access health insurance. However, many uninsured immigrant children are eligible for Medicaid or CHIP, but are not enrolled. The following provides a quick guide to health insurance options for immigrant children and their families:​

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​Immigrant Status​Medicaid1​CHIP2​ACA Subsidies
​Pregnant Women​​In some states, may be eligible for prenatal care regardless of immigration status3​In some states, may be eli​gible for prenatal care regardless of immigration status4​Not applicable
U.S. Citizen Children with undocumented parent(s)​​Eligible​Eligible​Eligible
​Lawful Permanent Resident
(under age 18)
​Eligible after 5 years of legal residency in the U.S.; states have the option to waive the 5 year ban​Eligible after 5 years of legal residency in the U.S.; states have the option to waive the 5 year ban​Eligible
​Lawful Permanent Resident
(age 18 and over)
​Eligible after 5 years of legal residency in the U.S.; states have the option to waive the 5 year ban​Eligible after 5 years of legal residency in the U.S.; states have the option to waive the 5 year ban​Eligible
Refugees, Asylees, Victims of Trafficking and other humanitarian grounds​​Eligible​Eligible​Eligible
Members of the military and veterans (and their spouses
and children)
​Eligible​Eligible​Eligible
Unauthorized Immigrants (including children
and pregnant women)
​Eligible for Emergency Medicaid Only​Not Eligible​Not Eligible
(barred from purchasing coverage on their own in the Health Insurance Exchange)
Temporary Protected Status (TPS)​​Not Eligible​Not Eligible​Not Eligible​


1
 Benefits not subject to “public charge” consideration.
Id.
3 Unborn Child Option is state specific. It only covers services related to pregnancy or conditions that could complicate pregnancy can be covered under this option. Check individual state regulations.
Id.
5 Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), 42 U.S.C., §§ 601 et seq. Before 1996, lawfully present immigrants were generally eligible for public benefits. Under PRWORA, lawfully present immigrants are banned from receiving benefits for the first five years they live in the United States. Some states have chosen to waive that ban. To see a list of states that have waived the five-year ban, see KARINA FORTUNY AND AJAY CHAUDRY, URBAN INSTITUTE, A COMPREHENSIVE REVIEW OF IMMIGRANT ACCESS TO HEALTH AND HUMAN SERVICES, 12-20 (June 2011), http://aspe.hhs.gov/hsp/11/ImmigrantAccess/Review/index.pdf.
6 42 U.S.C. § 1395DD.

  • Depending on their state of residence, applicants who are lawfully present immigrant children may be subject to a five-year waiting period before they are legally able to access Medicaid or CHIP.5

  • Children born in the United States are U.S. citizens regardless of their parents’ immigration status, and are therefore eligible for Medicaid or CHIP at birth with no waiting period.

  • Refugees, asylees, victims of trafficking, members of the military and veterans (and their spouses and children) are eligible for Medicaid, CHIP, and health insurance subsides without being subjected to the five-year waiting period.

  • Undocumented immigrant children are not eligible for Medicaid, CHIP or health insurance subsidies provided through the ACA. However, the Emergency Medical Treatment and Active Labor Act (EMTALA)6 requires hospitals to provide care to anyone needing emergency healthcare treatment regardless of citizenship, legal status or ability to pay. While EMTALA requires that hospitals offer emergency treatment to stabilize the individual, it does not mandate preventative or out-patient care. If an undocumented parent and child presents with a medical emergency, pediatricians should not hesitate to encourage treatment at a hospital’s emergency room.

References

  1. Foundation for Child Development. Children in immigrant families: essential to America’s future. Available at: http://fcd-us.org/node/1232. Accessed July 19, 2012

Resources:
Coverage of Lawfully---Residing Immigrant Children and Pregnant
Women without a 5 Year Waiting Period (January 2013)
Georgetown University Health Policy Institute Center for Children and Families
http://ccf.georgetown.edu/wp-content/uploads/2012/04/Coverage-of-Lawfully-Residing-Immigrant-Children-and-Pregnant-Women-without-a-5-Year-Waiting-Period-ICHIA-Option.pdf
Key Facts on Health Coverage for Low-Income Immigrants Today and Under the Affordable Care Act (March 2013) http://www.kff.org/uninsured/upload/8279.pdf


Are immigrant children and families eligible to receive public benefits such as SNAP, TANF, public/subsidized housing?

