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Prenatal Care – Illegals/Calif.
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Prenatal Care – Illegals/Calif.
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THE NEW YORK TIMES
NATIONAL
THURSDAY, NOVEMBER 28, 1996
L
Judge Halts California Cutoff of Prenatal Care to Illegal Aliens
compliance with Federal law and
migrants said the decision gave
will cost California approximately
them a chance to work for less se-
$25 to $35 million." He also said the
vere cutbacks.
By The New York Times
money for new applicants to the
ally all services to illegal immi-
such magnitude that public input
decision would be appealed.
"It's a victory in that in that there
SAN FRANCISCO, Nov. 27 - Less
state's prenatal care program be
grants except emergency medical
should be barred from the rule-mak-
Shortly after President Clinton
will be public comment and people
than a week before thousands of ille-
stopped on Dec. 1. Current recipients
care and public education.
ing process."
signed the welfare bill, Mr. Wilson
might see the mean-spiritedness be-
gal immigrants in California were to
would have been cut from the pro-
Under California law, emergency
The judge ordered state officials to
issued an executive order that di-
hind this," said Rodolfo Diaz, the
start losing state money for prenatal
gram as of Jan. 1.
regulations can be issued before the
follow standard administrative pro-
rected state agencies to assess which
executive director of the Community
care because of an order by the
State officials said that in the last
often lengthy sessions of public com-
cedures in drafting the new regula-
programs contrary to the new law
"Governor, a San Francisco Superior
Health Foundation of East Los Ange-
fiscal year, California provided pre-
ment and review.
tions, a process that is expected to
were being used by undocumented
Court judge has blocked the plan,
les, the state's largest prenatal care
natal care under a 1988 state law to
Judge Cahill rejected the argu-
take several months. Until those
aliens and to take steps to end those
saying the state could not support
provider for undocumented aliens
more than 70,000 undocumented
ment that there was an urgent need
rules can be approved, the state will
benefits.
bordering a cutoff on an emergency
aliens.
and one of the plaintiffs in the case.
for rewriting state regulations.
continue to offer care to illegal immi-
One of Mr. Wilson's targets has
basis.
Lawyers for the state argued that
"The mere enactment of a new
grants, said Lisa Kalustian, a spokes-
been prenatal care, which cost the
"These women will have health care
Judge William Cahill, ruling on
for Christmas."
Governor Wilson's plan, which was
Federal law does not automatically
woman for the Governor.
state $69.3 million in the last year.
Tuesday in a suit brought against
announced on Nov. 1, was justified as
create an emergency here in Califor-
Governor Wilson, a Republican,
Other areas in which Mr. Wilson
Gov. Pete Wilson by plaintiffs includ-
an emergency under the Federal
nia," Judge Cahill wrote.
immediately condemned the ruling.
expected benefits to be revoked were
ing the City of San Francisco, issued
welfare reform act that passed in
He added that he could not see how
"The decision is totally errone-
public housing, post-secondary edu-
More national news
preliminary injunction against the
August.
the Federal's law passage "suddenly
ous," Mr. Wilson said in a written
cation and professional licensing.
appears on pages B20-21.
Governor's emergency order that
That law cuts off money for virtu-
presented California with a crisis of
statement. "It takes California out of
Workers who care for illegal im-
ALL STORES
FRIDAY 8AM!
ao
A28
L
THE NEW YORK TIMES EDITORIALS/LETTERS THURSDAY, NOVEMBER 28, 1996
ARTHUR OCHS SULZBERGER JR., Publisher
Lithuania Will Share Jewish Books, but How?
JOSEPH LELYVELD, Executive Editor
GENE ROBERTS, Managing Editor
To the Editor:
scholars, and we regret that Lithua-
guages) faced with dire problems of
Assistant Managing Editors
We are grateful for your front-
nia is unable to provide proper facili-
preservation. This is part of the price
SOMA GOLDEN BEHR
CAROLYN LEE
page article Nov. 24 on the priceless
ties for this collection.
The New York Times
Lithuania is paying during a difficult
GERALD M. BOYD
JACK ROSENTHAL
treasure of thousands of rare Jewish
Unfortunately, as your article re-
economic transition.
