NATIONAL
Farm Bill Passes, Includes Restoration of Eligibility for Food Stamps for Some Immigrants
On May 13, 2002, President Bush signed the Farm Bill (HR 2646), which includes, among other things, additional restoration of eligibility for food stamp benefits for some immigrants. In 1996, the welfare reform law made immigrants ineligible for food stamps until they became U.S. citizens. The Agricultural Research Act of 1998 restored eligibility to "qualified" legal immigrant children who entered the U.S. before August 22, 1996 (when the welfare reform law was passed). Now, the Farm Bill (Section 4101) will restore eligibility for food stamps (starting in October 2003) to all "qualified" legal immigrant children, regardless of the date of their entry into the U.S. Beginning October 2003, the Farm Bill also eliminates the "deeming requirements" for immigrant children. Deeming is the practice of counting the income and resources of the immigrant's sponsor when determining food stamp eligibility and benefit amounts. More immigrant children should become eligible as a result of eliminating the deeming requirements.
The Farm Bill also restores eligibility for food stamps (starting October 2002) to "qualified" adult immigrants who are now receiving disability benefits, regardless of their date of entry and (starting in April 2003) to "qualified" adult immigrants who have lived in the U.S. continuously for 5 years as a "qualified" immigrant since their entry.
For detailed report and analysis, visit the Current News and Analysis page of the Food Research and Action Center (FRAC) website.
House Passes TANF Bill Without Restorations of Eligibility for Immigrants
On May 16, 2002, the House approved a bill (H.R. 4737) , largely along party lines, to reauthorize the Temporary Assistance to Needy Families (TANF) program created under the 1996 welfare reform law. The bill does not restore eligibility for benefits that were taken away from immigrants by the welfare reform law in 1996. Legal immigrant families that have been in the country for less than five years remain ineligible not only for TANF-funded cash assistance, but also for TANF-funded employment services and supports such as child care, transportation, job training, and English-language instruction. In addition, English-language instruction still will not count as an allowable work activity. Finally, this bill allows the Secretary of the Department of Health and Human Services to "waive" or make exceptions to, the federal laws and regulations in a variety of key low-income programs, including in the food stamp program. This "superwaiver" may result in sweeping authority to ignore federal laws that protect the rights of TANF recipients.
No companion bill has been introduced yet in the Senate. However, several Senators have issued outlines of their proposals for the Senate Finance Committee to consider. Senator Breaux (D-LA) and five other members of the Senate Finance Committee issued a "tri-partisan" TANF proposal that includes a state option to restore TANF eligibility for qualified immigrants. Senators Carper (D-DE) and Bayh (D-IN) have proposed an alternative that includes a number of positive provisions for immigrants, including a state option to eliminate the five-year period of ineligibility in TANF, supplemental funds to help states implement this provision, and an increase from 12 to 24 months in which TANF recipients may participate in vocational education. Their proposal also includes the Immigrant Child Health Improvement Act, which would restore Medicaid and State Children’s Health Insurance Program to lawfully present children and pregnant women. There are no "superwaiver" provisions in either alternative proposal.
Senate Passes Health Care Safety Net Bill, Including Grants for Linguistic Access
The Senate passed the Health Care Safety Net Amendments Act of 2002 (S.1533) on April 16, 2002. The House now has to consider the bill. In addition to reauthorizing the Community Health Centers program, the Senate bill attempts to address the needs of people who do not speak English by authorizing $10 million for Linguistic Access Grants. Health centers would be able to compete for funding for translation and interpretation services, including hiring professional translators and interpreters.
Office of Management and Budget Report Estimates Additional Cost of Providing Services to Persons with Limited English Proficiency to be Only 0.5% in the Healthcare Setting
The Office of Management and Budget (OMB) released a report in March on the costs and benefits of implementing Executive Order 13166, Improving Access to Services for Persons with Limited English Proficiency (LEP). The report estimates that LEP-associated costs across all government or government-funded services may be less than $2 billion, and perhaps less than $1 billion. However, they emphasize that this figure represents the aggregate cost of providing language assistance to LEP persons, not necessarily the additional cost of implementing the Executive Order. Furthermore, the OMB estimates the additional cost of providing language services for inpatient visits, outpatient physician visits, and dental visits to be only 0.5%.
The report further states that making interactions with the health care system more effective and more accessible for LEP persons may result in a multitude of benefits, including increased patient satisfaction, decreased medical costs, improved health, sufficient patient confidentiality in medical procedures, true "informed consent ", and understanding of other legal issues.
Many of the comments that APIAHF submitted to OMB were incorporated into the report. To see these comments, visit: APIAHF Comments to OMB Regarding Cost and Benefits Associated with Implementation of Executive Order 13166 - Submitted 12/28/01
Department of Justice Publishes Revised Guidance on Services for Persons with Limited English Proficiency
In April 2002, the U.S. Department of Justice (DOJ) published a revision of its LEP Guidance after receiving and analyzing numerous public comments. The DOJ revised its guidance with the expectation that other federal agencies will use the DOJ guidance as their own LEP guidance, with agency-specific provisions in appendices. The guidance will be useful in helping recipients of federal funding meet their obligation under Title VI of the 1964 Civil Rights Act to provide meaningful access to persons with Limited English Proficiency.
