Immigration Relief for Parents and Youth = Whole Family Health Coverage in California by Sonya Schwartz, Kristen Golden Testa, and Kristelle Jose Key Findings 1. When fully implemented, immigration relief As many as 609,000 parents and 223,000 provides California, in particular, with an children are estimated to be uninsured enormous opportunity to provide whole and are likely eligible for Medi-Cal. DAPA family health coverage.1 parents may be eligible for state-funded California is one of only a small number Medi-Cal and citizen or lawfully residing of states that provide state-funded health children may be eligible for full scope coverage to legal immigrants, including, when Medi-Cal.2 And, up to 262,000 children implemented, parents that have “Deferred and young adults are estimated to be Action for Parents of Americans and Lawful uninsured and likely to be eligible for Permanent Residents (DAPA)” and children state-funded Medi-Cal when they are and young adults that have “Deferred Action granted deferred action under the DACA for Childhood Arrivals (DACA)” status. When program (see Figure 1). expanded DACA and DAPA are federally Figure 1. implemented, many more immigrant parents 1.1 Million Californians Could as well as their citizen, and lawful permanent Gain Health Coverage If resident children who are currently uninsured Parents and Youth Are Granted will likely gain coverage. Immigration Relief 2. Immigration relief could provide a welcome mat for parents to enroll already eligible Citizen or lawfully 223,000 residing children in but hard-to-reach children in health DAPA Families insurance programs. Many uninsured Hispanics in California worry DACA children 262,000* that signing up for health insurance will and young adults draw attention to their immigration status. In addition to giving parents a reprieve from fear of deportation, immigration relief may lessen parents’ fears about signing up for health 609,000* DAPA parents insurance. 3. As many as 1.1 million parents, young adults and children living in immigrant families in California could gain health *Reflects state-funded Medi-Cal. coverage if granted immigration relief. July 2015 CCF.GEORGETOWN.EDU and CHILDRENSPARTNERSHIP.ORG IMMIGRATION RELIEF FOR PARENTS AND YOUTH 1 Introduction On November 20, 2014, President Obama percent) are estimated to be uninsured and eligible announced immigration executive actions that for Medi-Cal.6 And third, by encouraging parents to include a new program providing temporary work come out of the shadows, immigration relief also authorization and protection from deportation for provides a great opportunity to enroll their already- certain undocumented parents with U.S. citizen eligible children in health insurance. Many of these or lawful permanent resident (LPR) children. children are hard-to-reach citizens and lawfully This new program is called “Deferred Action for residing immigrants who qualify today for Medi-Cal Parents of Americans and Lawful Permanent but are not yet enrolled. When parents are eligible Residents”(DAPA). In addition to allowing themselves for health coverage, they are more likely parents to come out of the shadows and have to enroll their children. There are 1,590,551 children a reprieve from fears of deportation, this new likely to be living in DAPA families in California. As immigration policy also provides California with a many as 223,000 (14 percent) of these children are unique opportunity to cover a large share of the likely to be uninsured and eligible for Medi-Cal.7 remaining and hard-to-reach uninsured parents The new immigration and children in the state. On the same day, This brief provides information about DAPA and policy provides a the expansion of the Deferred Action for Childhood Obama also announced an expanded “Deferred Arrivals (DACA) program, and initial ideas about unique opportunity Action for Childhood Arrivals” (DACA) program how to conduct outreach and enroll parents and and other reforms to our immigration system. to cover a large share children in DAPA families into health coverage Expanded DACA is a program for people who of the remaining came to the U.S. before their 16th birthday, have programs. It is intended to educate organizations hard-to-reach parents continuously lived in the U.S. since January working with immigrant children and families in California and prepare them for opportunities to and children in 1, 2010, are currently enrolled in school, adult enroll individuals in health coverage that may come California. education, or have graduated or obtained a about as a result of changes in immigration policy. certificate of completion of high school, and meet It is also intended to help organizations working other requirements.3 to improve access to health coverage in California Immigration relief provides California in particular about immigration relief and what it means for with an enormous