Tennessee Immigrant Groups Help Create Comprehensive Policies to Ensure Equal Access to Medicaid, Food Stamps and TANF

This article appeared in the April 2002 Welfare News.

by Chris Griffin

Introduction

In June, July and October of 2001 Tennessee’s Department of Human Services (TDHS) issued a series of policy bulletins to improve immigrant access to public benefits, such as Medicaid, Food Stamps, TANF, and Emergency Medicaid.  The bulletins clarified and/or superseded all prior TDHS guidance on immigrant eligibility and were supplemented by statewide training. Tennessee’s bulletins could be helpful for other states and immigrant communities because they clearly and comprehensively address systemic barriers that prevent immigrants from obtaining benefits. The policies address the disclosure of social security numbers and citizenship information in the application process, the reporting of undocumented immigrants to the Immigration and Naturalization Service (INS), assistance to limited English proficient applicants, and the impact of INS public charge determinations. To help clarify the policy changes to applicants and staff, TDHS attached a notice of these changes to all its applications for public benefits, written in clear English and Spanish at a low-literacy level.

Collaborative Process for Creating the New Policies

Because Tennessee is a “new immigrant state” B  a state with a large increase in immigrants over the last decade B  representatives of the immigrant community were essential in identifying barriers and in creating an effective policy.  In the last decade, Tennessee’s immigrant population increased dramatically, and the Latino population alone grew almost 400%.   Tennessee’s Department of Human Services – like virtually every other state agency in Tennessee – did not have policies and procedures in place to accommodate large numbers of immigrants. As a result, immigrant groups reported that many eligible immigrants or eligible members of immigrant households were incorrectly denied benefits or deterred from applying.  According to immigrant groups, the worst problems were the following:

• Signs were posted in some offices which stated that if any member of a household was undocumented, that person or household would be reported to the INS.
• Some TDHS eligibility caseworkers threatened to report ineligible immigrants to the INS if they tried to obtain benefits for their eligible citizen children.
• Eligible household members were denied benefits if other members of their household did not have a Social Security Number (SSN).
• Undocumented immigrants were being denied emergency Medicaid.
• Non-English speakers were not provided interpreter services.

The Tennessee Justice Center (TJC), a non-profit legal organization, compiled evidence of these problems from community-based organizations and health clinics that work with the immigrant population.  TJC conducted outreach to these organizations on civil rights laws and immigrant eligibility for public benefits.  The Latino Memphis Conexion and the Parrotsville Health Clinic in East Tennessee were especially helpful in providing individual examples of systemic problems. With the help of the Center on Budget and Policy Priorities, TJC wrote a letter to TDHS’s General Counsel that explained the systemic problems and the applicable laws.

In writing the letter and in subsequent meetings with the state, TJC looked to Title VI of the Civil Rights Act, the Privacy Act, and guidance from the Department of Health and Human Services-Office for Civil Rights (OCR).  The latter included the OCR Guidance on Inquiries into Immigration and Citizenship Status and the OCR Limited English Proficiency Guidance.  TJC also looked to Federal guidance which interprets the requirement within PRWORA to report undocumented immigrants to the INS.  (Available athttp://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=2000_register&docid=00-24894-filed).

The letter was followed by a meeting with TDHS’s General Counsel and also by a series of letters clarifying what policy changes would be necessary.  Lee Anne Bruce, Deputy General Counsel, wrote the new policies but reached out to representatives from TJC for their comment on drafts.  TJC shared the drafts with community-based immigrant organizations and provided the state with its comments as well.

Description of New DHS Policy and Clarifications

The most important provisions of the new policy and policy clarifications are as follows:

Verification for Benefits

• Household and/or family members who are not applying for benefits for themselves do not have to provide an SSN or information about their immigration status.  (This allows an undocumented parent to apply for benefits for a citizen child.)
• Once a household member says that she does not have an SSN or that she is not applying for herself or that she does not have verification of her immigration status, that person is classified as a non-applicant and no further effort is made to obtain an SSN or citizenship information from that household member.
• Latino citizens are not required to provide more proof of citizenship than other citizens.

Emergency Medicaid
Emergency Medicaid applicants need not provide SSNs or proof of immigration status.

Reporting Undocumented Immigrants to the INS

• Immigrants should be reported to the INS if it is known that they are not lawfully present in the U.S. and if they have applied for TANF or Food Stamps for themselves. The agency can have the requisite knowledge only if it has documentation that shows the applicant is in the country illegally, such as a formal order of deportation.
• If an individual inquiring about benefits for herself states that she is “illegal” or undocumented, the individual is still not considered “known to be unlawfully present” since the statement is unsubstantiated by documentation.  In such a situation, the eligibility worker must explain eligibility requirements and inform the applicant that she may apply on behalf of eligible household members regardless of her own eligibility.
• Undocumented immigrants are allowed a fair hearing, with notice and an opportunity to be heard, before they are reported to the INS.
• Applicants for Medicaid only, including emergency Medicaid, should not be reported to the INS.

Public Charge
The policy clarified for benefits workers what the INS public charge determination is and which immigrants it could affect.

Language Access

• TDHS will provide interpreter services to clients who do not speak English well.
• Friends and family members may interpret for a client, but they should be first advised that free interpreters are available.
• All TDHS staff who may have contact with limited English proficient clients are required to undergo training on using a Language Line.

Conclusion

The new policies have already had significant impact on improving immigrant access to benefits in Tennessee.  Their success can be attributed to different groups of immigrants, immigrant service providers and legal organizations pooling their resources together to work effectively, and to the dedication of TDHS’s Deputy Commissioner and Deputy General Counsel to understanding TDHS’s immigrant and refugee clients.  Work to improve immigrant access to benefits continues in Tennessee.  TDHS and TJC convened a workgroup of immigrants, refugees and their representatives, which has met several times to create a language access policy for the county offices.

Note : Chris Griffin, who as a NAPIL fellow worked on immigrant access issues at TJC, moved to the Region IV OCR office after his fellowship to continue working on immigrant access and other civil rights issues in the Southeastern states (AL, MS, FL, SC, TN, GA, NC, KY).  For more information on TDHS’s immigrant access policies or the process, contact Lee Anne Bruce, TDHS Deputy General Counsel, at LeeAnne.Bruce@state.tn.us, (615)313-4731, or Chris Griffin at cgriffi1@os.dhhs.gov, 404-562-1591.  Chris is especially interested in hearing from any Southeastern community-based organizations or state representatives who would like to discuss improving immigrant access to public benefits or who have examples of best practices to share.  To reach an OCR representative in your area, call 800-368-1019.  For information on TJC’s ongoing efforts to improve immigrant access to public benefits, contact Lisa D’Souza at ldsouza@tnjustice.org, 615-255-0331.

Additional Information:

• Tennessee Dept. of Human Services Memo: Language line over-the-phone translation services (10/3/2001)
• Tennessee Dept. of Human Services Memo: new policy concerning social security numbers and persons who are not applying for assistance (7/2001)
• Tennessee Dept. of Human Services Memo: Guidance for Family Assistance Staff: Citizenship, Immigration Status, and Social Security Numbers (6/12/2001)