Prepared for the Northern Virginia HIV Consortium by its Public Affairs Committee (12/07)

Q. Can anyone, regardless of immigration status, receive health services from the health department?
Yes. Health department services are not “federal public benefits” or “state or local public benefits”, and therefore, existing laws that restrict “public benefits” by legal status do not apply to health department services.

Q. Are health department staff required to ask about citizenship status to provide services?
No. In fact, current VDH policy says that staff is not to inquire about status, since legal immigrant status is not necessary to receive health department services.

Q. Doesn’t the health department ask for social security numbers?
VDH uses the SSN as a unique identifier for each client. All clients (citizens or not) may choose not to give a social security number – this practice is voluntary and SSN’s are not required in order to receive care.

Q. If health department staff learns about immigration status, are they required to report to the feds?
No. Since legal immigrant status is not necessary to receive health department services, health department staff are not expected to report, and do not receive training about how to make any reports about illegal immigrants.

Q. What about Medicaid?
Medicaid is a “federal public benefit”, and there are rules that limit Medicaid-paid services to citizens and certain legal aliens. The rules can be complicated — local Social Services staff is well briefed regarding eligibility for non-citizens.  Even with those rules, “emergency medical services” (such as childbirth) can be provided using Medicaid funds without regard for immigration status.  Portions of this information is derived from “The Effect of Immigration Status on Services Provided to VDH Clients, April 2005, Virginia Department of Health; and Department of Health Resources Services (HRSA) to Program Grantee / State Agencies, “Guidance on definition of “public charge” in immigration laws, May 26, 1999.

Q. How about Medicare?
Medicare is also a “federal public benefit”, and therefore, legal status is required for Medicare eligibility.

Q. OK, how about Ryan White?
Legal status is not required to receive services funded with Ryan White dollars.  Because services funded by Ryan White are not "federal public benefits", immigration status is not used to determine eligibility.  And this guidance from HHS is important, too. It talks about the difference between programs that target an “individual, household or family” versus programs that target populations: “(Federal public benefits) … do not include benefits that are generally targeted to communities or specific sectors of the population (e.g., people with particular physical conditions, such as a disability or disease; gender; general age groups, such as youth or elderly) …” (emphasis added) 

Q. My provider is not a health department, but a non-profit. Are the rules different?
The answer to that question may best be answered by reviewing the rules connected to the funding sources (i.e. Ryan White or Medicaid). Agencies that provide services that are not "public benefits" under federal law (PRWORA) would not include citizenship or immigration status as factors in eligibility requirements. As stated above, services funded by Ryan White are not "federal public benefits", so agencies providing Ryan White services should not include citizenship or immigration status as factors in eligibility requirements.

Q. If my locality passes an ordinance about illegal immigrants does that mean that these rules don’t apply to me?
No! Local law can apply to local funding, but even then, there are certain federal rules that supercede local law — federal law counts first. Federal law says that it is to everyone’s benefit that certain core health services are available to anyone who is in this country — and today at least, that includes services for persons living with HIV.

Portions of this information are derived from “The Effect of Immigration Status on Services Provided to VDH Clients, April 2005, Virginia Department of Health; and Department of Health Resources Services (HRSA) to Program Grantee / State Agencies, “Guidance on definition of “public charge” in immigration laws, May 26, 1999.