opportunity to reduce its children and families in terms of eligibility for health uninsured rate. This is for a few reasons. First, coverage. California has the greatest number of parents As of the writing of this brief, no one can apply eligible for DAPA in the United States. There for DAPA or expanded DACA yet (note that you are 1,087,000 parents likely eligible for DAPA can apply for the initial DACA program and for in California.4 Second, California is one of only renewals of the initial 2012 DACA program). The a small number of states that provide state- DAPA program, which the President intended funded health coverage to whole families when to begin in May 2015, and the expanded DACA parents have this type of deferred action status; program are currently on hold until a court issues and offers state-funded health coverage to an order that allows DAPA (and expanded DACA) children and young adults with DACA status. to go forward.8 However, these programs could Of the 1,087,000 parents likely to be eligible for become available soon after a court issues such DAPA in California, 609,000 of these parents an order, so it is important for families to be (56 percent) are uninsured and likely eligible informed about these programs and prepared to for a state-funded version of Medi-Cal.5 Of the apply. Read on for more information on where 436,000 people eligible for the 2012 and 2014 the programs stand and what families can do to DACA programs in California, 262,000 people (60 prepare. 2 IMMIGRATION RELIEF FOR PARENTS AND YOUTH CCF.GEORGETOWN.EDU and CHILDRENSPARTNERSHIP.OR G July 2015 Understanding DAPA and DACA What is DAPA? expanded DACA until a court issues an order that In November 2014, Obama announced several allows the initiatives to go forward.11 However, eligible immigration executive actions that included DAPA. children and young adults may continue to apply DAPA will allow undocumented parents with U.S. for the existing DACA program. Until then, people citizen or lawful permanent resident children to can start saving money for the application fee and apply for work authorization and protection from begin preparing their cases, but an application form deportation, if the parent has been in the U.S. since is unlikely to be available until shortly before the January 1, 2010. Individuals granted DAPA cannot program’s start date. See the National Immigration have been convicted of certain criminal offenses. Law Center’s “Top 10 Ways to You Can Prepare DAPA does not confer legal status or a path to for Executive Action on Immigration” for more that citizenship for parents—only a temporary reprieve individuals can do to prepare to apply.12 from deportation. DAPA benefits are valid for three years, and can be renewed. Will People Step Forward and Apply for DAPA and Expanded DACA? What is DACA and How Was it Expanded It is important to remember that not all Californians in 2014? eligible for immigration relief will apply for DAPA The November 2014 executive actions also include an or expanded DACA once the programs start, it will expanded version of the Deferred Action for Childhood take time for individuals to apply and be granted Arrivals (DACA) program. The initial DACA program immigration relief. Some of the barriers to applying announced on June 15, 2012, is a program for youth are unique to immigration relief and others are similar who came to the U.S. before their 16th birthday; have to the barriers people face when applying for health continuously lived in the U.S. since January 15, 2007; insurance. These barriers include inability to afford are at least 15 years old; are currently enrolled in the $465 application fee, not having access to the school or qualifying adult education program, or have required paperwork, not knowing how to apply or graduated or obtained a certificate of completion of not being able to find assistance with the application high school; and have not been convicted of certain process,13 and other fears. The closest example we criminal offenses.9 The expanded DACA program, have to DAPA take-up in California is the take-up of announced on November 20, 2014 but also on hold the initial DACA program, which became available like DAPA, is also for youth who came to the U.S. in August 2012. To date a majority (54 percent) before their 16th birthday but have continuously lived of Californian’s DACA-eligible children have been in the U.S. since January 1, 2010.10 provided immigration relief.14 When Will the DAPA and Expanded DACA Are Parents Granted DAPA by Immigration Application Process Start? Authorities Eligible for State or Federally The Citizenship and Immigration Services (USCIS) Funded Health Coverage Programs? had planned to begin taking applications for Similar to DACA children, parents granted DAPA in expanded DACA on February 18, 2015 and for DAPA California are eligible for a state-funded version of on May 20, 