Undocumented Aliens: Medicaid-Funded Births in California and Texas

Published by the Government Accountability Office on 1997-05-30.

Below is a raw (and likely hideous) rendition of the original report. (PDF)

      United States
GAO   General Accounting Offke
      Washington, D.C. 20548

      Health, Education and Human Services Division

      May 30, 1997

      The Honorable Elton Gallegly
      House of Representatives

      Dear Mr. Gallegly:

      Subject: Undocumented Aliens: Medicaid-Funded Births in California and

      Media reports have heightened concerns that aliens are entering the United
      States illegally in order to receive public benefits. Although undocumented
      aliens’ are not eligible for many publicly funded benefits, they do have partid
      or full eligibility for some. For example, under the Medicaid program, they are
      eligible for emergency services, including those associated with childbirth, if
      they meet program requirements2 In addition, although not eligible
      themselves, undocumented aliens can receive some welfare benefits on behaIf
      of their U.S. citizen children, including food stamps and cash assistance
      through the Aid to Families With Dependent Children (AFDC)3 and
      Supplemental Security Income programs. Though it is the child and not the
      parent in such cases who qualifies for the program, benefits help support the
      child’s family.

      ‘The term “undocumented alien” is sometimes used interchangeably with the
      term “illegal alien,” which refers to aliens who have entered the country
      without inspection, overstayed the length of their admission, or otherwise
      violated the conditions of admission. This correspondence uses the term
      “undocumented alien” to refer to those illegal aliens who possess no valid
      documentation of their legal entry into the United States or permission to

      2See 42 U.S.C. 1396b(v).

      3States are in the process of replacing their AFDC programs. The Personal
      Responsibility and Work Opportunity Reconciliation Act of 1996 (P-L. 104-193)
      ended the AFDC program and instead provides states with Temporary
      Assistance for Needy Families (TANF) block grants,

                                 GAOLHEHS-97-124R     Births   to Undocumented   Aliens

The Congress recently stated that national immigration policy continues to be
that the availability of public benefits should not constitute an incentive for
immigration to the United States.’ Because of your concern about non-US.
residents crossing the border for the purpose of receiving public benefits,
including pregnant women seeking U.S. citizenship and welfare eligibility for
their children, you asked us to provide information on the number of
undocumented alien women who enter the United States to give birth. No
source of data exists that provides the actual number of such childbearing
aliens. Data are available, however, estimating the number of births to
undocumented alien mothers that are funded by Medicaid. Therefore, as
agreed with your office, to respond to this request we are providing data from
state health departments on Medicaid-funded births to undocumented alien
mothers in California and Texas5 It is important to note that the information
we obtained does not indicate whether the women giving birth were already
 residing in the United States or had recently crossed the border, nor does it
 identify their reasons for entering the United States. We also spoke with state
 health and welfare officials in Texas and state health and county welfare
 officials in California. Except for not independently verifying the information
 provided to us by state health departments, we conducted our review in
 accordance with generally accepted government auditing standards from
 January through March 1997.

In summary, in 1995, Medicaid-funded births to undocumented alien mothers
were estimated to number over 78,000 in California and 24,000 in Texas. As
shown in table 1, the births in California represented 14 percent of all births
and 34 percent of Medicaid-funded births in the state. Prom 1992 to 1995, the
number of Medicaid-funded births to undocumented alien mothers in California
declined 18 percent, with a significant decrease from 1993 to 1994.6 In
contrast, from 1992 to 1995 in Texas, the number of Medicaid-funded births to
undocumented alien mothers more than doubled, while the total number of
births remained fairly stable. As a result, during these years, undocumented

%ee section 400(2)(B) of the Personal Responsibility and Work Opportunity
Reconciliation Act
51n 1994, California and Texas accounted for about 90 percent of reported
births in the four states that border Mexico.
%%.lifornia officials did not have an explanation for the decline from 1993 to
1994; however, one official did note that the decrease mirrored, in part, an
overall decline in births statewide during that time and was not specific to
undocumented aliens.

 2                     GAOIHEHS-97-124R        Births   to Undocumented    Aliens

alien births funded by Medicaid increased from 4 to 8 percent of all births and
from 9 to 16 percent of Medicaid-funded births in the state.

Table 1: Births in California and Texas, 1992-95
                                  I            I                I               I
                                  1 1992       1 1993           1 1994          1 1995

    as a percentage of total

    rote: Includes births to state residents that occurred outside the state.

“Includes estimates of births provided by fee-for-service, prepaid health, and
managed care plans.

bIncludes estimates of births provided by managed care plans in 1994 (4,000
births) and in 1995 (4,509 births).

Sources: California and Texas Departments of Health.

3                         GAOIHEHS-97-124R        Births   to Undocumented      Aliens
Undocumented aliens may seek U.S. citizenship for their children for a variety
of reasons, including the prospects of enhanced educational and economic
opportunities for them. Although many factors motivate undocumented aliens
to give birth in this country, state and county welfare officials in California
stated that they believe that, in many instances, pregnant women have crossed
the border to receive free medical services and, after bearing a U.S.-citizen
child, other public benefits on behalf of their children. State welfare officials
in Texas also noted that the provision of health benefits to undocumented
aliens can serve as an incentive for women to give birth in this country.
However, Texas officials also said that public benefits might serve as less of an
incentive to cross the border in Texas than in Cal.ifornia, where the dollar
amount of cash assistance for needy families with children is much greater.
For example, in January 1996, the typical monthly AF’DC grant for a child-only
 case was $57 in Texas and $299 in California7

We obtained comments on a draft of this correspondence from California and
Texas state officials, who generally agreed with its contents. They also
provided technical comments, which we incorporated as appropriate. We will
make copies of this correspondence available to interested parties upon
request. If you or your staff have any questions about this information, please
call me on (202) 512-7215. Other staff who contributed to this correspondence
include Gale Harris and Deborah Moberly.

Sincerely yours,

Mark V. Nadel
Associate Director, Income Security Issues


 7The child-only rate represents the amount that would be paid for a case
 involving a U.S.-citizen child and an ineligible undocumented alien parent.

 4                      GAOiHEHS-97-124R       Births   to Undocumented    Aliens
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