Carissa van den Berk Clark, M.A., M.S.W. UCLA, & Yunju Nam, Ph.D., Washington University

Provides medical assistance to individuals and families with low income and limited resources

Categorically Needy 4 different public insurance

programs Optional programs

Allows states to design their own programs with few federal standardsNoncitizen eligibility was dramatically changed by PROWA

◦ Before Welfare Reform: No discrimination against legal immigrants (permanent residents).

◦ Welfare reform’s Noncitizen eligibility restrictions:

To reduce government spending for public assistance programs.

By discouraging foreign-born individuals who may need public assistance from immigrating to the U.S.

By shifting responsibility to individual immigrants and their families.

Under the assumption that foreign-born individuals immigrate to the U.S. to take advantage of the public assistance system.

◦ After Welfare Reform: Immigrants’ eligibilities differ by

Immigration status (naturalized citizen vs. noncitizen)

Timing of Immigration (Pre- vs. Post- Enactment Immigrants)

Length of stay in the U.S. (Established vs. Recent Immigrants)

State of Residency (Generous vs. Non-generous states)

Temporal and Geographic Variations in Immigrant Eligibilities

Pre-Reform Post-Reform

Naturalized

Citizens

No Restriction No Restriction

Noncitizens:

Pre-enactment

No Restriction

State discretion, federal funding

available, eligible in most states

Post-enactment

after 5 yr.

State discretion, federal funding

available, eligible in most states

Post-enactment

before 5 yr.

No federal funding; State-

funded program in 9 states

In 2004, 52% of non-citizens were uninsured, compared to 15% of citizens

SIPP data points out that foreign born adults are three times more likely to be uninsured than native born adults

Which states are more generous to

immigrants?

Which states are more generous to

citizens?

What role does state economics,

demographics and political trends play in

state Medicaid generosity?

Quantitative◦ Medicaid State Manuals, administrative

code, or State policy manuals◦ Surveys of State Medicaid Policy Analysts

and/or Directors◦ State Legislation◦ Census data

Qualitative◦ Semi-structured interviews of State

Medicaid staff or other state affiliated policy analysts to determine why Medicaid policies changed.

◦ Court documents◦ Court decisions on both general welfare

policy and immigrant welfare policy Used Atlas software to determine patterns

States have substantial leeway when it comes to determining Medicaid eligibility and reimbursement for both citizens and non-citizens

Body of welfare research that focuses on “generous” versus “non-generous” states◦ Studies often looked at relationship between state

generosity and economic and political indicators

◦ Median voter taxpayer theory and political leadership and fiscal integrity

What is generous?◦ Four levels of generosity determined:

generous, somewhat generous, not generous, extremely not generous

◦ Very generous states provided the same benefits to non-citizens as they provided to citizens

◦ Somewhat generous states offered Medicaid to only certain post enactment demographic groups which are considered high risk

◦ Somewhat restrictive states offered no more Medicaid benefits then the federal minimum standard (5 year bar)

◦ Very restrictive states went further than the federal minimum standard by not covering post-enactment immigrants past the 5 year bar

• In 2002, the number of very restricted states increased because it was time to decide eligibility of post-enactment immigrants after the 5 year bar.

• In 2003, the number of very generous states declined due to budget crisis.

0

5

10

15

20

25

30

35

40

1998 2002 2003 2008

State Generosity

Very restricitve Somewhat restrictive

Somewhat generous Very generous

•Federal policy changes•Balanced Budget Act of 1997

•Budget problems on the part of state governments•Immigrant voting power – translated into Latino voting power in California•Community Activism and political leadership

•Court Cases – Aliessa v. Novella and its precedence

Kim (2001) looked at how the Courts were looking at immigrant welfare rights after PROWA. She looked at 6 cases

We found 31 cases on immigrant welfare rights post-PROWA◦ Balanced Budget Act of 1997 restores SSI

to pre enactment immigrants◦ Balanced Budget Act of 1998 restores food

stamps to pre enactment immigrants◦ Farm Bill of 2002 restores food stamps to

post enactment immigrants after 5 year bar and to qualified immigrant children

◦ Aliessa v. Novella in NY set a different kind of precedence

Section 1 of the 14th Amendment reads, that the state shall not “deny to any person within its jurisdiction the equal protection of the laws”, 5th Amendment applies to Federal government

3 levels of scrutiny: Rational basis scrutiny, strict scrutiny, immediate level scrutiny

King v. Smith

Shapiro v. Thomas

Dandridge v. Williams

Goldberg v. Kelly

Graham v. Richardson

Mathews v. Diaz

Connecticut, Maryland, North Carolina, New York

•Used strict scrutiny & found no compelling government interest

•Argued federal government couldn’t compel states to violate equal protection clause

•The State government provided benefits inferior to Federal Standard

•State Constitution implies that welfare benefits are a Constitutional right

•Found a legitimate or compelling government interest to regulate immigration and promote self sufficiency (Slide 3)

•Found a legitimate government interest in fiscal sovereignty

•Compelling government interest had been interpreted by legislature

•Court cases decrease when federal policy changes

•Political controversy over immigration effects Medicaid and other welfare generosity

•State Medicaid generosity towards immigrants is sensitive to state fiscal pressures and political trends.•Fiscal pressure is considered by courts to be a “legitimate government interest” to discriminate against legal immigrants •Social workers should learn how to work with judicial system to promote social justice.