2015. However, USCIS is not accepting California’s Medi-Cal program if they meet income applications for DAPA or for the expanded DACA (below 138 percent of the federal poverty level) and program yet because a federal district court in Texas other guidelines.15 However, parents granted DAPA has issued an order that temporarily blocks these are not likely to be eligible for federally-funded programs from being implemented. This means programs like Medicaid or CHIP, or federally funded that people will not be able to apply for DAPA or premium tax credits for marketplace coverage provided through Covered California.16 July 2015 CCF.GEORGETOWN.EDU and CHILDRENSPARTNERSHIP.ORG IMMIGRATION RELIEF FOR PARENTS AND YOUTH 3 How Many Immigrant Parents are Eligible for DAPA in California and Where Do They Live? As mentioned earlier, California has the largest number of DAPA parents in the United States. Researchers at the Migration Policy Institute estimate that 1,087,000 parents in California qualify for DAPA.17 The vast majority of these DAPA eligible parents are estimated to live in Los Angeles County (367,000). Four other counties in the Southern Part of the state—Orange County, San Diego County, Riverside County, and San Bernardino County—have the next greatest population with more than 50,000 DAPA-eligibile parents estimated to be living in each of these counties.18 See Figure 2 below for more information about where DAPA eligible parents live in California. Del Norte Figure 2: Siskiyou Modoc Most DAPA Eligible Parents Live in Southern California Trinity Shasta Lassen Humbolt More than 350,000 Tehama Plumas 50,000 to 100,000 Mendocino Butte Glenn Sierra 25,000 to 50,000 Nevada Colusa Placer Yu 15,000 to 25,000 b Lake Su a tte r Yolo El Dorado Sonoma Napa Alpine Under 15,000 Sacra- dor mento Ama Solano s vera San Cala Marin Joaquin Tuolumne Contra Costa San Alameda Stanislaus Mariposa Mono Francisco San Santa Merced Mateo Clara Madera Santa Cruz San Fresno Benito Inyo Tulare Monterey Kings San Luis Obispo Kern San Bernadino Santa Barbara Ventura Los Note: Data for the regions shaded in grey are not Angeles available due to small sample size. Source: Migration Policy Institute (MPI) analysis of Riverside Orange U.S. Census Bureau data from the 2013 American Community Survey (ACS), 2009-2013 ACS pooled, and the 2008 Survey of Income and Program Imperial Participation (SIPP) by James Bachmeier of Temple San Diego University and Jennifer Van Hook of The Pennsylvania State University, Population Research Institute. 4 IMMIGRATION RELIEF FOR PARENTS AND YOUTH CCF.GEORGETOWN.EDU and CHILDRENSPARTNERSHIP.OR G July 2015 How Many Parents will be Eligible Many immigrant parents have shied away from for State-Funded Medi-Cal in applying for government programs for fear of California if Granted DAPA? detection and deportation, even though there Of these 1,087,000 DAPA-eligible parents, are strong privacy protections that prevent 609,000 parents (56 percent) were low income information in health insurance applications by Medi-Cal eligible standards in 2013 and from being shared with immigration officials.20 In lacked health insurance, and are themselves 2014, the majority of uninsured, undocumented, likely to be eligible for state-only funded immigrant Hispanics surveyed in California version of Medi-Cal if granted DAPA.19 said they were ‘very worried’ that signing up for health insurance would draw attention to Why is DAPA Also a Great their immigration status. For more information Opportunity to Cover More Kids? on Hispanics reluctance to sign up for health By removing the threat of deportation and insurance, see Figure 3.21 Even though DAPA providing work authorization for parents, benefits are temporary, parents who apply to DAPA effectively reduces a major barrier to participate in DAPA may also be more willing to coverage for children who are already eligible also apply for health insurance for their citizen or for Medi-Cal coverage but are not enrolled. lawfully residing children. Figure 3: California’s Undocumented Parents, in Particular, Worry That Signing Up for Health Insurance Will Draw Attention to Their Immigration Status Very Somewhat Not too Not at all worriedworriedworriedworried Total Hispanic 40% 14% 9% 37% Hispanics who completed the survey 53% 16% 10% 20% in Spanish Undocumented Hispanics 57% 15% 10% 17% Eligible Hispanics 24% 13% 6% 57% Note: Don’t know/refused to answer not shown. Source: Where Are California’s Uninsured Now? Wave 2 of the Kaiser Family Foundation California Longitudinal Panel Survey (April 1 - June 15, 2014). July 2015 CCF.GEORGETOWN.EDU and CHILDRENSPARTNERSHIP.ORG IMMIGRATION RELIEF FOR PARENTS AND YOUTH 5 How Many Children in DAPA The Migration Policy Institute estimates that Families in California Are Likely to be 436,000 people are estimated to be eligible Uninsured and Eligible for Medi-Cal? for the 2012 DACA and 2014 expanded