Welfare Reform Act Changes to Medicaid Leave Legal Immigrants Searching for Health Care

A provision in the welfare reform act passed by Congress on Aug. 22, 1996, that precludes "new green-card holders" from qualifying for Medicaid for their first five years in the country has created a "bewildering health care abyss" for immigrants who entered the United States after that date, the Wall Street Journal reports. About four million "legal permanent residents" have been affected by the ban. They, like recent immigrants and all uninsured citizens in every state, must "rely on the local safety nets of public and private charity." Congress, however, did allow states to "offer some or all Medicaid coverage to some or all new legal immigrants," and about 12 have done so at "their own expense," but the coverage in even the "more generous" states does not "match" traditional Medicaid. In addition to state coverage, local hospitals and clinics have "randomly tak[en] up the slack." The result has been a "crazy quilt" of health care for legal immigrants, whose ability to receive care often depends on where in the United States they have chosen to settle. Connecticut, for instance, "imposes a six-month residency rule" for most legal immigrants, while Wyoming covers three prescriptions a month plus oxygen for disabled immigrants. The National Health Law Program said the Medicaid restriction has created a "nearly incomprehensible patchwork of rules and restrictions that confuse even the most seasoned expert."

'Castigating' Congress
In June, New York's highest court struck down the state's five-year ban on Medicaid for legal immigrants, saying it violated the provision of the state Constitution guaranteeing equal protection for all poor people. The court also "castigated Congress for giving states a choice in filling the Medicaid gap for immigrants," which, it said, "usurped Congressional sovereignty over immigration and denied immigrants equal protection of the law." While the ruling was good news for immigrants in New York, which will now have to provide coverage with state funds, the Journal reports that the state's Constitution is "unusual, and similar challenges haven't surfaced in other states."

A 'Time Bomb' Ignites
The 1996 law also contains a less-noticed provision: For immigrants who apply for Medicaid after having been in the United States for five years, the income of their sponsor will also be considered to determine program eligibility, which in many cases will cause the applicant's income to exceed Medicaid eligibility thresholds. And for those who do qualify, their sponsors "must sign an affidavit binding them to repay the government" for the care of immigrants issued green cards after 1997, a "deal [that] lasts until the immigrants become citizens." The Journal reports that the sponsor liability provision is a "time bomb" that is just now -- five years after passage of the welfare act -- "go[ing] off." As a result, sponsors are becoming aware that they "may someday be saddled with huge medical bills"; subsequently, the rate of immigration is likely to decrease, as "[f]ewer Americans are showing the willingness to put their assets on the line to sponsor relatives or employees."

A Policy Favored By No One?
The health care provisions of the welfare reform act resulted from a compromise that "preserved the rate of legal immigration," but that "horse trade ... is often seen today as a poor compromise," the Journal reports. Proponents of more liberal immigration policy want to see the ban repealed, and "even some of those" who favor a reduction in legal immigration say that immigrants should not be "penaliz[ed]" by the Medicaid ban. "If we had a motto, it would be, 'Fewer immigrants and a warmer welcome,'" Mark Krikorian, executive director of the Center for Immigration Studies, said. A report on immigrant health insurance by the group -- "known for its efforts to keep immigrants at bay" -- concluded: "Cutting welfare benefits to immigrants after they have already been allowed into the country seems neither fair nor wise" (Newman, Wall Street Journal, 8/29).