"Immigrants & the Safety Net: Challenges from Health Care Reform”

1. "Immigrants & the Safety Net:Challenges fromHealth Care Reform” California Program on Access to Care Presented by: Monica Blanco-Etheridge Latino Coalition for a Healthy California October 29, 2012

2. Immigrants & the Safety Net: Challenges from Health Care Reform • Of the 38 million foreign-born people living in the U.S., California is home to the greatest number (over 10 million). (Department of Homeland Security 1999) • Of the esti­mated 7.5 million undocumented immigrants of Latino origin in the United States, 6.6 million are from Mexico. (Department of Homeland Security 1999) • Nearly half of the children in the state have at least one immigrant parent. (Joanna Lin, 2012 California Watch)

3. Immigrants & the Safety Net: Challenges from Health Care Reform • California remains the leading destination for immigrants to the United States, receiving more than 325,000 new arrivals each year. The state’s immigrant population now constitutes 27.2 percent of all residents, more than 9.9 million individuals. • California’s total population is 37% Latino and 26% immigrant. Over 4 million Mex­ican immigrants currently live in California; 47% have no health insurance, and 22% live in poverty. (Census 2009)

4. Immigrants & the Safety Net: Challenges from Health Care Reform Patient Protection & Affordable Care Act According to California Watch (July 2011), about 20 percent of the state's 1 million uninsured children will be left out because they or their parents are illegal immigrants, researchers at the UCLA Center for Health Policy Research • Researchers estimate that 170,000 children will be barred from enrolling in Medi-Cal or purchasing private insurance in the California Health Benefit Exchange because they are illegal immigrants.

5. Immigrants & the Safety Net: Challenges from Health Care Reform • California, 5.7 million Latinos will be newly eligible to purchase insurance on the Exchange • Undocu­mented immigrants are prohibited from purchasing insurance through the exchanges and receive no subsidies. (Families USA 2010) • An estimated 6.4 million Latinos in Cali­fornia will be newly eligible for coverage under Medi-Cal • Immi­grants are unqualified for coverage if they have resided in California for less than five years or if they are undocumented.(Families USA 2010, National Immigration on Law Center 2010)

6. Immigrants & the Safety Net: Challenges from Health Care Reform • 2007 California Health Interview Survey (CHIS), the study's authors estimate that under the ACA, approximately 30,000 undocumented immigrant children will be barred from participating in the Health Benefit Exchange, a newly established marketplace for health care plans with subsidies for lower-income Californians. • Approximately 150,000 uninsured children will be excluded from the ACA-funded Medi-Cal expansion due to their status as either undocumented immigrants or legal immigrants who have lived in the U.S. for fewer than five years. UCLA Center for Health Policy Research (June 2011)

7. “Immigrants & the Safety Net: Challenges from Health Reform”

8. Immigrants & the Safety Net: Challenges from Health Care Reform • California’s community clinics and public hospitals could continue to serve a significant number of uninsured immigrant children even after full implementation of ACA. UCLA Center for Health Policy Research (June 2011) • The law will provide $11 billion in funding to community health clinics (CHC) from 2011 to 2015 ($1.4 billion for Califor­nia), establish a prevention and public health investment fund and provide support for community health outreach work­ers. (National Association of Community Health Centers 2009, & CPEHN)

9. Immigrants Under the ACA: • No federal coverage. • Not allowed to purchase in state insurance exchange(s). • Not eligible for premium tax credits or cost-sharing reductions. • Exempt from individual mandate. • Not eligible for Medicare, nonemergency Medicaid or CHIP. • Remain eligible for emergency care (if the Dr’sdiagnosisesthe illness as an emergency) under federal law.

10. Immigrant Policy • The state may provide services to lawfully present immigrants without federal match such as full scope Medi-Cal for lawfully present immigrants.

11. Immigrant Policy • There are programs that provide health services irrespective of immigration status (not an exhaustive list) • Federally Qualified Health Centers (FQHCs) & Other Clinics • FQHCs receive grants from the federal government to provide health services to underserved populations without regard to a person’s ability to pay. • Access for Infants and Mothers (AIM) Program • Provides perinatal health care to women and children of limited economic means available to women who have resided in California for at least six months, regardless of immigration status • Child Health and Disability Prevention Program (CHDP) • Provides for the early detection and prevention of disease and disabilities for low-income children under age 20 whose family income is 200% FPL or below, regardless of immigration status • Children’s Health Initiatives • County programs to cover children who are uninsured and ineligible for either Medi-Cal or Healthy Families, often due to the child’s immigration status. • Family PACT • Program provides family planning including emergency contraception, screening and treatment for sexually transmitted diseases and other related services to women to age 55, men to age 60, and adolescents who are at risk for pregnancy prevention or at risk for causing pregnancy. Immigration status is not considered for Family PACT services

12. Contact Monica Blanco-Etheridge Executive Director Latino Coalition for a Healthy California 1225 8th Street Suite 550 Sacramento, CA 95814 (916) 448-3234 www.lchc.org