DAVID R. JONES
ALLAN M. SIEGAL
books in the Lithuanian capital of
ports, the Lithuanian National Li-
In 1997, the 200-year anniversary
Vilnius that for decades had been
brary is strapped for cash, with only
of the death of the Gaon of Vilnius,
HOWELL RAINES, Editorial Page Editor:
Founded in 1851
hidden from the Nazis and later from
a bare-bones budget for preserving
who wrote some of the books in the
PHILIP M. BOFFEY, Deputy Editorial Page Editor
the Soviets.
and restoring rare books. Indeed,
collection, will be commemorated by
ADOLPH S. OCHS, Publisher 1896-1935
Lithuania greatly values its multi-
these valuable Yiddish and Hebrew-
ARTHUR HAYS SULZBERGER, Publisher 1935-1961
JANET L. ROBINSON, President, General Manager
a conference in Vilnius. This meeting
cultural tradition and takes pride in
WILLIAM L. POLLAK. Executive V.P., Circulation
language volumes - whose proper
ORVIL E. DRYFOOS, Publisher 1961-1963
of scholars will be an excellent op-
PENELOPE MUSE ABERNATHY, Senior V.P.,
the rich history of its Jewish commu-
ARTHUR OCHS SULZBERGER, Publisher 1963-1992
safeguarding would run into the hun-
portunity to discuss ways to cooper-
Planning and Human Resources
nity. We agree that these books
dreds of thousands of dollars - are
ate in preserving this collection. One
DANIEL H. COHEN, Senior V.P., Advertising
should be made more accessible to
among many books (in various lan-
idea might be the construction of a
RICHARD H. GILMAN, Senior V.P., Operations
separate library. We welcome all
RAYMOND E DOUGLAS, V.P., Systems and Technology
suggestions and support from Amer-
DONNA C. MIELE, V.P., Human Resources
How Not to Book Better Math and Science
icans concerned with the fate of this
CHARLES E. SHELTON, V.P., Distribution
DAVID A THURM, V.P., Production
great Lithuanian Jewish cultural
To the Editor:
heritage.
ALFONSAS EIDINTAS
Your Nov. 21 news article reports
Ambassador, Republic of Lithuania
on the average marks of American
Washington, Nov. 25, 1996
A Cultural L egacy
A Breakthr
Millions of America
MUN 13:35 FAX 9202 619 3818
OCR/ES
00
NOY-15-96 SAT 05:44 PM CHEAC
916 441 4093
P.0:
D
Hayashi is contact. Star
County Health Executives Association
of California
Post-it" Fax Note
7671
Date
of
pages
/
November 15, 1996
Co/Dept. To ANDY Hyman
From
HrHS
Co.
Phone *
Phone #
EXECUTIVE COMMITTEE
Fax n
Donna E. Shalala. Secretary
Fax #
President
Department of Health and Hum
Ceorge Bleth
Fresno County
200 Independence Avenue, SW
Washington, D.C. 20201
Vice President
Thomas Peters. PhD
Marin County
Dear Secretary Shalala:
Secretary/Treasurer
Tom Uram
The County Health Executives Association of California (CHEAC) represents county
Orange County
public health officials who are responsible for providing for the public health and
welfare of the residents of California. We are concerned about the implications of
Immediate Past President
David Kears
Section 411 of the Personal Responsibility and Work Opportunity Reconciliation Act
Alameda County
(Act).
Diana M. Bonts RN, DIPH
We have noted that Section 411 of the Act does not include a deadline for compliance
City of Long Beach
by States and local governments with its provisions. We also understand that the Act
Michael Ford
gives the Attorney General discretion to grant exceptions.
Marced County
We are asking for clarification as to when the Attorney General will be Issuing
Robert Melton, MD
Monterey County
regulations pursuant to this section. Also, we need to know when Section 411
compliance dates for States and local governments will be established. Specifically,
Payllis Murdack
is there any deadline by which States or counties must come Into compliance?
Madera County
Ronald Probasco
Any guidance you can give us in this matter would be most appreciated. Given that
Tulare County
California's Department of Health Services is moving to implement Section 411 on an
Margaret Taylos
emergency basis, & prompt response would be appreciated.
San Mateo County
Susan Zepeda, PhD
Please call me at (415) 499-3696 if you have any questions.