DACA Of the 1,590,551 children living in DAPA- programs in California. Estimates indicate that families in California, 223,000 children (14 343,000 people in California are eligible for the percent) are Medi-Cal eligible but remain initial 2012 DACA program, and an additional uninsured.22 Reaching and enrolling the 92,000 are eligible for the 2014 expanded children in DAPA families in California DACA program. alone would make a dent in the numbers As of December 31, 2014, 187,000 individuals of uninsured children in California, and have been granted deferred action status particularly among children in immigrant through the 2012 DACA program (54 percent).25 families, who are often hard to reach and Because the 2014 DACA program is not yet enroll in health coverage programs. Nearly available, no one has been granted DACA half of all uninsured children in the U.S. live status under the 2014 program yet. However, in immigrant families,23 and more than two- people can continue to apply for the original thirds of uninsured Hispanic children in the 2012 DACA program and renewals for the 2012 U.S. are eligible for Medicaid or CHIP but are program are also available. not enrolled.24 While Hispanic children are the single largest group of children in DAPA How Many People Eligible for DACA families nationwide (immigrants from Mexico are Likely to be Uninsured and and Central America comprise more than 70 Eligible for State-funded Medi-Cal in percent of the unauthorized population), there California? are additional eligible children of immigrants in Of the 436,000 people eligible for the 2012 other racial and ethnic groups who also live in and 2014 DACA programs in California, DAPA families. 262,000 people (60 percent) are estimated to be uninsured and eligible for Medi-Cal.26 It Further, at least one child in each DAPA family is unclear how many people already granted is a lawful resident or citizen and thus eligible DACA status have successfully enrolled in for health coverage. To qualify for DAPA, state-funded Medi-Cal. There have been parents must have been in the United States reports that Medi-Cal eligible DACA grantees for five years, and have U.S. citizen or lawful were incorrectly rejected when they applied permanent resident children. In California, all for state-funded Medi-Cal and that county citizen and LPR children who meet the income, eligibility workers are not aware that DACA residency and other guidelines are eligible grantees are eligible for state-funded Medi- for Medi-Cal, regardless of their parents’ Cal.27 The state has since issued guidance immigration status or year that they arrived. to counties clarifying that individuals granted How Many People Are Eligible for deferred action status through the 2012 DACA DACA and Expanded DACA in program are eligible for state-funded full scope California? Medi-Cal.28 California also has the largest number of children and young adults eligible for DACA and expanded DACA in the United States. 6 IMMIGRATION RELIEF FOR PARENTS AND YOUTH CCF.GEORGETOWN.EDU and CHILDRENSPARTNERSHIP.OR G July 2015 Conclusion Immigration relief can provide California, more for DACA; and many hard to reach uninsured than any other state, with a unique opportunity children living in DAPA families. If advocates, to significantly reduce its uninsured rate. service providers, and others working on The state has the greatest number of people health care, immigration, and child and family eligible for DAPA and DACA in the entire United well-being work together to educate and help States; state-only-funded full scope Medi- enroll these whole families in health insurance, Cal coverage for low-income parents eligible it could lead to a significant reduction in for DAPA and low-income individuals eligible California’s uninsured. How Can Your Organization Help Get DAPA and DACA Families Covered? People with DACA and DAPA status may be eligible for health coverage and there are many ways to help families. Here are some ideas to get you started: XXReach out to organizations that are planning to help immigrant families apply for DAPA and ask how your organization can help. Probably the best way to get started is to reach out to organizations in your state or local area likely to help with DAPA and DACA applications ask how you can help. Organizations are continuing to prepare as they wait for the court’s decision. You can find organizations that will be providing immigration-related assistance by state and county at http://www.adminrelief. org/legalhelp/. Recognize that organizations planning to help immigrant families apply for DAPA and expanded DACA are likely to be overwhelmed with requests and are getting ready to handle large case volumes, and so they may need your assistance to include a health insurance component to the work. XXParticipate in and/or host community forums on DAPA and DACA.29 Include related practical concerns that