In May 1999, the Immigration and Naturalization Service (INS) issued the clarification which benefits may have immigration consequences and which will not under the "public charge" provisions of the immigration laws. The clarification send a clear message that an immigrant’s use of health care benefits including programs such as MediCal, Healthy Families or services provided at community health centers will not make him or her a "public charge". However, use of public benefits for long-term care in a nursing home or similar institution may be usedin the determination of "public charge".

"Public charge" is a term used by the INS in describing persons who cannot support themselves and who depend on public benefits. Depending on one’s immigration status, being determined a "public charge" may prevent the person from being allowed to enter or re-enter the U.S. by the INS. Confusion on which government assistance programs will or will not one’s immigration status resulted in fear among immigrants in seeking critical public health care services. The fear has also affected enrollment in California’s Healthy Families Program.

For more information on the INS guide to "public charge" and receipt of public benefits, visit California Primary Care Association’s website at: www.cpca.org.

$500 million in tobacco tax settlement money will come to Alameda County over the next 25 years. An estimated $19 million of the amount is expected by June 2000.

Asian Health Services (AHS) has joined other groups to call on the Board of Supervisors to direct the money to go solely to health care needs including expanding health insurance coverage to parents of children covered by Healthy Families, home health workers, and immigrants.

A public workshop session on November 16, 1999 at 1:30 PM is being held by the Board of Supervisors to discuss ways to spend the money. AHS Executive Director, Sherry Hirota will be one of the speakers calling on the Board of Supervisors to use the tobacco settlement money on health care.

If you wish to join us in calling for the tobacco settlement money to go to health care, please write the Board of Supervisors at 1221 Oak Street, Oakland, Ca 94612.

On June 7, 1999, President Clinton signed Executive Order (EO)13125 officially establishing the White House Asia and Pacific Islander (API) Initiative. The EO will seek to improve the health and well being of Asian Americans and Pacific Islanders through increased participation in federal programs. AHS welcomes the EO as a major victory for promoting API health.

The health and human services disparities in access, utilization, and outcomes for APIs has been given little attention in the past. This would change with the creation of a 15-member Presidential Advisory Commission on Asian Americans and Pacific Islanders. All departments including the Department of Health and Human Services will be required to monitor progress in the area of assessing gaps in health data, research, direct services, health education for APIs and the number of APIs in meaningful positions within the departments as well.

15 Asian Americans and Pacific Islanders who have a history of involvement with the API communities and expertise in a specific field will be appointed in January 2000 by the President to serve in the Advisory Commission on Asian Americans and Pacific Islanders. The Advisory Commission will serve until June 7, 2001.

The Managed Risk Medical Insurance Board (MRMIB) is currently considering the cultural and linguistic competency standards for the Healthy Families Program (HFP). The proposal being looked at by MRMIB is being criticized by healthcare access advocates as inadequate in meeting the cultural competency service needs of the of those eligible for HFP.

The HFP is the state’s program to provide health insurance for uninsured, low-income children below 19 years old. There has been mounting concern that the program’s enrollment efforts be able to reach immigrant communities; otherwise, eligible children will remain uncovered and without access to care. Likewise, it is imperative that service providers on contract with HFP be held to cultural and linguistic competency standards that ensure fullest access to services.

Asian Health Services has joined other advocates through the California Pan-Ethnic Health Network in calling on MRMIB to fully adopt the existing DHS Medi-Cal managed care cultural and linguistic service requirements. Furthermore, advocates are also calling on MRMIB to convene a cultural and linguistics standards task force or work group to monitor implementation of the requirements and to further develop the standards.

On August 4^th, the Department of Health and Human Services (federal) issued its definition of "Federal Public Benefit". According to the welfare reform law, an immigrant who is not a qualified alien is not eligible for any "Federal public benefit". We were concerned that services at federally funded Section 330 clinics like AHS would be considered "Federal public benefit" so we had written letters in March 1998 to President Clinton to keep the definition narrow. And the good news is . . .

Grants under Section 330 of the Public Health Service Act to health centers (such as AHS) are not considered a "Federal Public Benefit" under the DHHS’ definition.

Efforts by community and advocacy groups in the past two years to call attention to the negative public health impact of a definition of federal public health benefit that includes health centers like AHS directly affected the outcome of this issue.