San LUIS Obispo County
Sincerely,
EXECUTIVE OFFICER
Mickey Richie
Summ Lite
Thomas Peters. PhD
President
c:
Bruce Vladeck, Administrator, Health Care Financing Administration
A CSAC AFFILIATE
1100 Street, Suite 101 Sacramento, CA 95814-3941 ATSS 467-7540 (916)327-7540 FAX(916) 441-4093
11/19/96 17:42
001
ODCLCA QUICK FAX
(202)358-6030- Voice / (202 358-6074/6075- Fax)
11/19
TO: Diana Fortuna
Stene Warnath
FROM: Judy Chesser
COVER + 2 pages
COMMENTS:
This form is produced OR reused paper
002
11/19/96
17:42
PAGE
2
Wilson Sets Date
San Francisco Chronicle
SATURDAY, NOVEMBER 1096
To End Care for PRENATAL: Benefit Cutoff
From Page AIS
Francisco.
Pregnant Illegals
year "Half the people WA sen, we
"You could face medical condi
don't get payment for anyway.'
tions impacting the fetus in an
County officials. doctors and
emergency delivery) that might
advocates for immigrants and the
have been solved in prenstal care,
But Bay Area counties
poor blasted Wilson's move as pen
such as syphilis and hepatitis B."
ny-wise and pound.foolish, saying
said Newhart. "If professional lia-
routine prenatal care can prevent
bility costs increase and physician
refuse to halt benefits
costly complications in emergency
and hospital insurance goes up he
room deliveries.
rause of those increased deats and
Hy Grey Lucas
complications. then those COSIS
"If's 1 no-brainer." said Kears.
and Parid Poller
will be shifted to all patients in Cal-
"Why would you not provide pre.
Chromicio staff Wystern
(fornia."
Datal care if you're going to end up
Secramento
paying for the cost of delivery or
Wilson has tried repeatedly
hospitalization? Why would we
tricd to end prenatal care for un
The state plans to stop provid-
ing prenatal care to 70,000 undocu-
not provide something If it will
documented women. His budger
end up costing us more?"
plans last January and in January
mented pregnant women on De-
of 1095 proposed eliminating the
cember 1 under regulations pro-
Bat providing the service will
service,
but STBLE Inwmakers re-
posed yesterday hy Governor Pate
pôse other health dilemmas for
fuxud,
Wilson.
cash-strapped counties, cautioned
Tom Peters, director of Marin
The governor claimed yester-
State health officials say prens-
County Department of Health and
day that he needed to issue "emer-
tal CATE helps keep health COSTS
Human Services and chairman of
geney" fregulations 10 end the state
down by reducing infant mortality
and low-weight births, but the He
the Association of Bay Area Health
ald, because the federal wolfare
Officials.
overhaul signed in August by Pres-
publican governor Is arguing that
Ident Clinton precludes the states
he must end all state aid 10 illegal
The standard outcome 15 that
from giving illegal Immigrants
immigrants under the new federal
the urlage decisions become more
memergancy health care.
welfare law.
paluful, the walts at hospitals and
"It's my understanding the 2d.
clients become longer. and the
Peters. however. disputed that
information wants to come into
clinical consequences become
interpretation. The federal wel-
more severe." Peters said,
PAPE bill does not mandate this CUI-
compliance (with the new law) as
quickly as possible." said Lynda
Modi-Cal. the state's health pro-
off." he said. "It makes 12 a state
Frost, a spokerwoman for the state
gram for the poor, now pays about
option.
Department of Health Services
388 million 2 year to cover prenatal
Immigrant advocates, anticl.
"This happens to be the first
care for Ulegal immigrants. A
paring the new regulations. had ai-
health-related public benefit for
growing number of Uin births Daid
rrady sought a court order block.
which we've completed our re-
for by Medi-Cal are children born
ing the rills But U.S. District
view,"
to undocumented aliens. Under
Juilge Mariana Pfaelzer. who has
County busith departments in
the law. the children are U.S. citi-
blocked prenatal and other cuts to
zers
the Bay Area said they will contin-
immigrants under Proposition 187,
ue providing prenatal care to un-
For example. In Napa County,
declined yesterday to Issue I new
37 percent of Medi-Cal births are
order.
documented women, though other
health services may suffer as A re-
the children of undocumented
Emergency regulations can
sult.
aliens in Sonoma County, the fig.
take effect faster than normal
"If the state simply stops the
are is $5 percent. Ln San Francisco.
state regulations, which must go
payments, we're still going to de-
il is 20 percent.
through a lengthy review and 50-
liver the services." said David
The proposed regulations could
day period of public comment
Kears. director of health care sur
also east Californians by driving
up malpractice insurance casts for
Eugenie Denise Mitchell, a law-
viers for Alameda County. which
obstetricians and gynecologists,
yor for Northern California Lew.