families face, like health coverage, taxes and more. Many local organizations are already planning workshops and community educational sessions about DAPA and expanded DACA in advance of the programs’ roll out. In addition to learning about DAPA and DACA and how to apply, families will be interested in learning about getting a driver’s license, any changes in filing taxes, access to health care and coverage, and other family support programs. Being available to provide information about health coverage at these forums is a great idea. XXProvide health-coverage enrollment assistance at locations where families will learn about DAPA and DACA. If you, or organizations you work with, provide health coverage outreach and enrollment assistance to children and families, reach out now to organizations in your community that are likely to help families learn about DAPA and DACA. Ask them if there are ways you can help support connecting children and families to coverage as parents learn about the DAPA and DACA programs. Remember that while open enrollment for Covered California is closed, Medi-Cal enrollment is open all year round. July 2015 CCF.GEORGETOWN.EDU and CHILDRENSPARTNERSHIP.ORG IMMIGRATION RELIEF FOR PARENTS AND YOUTH 7 XXProvide engaging, culturally competent, translated materials to post and share with families applying for DAPA and DACA. DAPA and DACA legal clinics and services will often have an “exit” table where they share packets with important information like, how do you get driver’s license, where can you access health care services, what other programs are you or your children eligible for. Partner with immigrant organizations in your community to create posters and handouts that let parents know that it is “safe to apply” for health coverage for their children. Materials may also need to educate parents about why health insurance is important for children and its benefits. To view examples of materials, visit www.allinforhealth.org/undocumented. XXAdvocate for California to provide affordable health coverage options for all immigrants similar to those options provided to DAPA, DACA and other lawfully present immigrants. One of the best ways to get children into coverage is by covering their parents as well.30 California is one of few states that automatically covers DAPA parents and DACA grantees under 138 percent of poverty in a state-funded version of Medi-Cal.31 However, low and moderate income families with slightly higher incomes may not have an affordable coverage option because they are not eligible for federal premium tax credits to help them purchase coverage in Covered California, California’s state run health insurance marketplace.32 As this brief went to publication, California passed a budget bill (SB 75) that includes health coverage for all children up to 266 percent of the federal poverty level regardless of immigration status. Coverage can begin in May 2016, and the bill is estimated to cover 170,000 children. Two related proposals to expand coverage for immigrants continue to move through the California legislature. The first would provide state-funded Medi-Cal coverage to low income adults who meet income qualifications but are currently denied full scope Medicaid based on their immigration status (SB 10). The second directs the state to seek permission from the federal government to allow individuals who are not lawfully present in California to purchase non- subsidized health coverage through Covered California (SB 4). XX can also help families in need of health coverage learn about DAPA You and DACA. Training health coverage intake or outreach staff on recognizing if someone might be eligible for DAPA and DACA and referring them to appropriate place to learn more would also be helpful. As part of this, knowing what documentation individuals need to provide is key. In some cases, documentation from health care providers may be helpful to prove families and children have been in the country—for instance to prove birth of a child, or to use vaccinations or other doctors’ appointment to prove U.S. residence. Immigrant-oriented organizations are working on outreach campaigns to educate individuals about DACA in the same way health coverage-focused organizations run campaigns about enrollment in coverage. To see materials from the ALL IN For Health Campaign, go to www.allinforhealth.org. 8 IMMIGRATION RELIEF FOR PARENTS AND YOUTH CCF.GEORGETOWN.EDU and CHILDRENSPARTNERSHIP.OR G July 2015 Endnotes 1 As of the writing of this brief, no one can apply for the Center (March 2015). Note that these estimates do not DAPA or expanded DACA programs yet. The programs, reflect California’s June 2015 budget action. 