30 percent of children in immigrant families live below the federal poverty level; however these families may face barriers to accessing public assistance programs that help with basic needs such as food and housing. Eligibility requirements, lack of knowledge about programs, or fear can prevent families from securing benefits for their children. The eligibility standards for immigrant children and families to access key public benefit programs are outlined below:​
Overview of public benefits options for immigrant children and families:7

Immigrant​ Status
​SNAP8​TANF​Non-cash benefits under TANF such as subsidized child care or transit subsidies9​Public Housing10
Lawful Permanent Resident
(under age 18)
​Eligible with no waiting period​Eligible after 5 years of legal residency in the U.S.; states have the option to waive the 5 year ban​Eligible after 5 years of legal residency in the U.S.; states have the option to waive the 5 year ban​Eligible
Lawful Permanent Resident
(age 18 and over)
​Eligible after 5 years of legal residency in the U.S.; states have the option to waive the 5 year ban​Eligible after 5 years of legal residency in the U.S.; states have the option to waive the 5 year ban​Eligible after 5 years of legal residency in the U.S.; states have the option to waive the 5 year ban​Eligible
Refugees, Asylees,
Victims of Trafficking, other humanitarian grounds​
​Eligible with no waiting period​Eligible with no waiting period​Eligible with no waiting period​Eligible
​Members of the military and veterans
(and their spouses
and children)
​Eligible with no waiting period​Eligible with no waiting period​Eligible with no waiting period​Eligible with no waiting period
​Unauthorized Immigrants
(including children
and pregnant women)
​Not Eligible​Not Eligible​Not Eligible​May live in residence with eligible family member
​Temporary Protected Status
(TPS)
​Not Eligible​Not Eligible​Not Eligible​Not Eligible

7 Fortuny & Chaudry, supra note 10.
8 Benefits not subject to “public charge” consideration
9 Id.
10 Id.

  • Supplement Nutrition Assistance Program (SNAP) (formally “Food Stamps”):
    SNAP is available to almost all low income households. The program is meant to help low income individuals purchase food and improve their nutrition. Nearly 72 percent of SNAP participants are in families with children. The average SNAP benefit is about $133.41 a month (or about $4.45 a day). Undocumented parent(s) may apply for SNAP benefits on behalf for their U.S. citizen children. The SNAP benefit amount will be calculated based on the parents’ income, but the parent (and any undocumented children) will be excluded from the household size.
  • Temporary Assistance for Needy Families (TANF):
    TANF is a federal block grant that provides states, territories, and Tribes federal funds each year. The funds are used to provide beneficiaries with cash and/or benefits and services, such as subsidized child care or transit subsidies. In general, undocumented immigrants are not eligible for TANF. However, ineligible parents can receive TANF benefits for their U.S. citizen children.
  • Public Housing/Subsidized Housing:
    Public and subsidized housing programs were created to provide safe and affordable rental housing for low-income individuals, people with disabilities and the elderly. U.S. citizens and qualified immigrants are eligible for assistance regardless of the immigration status of other family members. For mixed-status families living in the same household, benefits are prorated: the benefit is reduced by the proportion of nonqualified immigrants in the household.

11 CENTER ON BUDGET AND POLICY PRIORITIES, POLICY BASICS: INTRODUCTION TO SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP) (2012).
12 U.S. Dep’t of Housing and Urban Dev., HUD’s Public Housing Programhttp://portal.hud.gov/hudportal/HUD?src=/topics/rental_assistance/phprog
13 Qualified aliens are defined as: legal permanent residents; refugees; asylees; an alien who is paroled into the U.S. (under INA §212(d)(5)) for a period of at least one year; an alien whose deportation is being withheld on the basis of prospective persecution; an alien granted conditional entry pursuant to INA §203(a)(7) as in effect prior to April 1, 1980; and Cuban/Haitian entrants. For further explanation and legal citations, see CONGRESSIONAL RESEARCH SERVICES, IMMIGRATION: NONCITIZEN ELIGIBILITY FOR NEEDS-BASED HOUSING PROGRAMS 1-2 (Jan. 23,2012), http://www.fas.org/sgp/crs/homesec/RL31753.pdf.

What rights do immigrant children have in schools? Can they obtain English language assistance or any other special services?

Immigrant children, regardless of immigration status, have the right to free public K-12 education.14 Public schools may not:

  • Require proof of citizenship or legal residence to enroll or provide services to immigrant students.
  • Make inquiries of students or parents that may expose their immigration status.
  • Require students or parents to provide social security numbers.
  • Treat a student differently to determine residency.
  • Engage in any practices to "chill" or “hinder” the right of access to education.

Like other children, undocumented students are obligated under state law to attend school until they reach a mandated age. Even if an undocumented student is not living with a parent or legal guardian, school districts must enroll the student if the child resides in the district and the district cannot establish parents/guardians residence in a different district.