Among the major revisions made by the DOJ are clarifications on use of family and friends as interpreters, additional criteria for determining interpreter competence, and a statement that, even when contact with LEP individuals is infrequent or unpredictable, recipients of federal funds should still analyze their situation to determine what to do when an LEP individual seeks their services.
The DOJ LEP guidance states that competency in interpretation requires more than self-identification as bilingual, acknowledging that being bilingual does not automatically mean that one is competent to interpret in and out of English. The guidance lays out criteria for competency that apply whether the interpreter is an employee, volunteer or contractor. It also states that in many instances, family members and friends are neither appropriate nor competent to provide accurate interpretations. The DOJ acknowledges that there may be other instances where using family or friends is permissible, but that proper planning and implementation should help the recipient avoid such situations.
The revised guidance was published in the Federal Register on April 18, 2002. The DOJ has established a clearinghouse website (www.lep.gov) providing and linking to information, tools, and technical assistance regarding limited English proficiency and language access. To read APIAHF comments to the DOJ on their guidance, visit: APIAHF Comments to DOJ Regarding Republication of LEP Guidance - Submitted 2/19/02
Department of Health and Human Services to Publish Revised LEP Guidance
The U.S. Department of Health and Human Services (HHS) is currently reviewing comments received by April 2002 about its LEP guidance. HHS will republish its revised LEP guidance for further comment and review later this summer. The most current version of the HHS LEP guidance can be found at http://www.hhs.gov/ocr/lep/. To read APIAHF comments to HHS, visit: APIAHF Comments to HHS Regarding Republication of LEP Guidance - Submitted 4/2/02
Association of American Medical Colleges to Redefine "Underrepresented Minority"
The Association of American Medical Colleges (AAMC) is in the process of revising the definition of Underrepresented Minority (URM). This definition has a large impact on the diversity and ultimately the cultural and linguistic competency of the health care workforce. The definition of URM is used in policymaking, benchmarking, eligibility for programs ranging from K-12 pipeline programs all the way to faculty development programs, and data collection and reporting. Currently, this definition does not include any Asian American or Pacific Islander (AAPI) populations (except Native Hawaiians).
AAPIs are an extremely heterogeneous group encompassing hundreds of different languages and dialects, diverse cultural backgrounds, and unique experiences in immigration and history. AAPI populations are also growing faster than any other minority population and there are currently few health care providers from many of these communities. The current AAMC definition, however, does not recognize these differences or allow for the designation of groups that are underrepresented within the "AAPI" category. In response, APIAHF issued an action alert urging comments to the AAMC to encourage the expansion of the URM definition to include underrepresented AAPIs. For more information about the AAMC and definition of URM, visit www.aamc.org/meded/urm/ .
Underwood Introduces Legislation to Create AAPI Serving Institutions
Congressman Robert Underwood (D-Guam) introduced legislation this month (H.R. 4825) that would authorize the Department of Education to designate higher education institutions with an undergraduate enrollment of at least 10% Asian American and Pacific Islander American students as "Asian American and Pacific Islander Serving Institutions (AAPISI)." Institutions so designated would become eligible for federal funding to improve their capacity to provide higher education opportunities to these populations.
The Department of Higher Education already designates Historically Black Colleges and Universities (HBCU), Hispanic Serving Institutions (HSI), and Tribal Colleges and Universities (TCU). In addition to Department of Education, other federal agencies use these designations to target funding and implement a variety of programs. For example, the Centers for Medicare and Medicaid Services (CMS) made grants to HBCUs and HSIs for minority health services research. AAPI serving institutions would be encouraged to work with community-based organizations in carrying out their programs. For a copy of the bill, visit http://thomas.loc.gov and search for bill number "HR 4825", or contact Gem P. Daus at gdaus@apiahf.org
CALIFORNIA
Legislation Codifying Cultural Competence and Linguistic Access Requirements in Medi-Cal Managed Care and Healthy Families Programs (AB 2739) Passes Assembly
APIAHF, its six project partners (Asian Pacific American Legal Center, California Pan-Ethnic Health Network, California Primary Care Association, Fresno Health Consumer Center of Central California Legal Services, Latino Coalition for a Healthy California, and National Health Law Program), and numerous health and low-income organizations continue to monitor the progress of Assembly Bill 2739 through the California legislative process. As reported in the last Policy Update, this legislation, authored by Assemblymember Wilma Chan (D-Oakland), would ensure language access and cultural competence in the Healthy Families and Medi-Cal managed care programs, by codifying these programs' existing cultural competence and linguistic access (C/L) requirements in California law. This legislation would also make the C/L requirements between the two programs more uniform and require the regulatory agencies responsible for the two programs to report on the compliance with the C/L requirements.