A behind-the-scenes budget agreement between Governor Wilson and California’s legislative leaders saved the funding for a controversial anti-immigrant program called the Port of Entry Detection Program/California Airport Residency Review. Collaboratively run by the Immigration and Naturalization Service (INS) and the Department of Health Services (DHS), the program has been criticized for intimidating immigrants from using MediCal. INS agents at the Los Angeles and San Francisco airports stop immigrants who fit INS’ "profile" of immigrants who are likely to have used MediCal. Side by side with the INS is the DHS representative who reviews the immigrant’s record of use of MediCal and tries to get the immigrant to repay for MediCal benefits they received or risk their immigration status.

The program had been defunded through an earlier vote by California’s legislature. In late July, Governor Wilson re-raised the issue of funding for the Port of Entry Detection Program during the state budget negotiations with legislative leaders. The agreement that was reached restored the program’s 13 positions, including three assigned at the San Francisco airport. Asian Health Services first learned of the existence of the program in early 1997 when some patients were stopped at the airport and asked to pay back money for MediCal benefits received for prenatal services.

Asian Health Services will work with other organizations to continue advocacy efforts against this program’s chilling effect on immigrants in using publicly funded health care services.

PLEASE CONTACT THE PRESIDENT AND ASK HIM TO DEFEND PUBLIC HEALTH BY ENSURING THAT COMMUNITY HEALTH CENTER SERVICES ARE AVAILABLE TO EVERYONE.

California's Governor Pete Wilson is actively taking steps to set a dangerous precedent of a very broad definition of "federal public benefit." This broad definition "could affect millions of workers from truckers and bar owners to barbers, accountants and physicians." (3/2/98 - Los Angeles Times) Licenses to work in these jobs would be considered benefits that some immigrants who are here lawfully would no longer be qualified for.

TALKING POINTS:

There are many reasons why community/migrant health center services should not be defined as a "federal public benefit."

1. The purpose of the community/migrant health center is to serve as the front line defenders of public health and serve the entire community rather than individuals or household. Many C/MHC services and programmatic activities are not directed at individuals but at the entire community.
   
2. The federal funding to C/MHCs supports their general operations not services. The level of federal funding is not based on reimbursements for actual services or dependent on the income of individual clients but on the needs of the community such as infant mortality, physician shortage, poverty rate.
   
3. C/MHC services to the community include: health promotion and education, immunization, disease screening, prevention of diseases and provision of health care. Services provided by C/MHC should be seen as public health assistance for immunization, testing and treatment of communicable diseases.

Therefore, given the nature of community/migrant health centers and interpretation of the legislation, C/MHC services fall outside the definition of federal public benefit programs.

SAMPLE MESSAGE:

"Dear Mr. President:

We are writing to strongly urge you to ensure that community and migrant health center services are available to everyone in the community that they serve by excluding them from the definition of "federal public benefit." Community and migrant health centers are front line defenders for public health. If their services are defined as "federal public benefit" it will threaten their ability to protect their communities from communicable diseases and effectively conduct health promotion.

Community/migrant health center services should not be defined as a "federal public benefit" because:

(1) Most C/MHC services and programmatic activities such as health promotion and education, prevention of disease are not directed at individuals but at the entire community.

(2) The federal funding to C/MHCs supports their general operations not services. The level of federal funding is not based on reimbursements for actual services or dependent on the income of individual patients or clients but on the needs of the community such as infant mortality, shortage of physicians, poverty rate.

(3) C/MHC services to the community include immunization and screening of diseases. Services provided by C/MHC should be seen as public health assistance for immunization, testing and treatment of communicable diseases.

Therefore, given the nature of community/migrant health centers and interpretation of the legislation, C/MHC services fall outside the definition of federal public benefit programs. You have been a tireless advocate for public health and we expect you to ensure that community and migrant health centers continue its role in protecting health of vulnerable communities.