Immigrant children with unstable housing are also protected by the McKinney-Vento Homeless Education Assistance Act.15 The McKinney-Vento Act requires that school districts allow homeless children16 to enroll in public schools, even if they are unable to prove residency or guardianship.

The Right to Secondary Services in School
All secondary services, such as transportation, school based nursing services, free or reduced-meals, special education,17 and counseling are available and should be accessible to immigrant children regardless of their legal status because they are central to the student’s educational experience.

Immigrant parents and students who have limited English proficiency (LEP) are also entitled to language-assistance programs. Under Title VI of the Civil Rights Act of 1964, private entities and state agencies that receive federal funding for programs are required to provide equal access to aid for eligible persons, regardless of their race, color, or national origin. Title VI prohibits conduct that has a disproportionate effect on LEP individuals because such conduct constitutes national-origin discrimination. Because refusing to provide services in other languages might be discriminatory in some localities, special efforts should be made to ensure that there is access to translated materials and interpreters.​

14 Plyer v. Doe, 457 U.S. 202 (1982). The Supreme Court of the United States found that states must educate children of undocumented immigrants, interpreting the equal protection clause of the 14th Amendment to apply to anyone who lives in the U.S., regardless of citizenship.
15 42 U.S.C. §1143a(2)(B)(i).
16 Id. The McKinney-Vento Act defines homeless children as "individuals who lack a fixed, regular, and adequate nighttime residence." The act provides examples of children who would fall under this definition: children and youth sharing housing due to loss of housing, economic hardship or a similar reason; children and youth living in motels, hotels, trailer parks, or camp grounds due to lack of alternative accommodations; children and youth living in emergency or transitional shelters; children and youth abandoned in hospitals; children and youth awaiting foster care placement; children and youth whose primary nighttime residence is not ordinarily used as a regular sleeping accommodation (e.g. park benches, etc); children and youth living in cars, parks, public spaces, abandoned buildings, substandard housing, bus or train stations; migratory children and youth living in any of the above situations.
17 Undocumented children with disabilities have a statutory right to services under the Individuals with Disabilities Education Act (IDEA) or Section 504 of the Rehabilitation Act of 1973 (Section 504). For a state to be eligible for federal assistance under IDEA Part B, it must provide assurance that a free appropriate public education is available to all children with disabilities residing in the state.


How can I help immigrant children access the benefits that they are eligible to receive?

  1. Screen for basic needs.
    Screening for basic needs as a standard part of practice is essential for detecting and addressing issues such as hunger and housing insecurity. Practices can use a brief written screener or verbally ask family members questions if the family is having difficulty with issues such as food, housing, and heat. Screening for basic needs can help uncover new and “hidden” economic difficulties that impact child health. Practices should take a universal approach to screening, and never target specific families.

  2. Work with community partners to provide public benefits information.
    When unmet basic needs are identified, immigrant families will need up to date, understandable information about public benefits programs. In order to provide families with the most accurate information and referral resources, practices should build relationships with trusted local and state organizations that have expertise with public benefits. Key partners will likely include local and state departments of public health, legal services organizations, and community development organizations that have ties to immigrant communities. These partners can help provide pediatricians with accurate benefits information to provide for families in the practice.

  3. Work with the care team and community partners to help encourage families to access public benefits.
    Immigrant families may be reluctant to sign up for public benefits for a variety of reasons. Pediatricians can work with organizations and individuals that are trusted in the community to conduct education and outreach activities about public benefits. Within the practice, social workers, case managers, legal advocates, or peer educators can be effective messengers about public benefits. Working with local community institutions, faith based institutions, and community development organizations can also help pediatricians promote public benefits to immigrant families.

  4. Reassure families that the information they provide in the health care setting is confidential and that the practice is not involved in immigration enforcement. Inform them that undocumented parents of US citizen children can apply for benefits on behalf of their eligible citizen children.


Resources:
Connecting Eligible Immigrant Families to Health Coverage and Care: Key Lessons from Outreach and Enrollment Workers. Kaiser Commission on Medicaid and the Uninsured. October 2011.
Helping Immigrant Patients (page 10) in “Clinical Partners in Advocacy: How Can I-HELP?” Medical Legal-Partnership, Boston. October 2009.
Reaching, Supporting, and Empowering Immigrant Families: Experiences of the Statewide Parent Advocacy Network (SPAN)
Strategies for Engaging Refugee and Immigrant Families. 2011. Education Development Center.
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