170,000 which the President intended to begin in 2015, are children are estimated to be eligible for state-funded currently on hold until a court issues an order that Medi-Cal pursuant to the budget action. allows DAPA (and expanded DACA) to go forward. The 7 The estimate of 1,590,551 children in DAPA families 2012 DACA program is still in effect. comes from Manuel Pastor, et al., “The Kids Aren’t 2 As this brief went to publication, California’s governor Alright—But They Could Be,” USC Dornsife Center for signed a budget plan that includes health coverage the Study of Immigrant Integration (March 2015). The for all low-income children, regardless of immigration estimate of 14 percent is the percentage of Medicaid status. Under the signed budget, California will provide eligible citizen children living in immigrant families in state-funded Medi-Cal coverage for income-eligible California [who were uninsured in 2008-2010]. See E. children regardless of immigration status. Coverage will Seiber, “Which States Enroll Their Medicaid-Eligible, begin in May 2016. The federal government will share in Citizen Children with Immigrant Parents?,” Health the cost of emergency and pregnancy related services. Services Research (April 2013). 3 See “What is DACA and How Was it Expanded in 8 For more information about DAPA and to track the 2014?”on page 3 for more information. DAPA-related litigation, visit the American Association of Immigration Lawyers Media Clipping Service, available 4 The estimate of 1,087,000 parents likely eligible for at http://www.aila.org/advo-media/news/clips. DAPA comes from Migration Policy Institute, “National and State Estimates of Populations Eligible for DAPA 9 National Immigration Law Center, “Frequently Asked and DACA Programs 2009-2013,” available at http:// Questions: The Obama Administration’s Deferred Action www.migrationpolicy.org/programs/us-immigration- for Childhood Arrivals,”(January 23, 2015). policy-program-data-hub/unauthorized-immigrant- 10 Ibid. population-profiles (accessed May 20, 2015). Note 11 National Immigration Law Center, “Frequently Asked that the Migration Policy Institute’s estimate of DAPA Questions: The Obama Administration’s DAPA and eligible parents is higher than UCLA/UC Berkeley’s Expanded DACA Programs,” (March 2, 2015), available estimate of 884,000 parents eligible for DAPA. We at http://www.nilc.org/dapa&daca.html. use Migration Policy Institute DAPA data because it provides information by California counties in addition 12 National Immigration Law Center, “Top 10 Ways You to state data. L. Lucia, et al., “Health Insurance and Can Prepare for Executive Action on Immigration,” Demographics of California Immigrants Eligible for (November 21, 2014), available at http://www.nilc.org/ Deferred Action,” UCLA Center for Health Policy toptenwaystoprep.html (viewed May 20, 2015). Research and UC Berkeley Labor Center (March 2015). 13 As this brief went to publication, California’s governor 5 The 56 percent is based on eligibility standards in signed a budget plan that included $15 million for DAPA, 2013, people who are low-income and also lacked DACA, and citizenship support and a new statewide health insurance, and are themselves likely to be eligible Director of Immigrant Integration. for a state-funded version of Medi-Cal when they are 14 In California, 186,729 initial applications for DACA had granted DAPA status. L. Lucia, et al., “Health Insurance been approved by December 31, 2014. The Migration and Demographics of California Immigrants Eligible Policy Institute estimates that 343,000 Californians are for Deferred Action,” UCLA Center for Health Policy eligible under the original DACA program. Therefore, Research and UC Berkeley Labor Center (March 2015). 54 percent of those eligible for the initial DACA have 6 The estimate of 436,000 people eligible for 2012 and been granted DACA status in California. See U.S. 2014 DACA programs comes from Migration Policy Citizenship and Immigration Services, Data Set: Institute, “National and State Estimates of Populations Deferred Action for Childhood Arrivals, December 2014 Eligible for DAPA and DACA Programs 2009-2013,” data, available at http://www.uscis.gov/sites/default/ available at http:// www.migrationpolicy.org/programs/ files/USCIS/Resources/Reports%20and%20Studies/ us-immigration-policy-program-data-hub/unauthorized- Immigration%20Forms%20Data/All%20Form%20 immigrant-population-profiles (accessed May 20, 2015). Types/DACA/I821d_performancedata_fy2015_qtr1. The 60 percent is based on people who are low- pdf (viewed May 28, 2015). See also, Migration Policy income as defined using the Medi-Cal income eligibility Institute, National and State Estimates of Populations thresholds, and also lacked private health insurance. L. Eligible for DAPA and DACA Programs, 2009-2013, Lucia, et al., “Health Insurance and Demographics of available at http://www.migrationpolicy.org/programs/ California Immigrants Eligible for Deferred Action,” UCLA us-immigration-policy-program-data-hub/unauthorized- Center for Health Policy Research and UC Berkeley Labor immigrant-population-profiles (viewed May 20, 2015). July 2015 CCF.GEORGETOWN.EDU and CHILDRENSPARTNERSHIP.ORG IMMIGRATION RELIEF FOR PARENTS AND YOUTH 9 15 Low-income Californians with DAPA status should at http://www.ice.gov/doclib/ero-outreach/pdf/ice-aca- be enrolled in full-scope Medi-Cal and not emergency memo.pdf (viewed May 20, 2015). Medi-Cal. Since the income eligibility criteria for 21 B. DiJulio, et al., “Where are California’s Uninsured emergency Medi-Cal and full scope Medi-Cal are the Now? Wave 2 of the Kaiser Family Foundation California same, no one granted DAPA status should continue to Longitudinal Panel Survey,” Kaiser Family Foundation receive emergency Medi-Cal. However, in practice some (July 30, 2014), available at http://kff.org/health-reform/ Californians granted DACA have remained enrolled report/where-are-californias-uninsured-now-wave-2- in emergency Medi-Cal because they are given an of-the-kaiser-family-foundation-california-longitudinal- incorrect code in the eligibility system. Note also that full panel-survey/. scope Medi-Cal for pregnant women up to 138 percent 22 The estimate of 1,590,551 children in DAPA families of FPL is pending federal approval. Limited scope or comes from Manuel Pastor, et al, “The Kids Aren’t pregnancy related coverage is available with incomes up Alright—But They Could Be,” USC Dornsife Center for to 213 percent of FPL. See file:///Users/sonyaschwartz/ the Study of Immigrant Integration (March 2015). The Downloads/PregnantWomansCoverageChart_Final. estimate of 14 percent is the percentage of Medicaid pdf (viewed May 28, 2015). For a list of health coverage eligible citizen children living in immigrant families in options for undocumented immigrants, see T. Broder and California [who were uninsured in 2008-2010]. See E. J. Blazer, “Overview of Immigrant Eligibility for Federal Seiber, “Which States Enroll Their Medicaid-Eligible, Programs,” National Immigration Law Center (October Citizen Children with Immigrant Parents?,” Health 2011), available at http://www.nilc.org/overview- Services Research (April 2013). Note that 93 percent immeligfedprograms.html. of children in DAPA families in California are estimated 16 S. Schwartz, “The President’s Immigration to be citizens, and some of the remaining 7 percent Announcement: What Do Health Policy Wonks Need to of children of children in DAPA families are lawfully Know?” Georgetown University Center for Children and residing and eligible for Medi-Cal, but a small number Families Say Ahhh! Blog (November 24, 2014), available of siblings in these families could be undocumented at http://ccf.georgetown.edu/all/presidents-immigration- and ineligible for Medi-Cal under current law. Data are announcement-health-policy-wonks-need-know/. not available on exactly what share of DAPA families in 17 Migration Policy Institute, “National and State California have income below 266 percent the Federal Estimates of Populations Eligible for DAPA and DACA Poverty Level, the Medi-Cal eligibility threshold for Programs 2009-2013,” available at http://www. children. However, the UCLA Center for Health Policy migrationpolicy.org/programs/us-immigration-policy- Research and UC Berkeley Labor Center estimate that program-data-hub/unauthorized-immigrant-population- 95 percent of undocumented teens in California are in profiles (accessed May 20, 2015). families with income below that threshold (March 2015). 18 Note that these county numbers come from a higher A similarly high share of children in DAPA families are estimate of DAPA eligible parents in the United States assumed to be income-eligible for Medi-Cal. However, by the Migration Policy Institute. The UCLA/ UC this may be a higher end estimate because it could Berkeley study notes three different estimates of DAPA include a small number of undocumented children or eligible parents. The migration Policy Institute estimates children in higher income households who would not be 1,087,000 total DAPA eligible parents in California, eligible for Medi-Cal. L. Lucia, et al., “Health Insurance while UCLA and UC Berkeley estimate 884,000. See and Demographics of California Immigrants Eligible Migration Policy Institute, “County-Level Estimates on for Deferred Action,” UCLA Center for Health Policy DACA and DAPA Populations,” available at http://www. Research and UC Berkeley Labor Center (March 2015). migrationpolicy.org/programs/us-immigration-policy- 23 S. Schwartz, “Improving Enrollment for Immigrant program-data-hub/unauthorized-immigrant-population- Families Could Cut the Number of Uninsured Kids in profiles (viewed April 6, 2015). Half,” Georgetown University Center for Children and 19 The 56 percent is based on eligibility standards in Families Say Ahhh! Blog (June 5, 2014), available at 2013, people who are low-income and also lacked http://ccf.georgetown.edu/all/lets-improve-enrollment- health insurance, and are themselves likely to be eligible for-immigrant-families-and-cut-the-number-of- for a state-funded version of Medi-Cal when they are uninsured-kids-in-half/. granted DAPA status. L. Lucia, et al., “Health Insurance 24 S. Schwartz, et al., “Hispanic Children’s Coverage: and Demographics of California Immigrants Eligible Steady Progress, but Disparities Remain,” Georgetown for Deferred Action,” UCLA Center for Health Policy University Center for Children and Families and National Research and UC Berkeley Labor Center (March 2015). Council of La Raza (November 2014). 