provides prenatal care to some 3,-
000 undocumented immigrants a
who now pay the lowest rates in
yers for Civil Justice, said It plans
the nation. usid Charlotte New.
additional challenges to the pro-
PRINATAL: Page A IDCal. 1
liazi, chief administrative officer
pused rules.
of the American College of Obste-
"There IS no emergency." said
tricians & Gynerologists in San
Mitchell
003
PAGE 3
A.28 Friday. November 1996 *
#
SAN FRANCISCO EXAMINER
"Is was kind o! a fool's errand
Judge delays food stamp
for the people atio brough: the
isasuit, because all shey have suc-
caeded in doing is delaying the in-
evitable by about 10 days." Wilson
ban for legal immigrants
said, adding the state would appeal
The federal law cuts off food
stamps for legal immigrants, with
ID: 6074
exceptions for those who arepoliti-
Care offices late last month to begin
evigrants would qualify for exemp-
Injunction says state
cal refugees, wisnssa, in the armed
denying DEW food stamp applion-
tions
services or who have worked in the
Lions from immigrants as part at
must adopt clear
"This sends a very important
country for at least 10 years.
the new federal welfare overhaul,
message to the state (that) when
But Secramento Superior Court
eligibility rules
they're implementing the new re-
Child said the rules were to con-
Judge John R Lewis lassed & pre-
form measure, they have to do to in
fusing counties were applying them
liminary injunction Thursday
an orderly fashion," said Curtie
di flerently and some immigrants
By Kathloon Helder
egainst the etate directive. The rul-
Child of Northern California Law-
who were eligible for food stamps
ASSOCIATES PREDO
ing could lead countine to resume
yers for Civil Justice, which sought
might not got them
SACRAMENTO - Callfor-
accepting applications, at Least for
the injunction.
He argued the state was re-
nin's first efforts to cut off food
the time being.
Gov. When said the buling
quired to go through a formal pro-
stamps to legal immigrants WETE
Lewis sided with welfare rights
would have Little effect because the
cese of adopting regulations, in-
put on hold by B judge who anid the
advocates, who argued the state
state has submitted fast. track reg.
clading holding public beerings.
NOV-19-96 18.30 FROM: DC 202 3586074
state must fund adopt regulations.
moved too quickly and failed to
ulations to the state Office of Ad-
That process takes at least two
The state directed county wal.
adopt clear rules about which im-
ministrative Law.
months.
The state Department of Social
Services submitted regulations to
an administrative law judge on Oct
25, and state lawyers argued that
was enough to meet legal require-
ments.
Deputy Attorney General Paul
Reynaga argued in court public
bearings would not change the food
stamp restrictions. "What you see
17:42
is what they would get," Reynage
said.
A
n
11/19/96
3
11/19/96
Torres
Kenn Fernst amdt
slading fee scale
# What did AG order do? why noF? Is it permissive?
Wost Ctr + SF suing too
187 hit hand
just slowt down 3-8mos
If lose on Friday, need "reg" by 12/15/16 ?)
1/1 mylementation pld Gr, State
State - "emery reg" issued
- no ex for diabetes etc, 01 HIV
Other suits - 10th Amilt
Fear Wilson haras ment - to clinics
Rel to LA was her
Deboxe chc on hlth not illegal
), AG / - peen cale
2. counties moving - say afr of Fed $ -ho - central Comm just
regional office said OK J. they want
state, GI letter loc pub us ben- communicate we don't if countries - explore guidance
*
3. HCFA rensit few lewise (Pwoods, (Bishop) - sd at -Don Jthere
from saying Grinker yet hu plans in a delay
only a states (4) are affected by this?
Wilson Us it has appropriate lost 3x ; will devia gogue what the
pro pose we do, other +
the AG order
11/06/96
13:50
TURRES
&
TURRES
12024567028
NU. 221
003
5.) While other states may argue that they will not have the same consequences as California, it is
important to remember that with the exception of California, no other state has had a state law
providing pre-natal care services to undocumented mothers and no other state has invested the
amount of resources to reach out to this population in order to serve their pre-natal needs,
6.) In communities where there are high numbers of uninsured persons and undocumented persons,
such as throughout the State of California, this action will place in serious jeopardy (over a period
of a year) the public health. Large segments of communities will not seek health care until there
are medical crisis if at all. The idea that these individuals will all return to their country of origin
will not materialize due to the reality that they have blended families. Their medical conditions will
be allowed to worsen and increase the serious medical consequences.