On May 22, 2002, the California Assembly passed AB 2739, sending it to the California Senate for its consideration. More information is available by visiting: California Assembly Bill 2739 (Chan) - Fact Sheet. The legislation and information on it can be viewed at: www.leginfo.ca.gov/bilinfo.html (search for "2739" under Bill number)
"Racial Privacy Initiative" Delayed Until March 2004 Ballot
The California ballot initiative, referred to by proponents as the "Racial Privacy Initiative," would make it illegal for public entities to collect or use information by race, ethnicity or national origin. While originally slated for the November 2002 general election, proponents have failed to collect enough signatures to ensure its qualification in time. Instead, it is very likely that after a full signature verification process, the initiative will be placed on the March 2004 primary election ballot. A broad range of civil rights, health, and education groups have formed a coalition and plan to continue their efforts to defeat the initiative.
On May 17, the U.S. Commission on Civil Rights convened a hearing on Implications of Racial Data Collection Bans on Civil Rights. The Commission invited APIAHF to testify on the impact of such a ban, as well as the impact of the "Racial Privacy Initiative" on health and civil rights enforcement. Following the hearing, the Commission voted unanimously to oppose attempts to ban the collection of race data and is planning to issue a public statement. APIAHF’s written testimony can be found at: APIAHF Testimony to U.S. Commission on Civil Rights Regarding Consequences of Race Data Collection Bans - Submitted 5/17/02.
Governor Releases May Revision to State Budget with Large Cuts in Health Programs
The May Revision to the Governor’s January Budget contains a number of significant cuts to health and human services programs for Californians. Estimates for the 2002-03 fiscal year budget deficit have reached $23.6 billion, compared to January estimates of $12.5 billion. Governor Davis is proposing to address this enormous shortfall primarily through program reductions (32% of the solution), selling bonds based on the expected payments from the settlement of litigation with tobacco companies (19% of the solution), and a number of other fund shifts, loans, accelerations, transfers and deferrals.
Future Tobacco Funds Jeopardized by $4.5 Billion Securitization - The May Revision proposes to issue a $4.5 billion bond backed by Tobacco Settlement Fund revenues, thereby "securitizing" state tobacco funds to be received over the next 22 years. The bond proceeds would be placed in the General Fund to reduce the current budget deficit. Each year, a portion of the monies received by the state from the Tobacco Settlement Fund would be committed to service debt payments. If enacted, the tobacco securitization would reduce the annual funds available to the state from the settlement by well over half.
Healthy Families Expansion Delayed - Despite approval of a federal waiver to expand the Healthy Families program to parents, the budget proposes to delay implementation of the program until July 2003.
Selected Medi-Cal Optional Benefits Eliminated - The May Revision proposes to eliminate certain Medi-Cal benefits to save $526 million. These benefits include: dental coverage; psychiatric; chiropractic; and podiatric services; rehabilitation and occupational therapy; acupuncture; and certain medical supplies.
Requirement for Medi-Cal Quarterly Status Reports Reinstated - The May Revision includes reinstating burdensome quarterly status reports for adults in Medi-Cal. This requirement could threaten coverage for 200,000 adults who lose their coverage due to incomplete status reports.
Medi-Cal Benefits Revoked for Parents In Poverty - Two-parent working families with incomes below poverty who are currently not enrolled will no longer be eligible for Medi-Cal under the 1931(b) program in the revised budget. It is estimated that 92,000 low-income adults and children would no longer be able to enroll in Medi-Cal in 2002-03 if the cut is enacted.
Provider Rates Further Reduced - The revised budget includes an addition reduction in reimbursement rates to providers to save $94 million.
Express Lane Eligibility Delayed - Expansions passed in 2001 to facilitate Medi-Cal enrollment by linking it with free school lunch and food stamp eligibility would be delayed until July 2005 under the revised budget. It is estimated that by linking with the school lunch program, an additional 21,200 children would have received Medi-Cal benefits, and by linking with the food stamp program, an additional 14,900 parents and children would have received Medi-Cal benefits in 2002-03.
Expanded Access to Primary Care (EAPC) Reduced - The previously proposed $17.5 million increase to Expanded Access to Primary Care for safety-net providers has been eliminated with the restoration of CHDP funding.
Child Health and Disability Prevention (CHDP) Program Restored - The May Revision proposes, rather than eliminate CHDP, to use it as a gateway to streamline enrollment into Medi-Cal and Healthy Families. An additional $2.7 million is included to develop an internet pre-enrollment application to do this.
Cuts are also proposed for the following health programs:
- Early and Periodic Screening, Diagnosis, and Treatment Program
- Disproportionate Share Hospital Funds
- Pharmacy Reimbursement
- Medi-Cal/Healthy Families Outreach for Children
- Medical Case Management Program
- Dental Cleanings and Exams
- Contracting for Durable Medical Equipment and Lab Services
- Development of Staffing Ratios and Reimbursement Methodology for Nursing Facilities
- County Administration Funding for Medi-Cal
The California Senate and Assembly also have released their proposals for the budget. These proposals do not include all of the cuts proposed by the Governor, however, much is expected to change as differences are worked out between the Governor, the Assembly and the Senate versions. For detailed information about the Governor’s May Budget Revision, visit www.dof.ca.gov.
For more information, contact the APIAHF Policy Division staff:
Gem Daus, Legislative and Government Affairs Coordinator, GDaus@apiahf.org