20 U.S. Immigration and Customs Enforcement, 25 U.S. Citizenship and Immigration Services, “Data Set: “Clarification of Existing Practices Related to Certain Deferred Action for Childhood Arrivals,” (December Health Care Information,” (October 25, 2013), available 2014), available at http://www.uscis.gov/sites/default/ 10 IMMIGRATION RELIEF FOR PARENTS AND YOUTH CCF.GEORGETOWN.EDU and CHILDRENSPARTNERSHIP.OR G July 2015 files/USCIS/Resources/Reports%20and%20Studies/ Immigration%20Forms%20Data/All%20Form%20 Authors Types/DACA/I821d_performancedata_fy2015_qtr1.pdf Sonya Schwartz, Kristen Golden Testa, and (viewed May 28, 2015). Kristelle Jose 26 The 60 percent is based on people who are low-income as defined using the Medi-Cal income Acknowledgments eligibility thresholds, and also lacked private health The authors wish to thank Randy Capps at insurance. L. Lucia, et al., “Health Insurance and the Migration Policy Institute for reviewing an Demographics of California Immigrants Eligible for Deferred Action,” UCLA Center for Health Policy initial draft of this paper and Laurel Lucia at the Research and UC Berkeley Labor Center (March UC Berkeley Center for Labor Research and 2015). Education and Shiu Ming Cheer at the National 27 V. Sundaram, “DACA Students’ Right to Medi-Cal Immigration Law Center, for their review of a Routinely Rejected,” New American Media (June 16, 2014), available at http://newamericamedia. subsequent draft. org/2014/06/daca-students-right-to-medi-cal- routinely-rejected.php (viewed May 28, 2015). Design and layout assistance provided by 28 Medi-Cal Eligibility Division Information Letter No: I Nancy Magill. 14-45: Clarification of Medi-Cal Eligibility for Deferred Action for Childhood Arrivals (August 6, 2014), The Center for Children and Families (CCF) available at http://www.dhcs.ca.gov/services/medi- is an independent, nonpartisan policy and cal/eligibility/Documents/MEDIL2014/MEDILI14-45.pdf (viewed May 28, 2015). research center whose mission is to expand 29 The initial Deferred Action for Childhood Arrivals and improve health coverage for America’s (DACA) program announced on June 15, 2012, is a children and families. CCF is based at program for youth who came to the US before their Georgetown University’s Health Policy Institute. sixteenth birthday; have continuously lived in the US since January 15, 2007; are currently enrolled in The Children’s Partnership (TCP) is a school or qualifying adult education program, or have California-based research, policy, and advocacy graduated or obtained a certificate of completion of high school; and have not been convicted of certain organization working to ensure that all children, criminal offenses. The expanded DACA program, especially those at risk of being left behind, announced on November 20, 2014 but also on hold have the opportunities and resources they like DAPA, is also for youth who came to the US before their 16th birthday but have continuously lived need to grow up healthy and lead productive in the US since January 1, 2010. For more information, lives. For more information, please visit www. see National Immigrant Law Center, “Frequently Asked childrenspartnership.org. Questions: The Obama Administration’s Deferred Action for Childhood Arrivals,” (January 23, 2015). 30 Georgetown University Center for Children and Families, “Medicaid Expansion: Good for Parents Center for Children and Families and Children,” (January 2014), available at http:// Health Policy Institute ccf.georgetown.edu/wp-content/uploads/2013/12/ Georgetown University Expanding-Coverage-for-Parents-Helps- Box 571444 Children-2013.pdf. 3300 Whitehaven Street, NW, Suite 5000 31 Title 22, California Code of Regulations (CCR) Washington, DC 20057-1485 §50301.e(l)), Citizenship or Immigration Status for Full Phone (202) 687-0880 Medi-Cal Benefits State of California—Health and Email childhealth@georgetown.edu Human Services Agency, Medi-Cal Eligibility Division Information Letter No: I 14-45: Clarification of Medi- ccf.georgetown.edu/blog/ Cal Eligibility for Deferred Action for Childhood Arrivals (2014). facebook.com/georgetownccf 32 For general information, visit http://www.calendow. org/ and for Health For All information, visit http:// health4allca.org/. twitter.com/georgetownccf July 2015 CCF.GEORGETOWN.EDU and CHILDRENSPARTNERSHIP.ORG IMMIGRATION RELIEF FOR PARENTS AND YOUTH 11