Sincerely,

(Your name)"

CONTACTS:

White House Comment line: (202)456-1111
E-mail: president@whitehouse.gov

Mailing Address:

The President
1600 Pennsylvania Avenue, NW
Washington, DC 20500

For more information, please contact:
Lisa Hasegawa
tel: (510)986-6830
fax: (510)986-6890
lhasegawa@ahschc.org

Published in March 1998

On March 5, 1998 the L.A. County Superior Court issued a preliminary injunction in the case Milagro Doe v. State Department of Health Services. This means that prenatal care continues to be available through the Medi-Cal program for low-income women regardless of immigration status. The state can not implement the cuts it planned to take effect on April 1, 1998 for new cases and May 1, 1998 for existing cases. For more information please contact the California Primary care Association at www.cpca.org.

Published in March 1998

One of California's state appellate courts ruled that Governor Pete Wilson's Administration can refuse prenatal care to "not qualified" immigrant women.  The appellate court's January 28, 1998 ruling overturned the lower court's earlier ruling which said that the State could not refuse prenatal care to these women until the federal government gives its support.   Not qualified immigrant women who are currently receiving prenatal care will continue to receive it until April 1, 1998 when the State will stop payment.  For new applicants to the program, the State will pay for prenatal care until March 1.  For more information, please see http://www.cpca.org.

A bill to preserve the prenatal care program has been passed by the California State Senate (SB 34--Vasconcellos, Solis).  The bill is required to move through the assembly for full approval by the Legislature.

We are asking that you please send a letter to Senator John Vasconcellos to support this bill. Thank you.

Senator John Vasconcellos
State Capitol, Room 4061
Sacramento, CA 95814

RE: SB 34 - SUPPORT

Dear Senator Vasconcellos,

(Insert a description of your organization here.)

We write to support SB 34, a bill that would maintain prenatal care for all low-income women, regardless of their immigration status.   Providing this care makes both fiscal and public health sense.  Study after study probes that prenatal care is a cost-effective program that provides health benefits for both mother and child.

Thank you for your support of this important program.

Sincerely,

(Your name)

Published in February 1998

Restoration of food stamps for immigrants who lost their eligibility as a result of federal welfare reform law is being considered by the U.S. Department of Agriculture and the Clinton Administration.   Please send a letter to:

Dan Glickman
Secretary of Agriculture
14th Street and Independence Ave., SW
Washington, DC 20250

Dear Secretary Glickman:

Since September 1997, at least 180,000 Californians have lost their food stamps because of the eligibility restrictions on immigrants imposed by federal welfare reform law.   I urge you to support and advocate for full restoration of food stamps for immigrants.

Signed:  Your Name and Address

Published on December 12, 1997

California did not institute changes in the Medi-Cal eligibility requirements for immigrants.  Immigrants who arrive in the US after August 22, 1996, should be able to apply and receive full-scope Medi-Cal.  However, the 1996 immigration act which provides for a new legally enforceable affidavit of support expected to be released sometime in the month of December will have an impact on immigrants' ability to access Medicaid and other federal means tested benefits.   (See below for more info on federal means tested benefits.)

Published on December 12, 1997

The Department of Health and Human Services and Social Security Administration have now defined "federal means-tested public benefits" under the federal welfare law. Programs that fall under the definition are SSI, TANF, and Medicaid. To receive a copy of the definition, visit the Asian Pacific American Health Forum web page at http://www.apiahf.org/policy/Test4NHDR.pdf

If you wish to receive more detailed information on welfare reform, please leave a message.

Published on December 12, 1997

Last year Congress passed and President Clinton signed federal welfare legislation which made many immigrants ineligible for certain federal programs including Food Stamps and Supplemental Social Security Insurance (SSI). Immigrants receiving these benefits were to be cut off in August or September 1997.

Legislation passed in August 1997 made changes in the 1996 welfare reform law and restored some of the benefits it cut. Although not all the cuts were restored, it allowed immigrants already on SSI to continue receiving the assistance. "Qualified" immigrants who were in the US on August 22, 1996, but who were not receiving benefits as of that date can now apply for SSI on the basis of disability.

At the state level, efforts waged by advocates and their legislator supporters failed to create a state SSI program. Immigrants who do not qualify for SSI may apply for county-funded government assistance.

Published in October 1997

All immigrants are eligible for CalWORKS benefits.

Published in October 1997

For Asian American/Pacific Islander Health Care Issues:

http://www.apiahf.org
http://www.aapcho.org

For Policy issues affecting community clinics:

http://www.cpca.org