Governor's Fiscal Projections:
Lastly, you requested clarification on how the Governor estimates the cost to the state for
providing state funded pre-natal care services to undocumented mothers. According to the data
submitted by the Governor's office to the State Office of Administrative Law, he contends that the
cost to the state is an estimated $69.3 million. This number has not changed significantly since the
Governor first proposed to eliminate this program four years ago.
In addition, what we have reviewed of the Governor's data reflects that he is including all women
who identify themselves requesting these services which includes pregnant mothers from other
adjacent states entering California. In fact, SB 485, the state budget trailer bill in 1993-94 carried
provisions designed to provide greater scrutiny of U.S. citizen women entering California from
other states requesting pre-natal care services under this program for undocumented mothers.
The Governor's data does not provide for a distinction between these two types of persons
receiving this service, nor other women who claim this services but are U.S. citizens but only seek
pre-natal care services.
Conclusion:
I hope that this data responds appropriately to your requests for additional information.
Furthermore, the broader consequences we describe occurring with CHFELA in Los Angeles
County also took place in such counties as Ventura, Santa Clara, Kem, San Francisco, Orange,
San Diego and Fresno. This will repeat itself in these and others counties throughout California.
Should you have any further questions or need other data, please feel free to contact me at your
earliest convenience.
Due to the Governor moving last week to submit his regulations to the State Office of
Administrative Law and requesting that they be issued as emergency regulations, we are in urgent
need to revisit this issue with you and other decision makers as soon as possible. We appeal to
those of you at the White House to not lose sight of the urgency this matter carries to not only the
undocumented mothers and their citizen children, but also the results the denial of pre-natal care
can bring about to communities throughout the state and nation.
Thank you for your attention to this matter and for meeting with us. I will follow-up mid week.
11/06/96
13:49
TURRES & TURRES
12024567028
NU. 182
602
Torres & Torres
POLICY CONSULTANTS
926 J STREET, SUITE 1016
Diana
SACRAMENTO, CA 95814
Arnoldo Torres
(916) 442-2207
FVI
Rodrigo Torres
Memorandum
S
To: Steve Warnuth, Domestic Policy Council/The White House
Michael Myers, Staff, Senator Kennedy
From: Arnoldo S. Torres, as Policy Consultant
California Hispanic Health Care Association (CHHCA)
RE: Additional Information on Pre-Natal Care for Undocumented Mothers
Date: 11-1-96
You requested additional information on the broader but direct consequences of denying pre-natal
care for undocumented mothers to communities at large throughout California and other localities
with high concentrations of undocumented persons.
Mr. Rodolfo Diaz informed you that the consequences of not providing pre-natal care to
undocumented mothers were not isolated to poor-birth deliveries and the costs associated with
medical conditions requiring treatment beyond delivery. The consequences were reflected
concretely one month before Proposition 187 was approved and until January/February 1995.
Specifically, Mr. Diaz experienced the following:
1.) Prior to October 1994, Mr. Diaz' clinic averaged 10,000 medical encounters monthly. From
October to February 1995, the monthly encounters were reduced by 80% to 2,000 per month.
These medical encounters cover the full spectrum of primary medical care services, including
dental, mental health and optometry services,
2.) Even more pronounced was the reduction in immunizations. Community Health Foundation of
East Los Angeles (CHFELA) was providing 1,000 immunizations per month up through
September 1994. From October 1994 to February 1995, CHFELA provided 83 immunizations per
month during this time,
3.) This data underscores that undocumented mothers will not bring in there children (even if they
are citizen children) for children health services due to their fear that they will be identified and as
a consequence there family will be separated. It took four to five months of intense outreach after
the passage of Prop. 187 to inform this population that they were eligible for health care services.
Issuing notices on December 1 informing mothers of the repeal of pre-natal services will be the
second time that such an official message would have been circulated. It is our considered opinion
that this will casue irreparable damage to the outreach efforts taken before and after 187. This will
bring about a great deal more medical consequences to the greater society,
4.) Many of the undocumented mothers are part of a blended family in which there are legal
residents, citizens and undocumented members. These various immigration status cause the fear
and anxiety which result in undocumented mothers not bringing in their children unless it is a
medical emergency. Under these circumstances, the cost of providing care escalate significantly as
well the threat to the public health,
MagariA
02:37P Richard P. Fajardo
(213) 259-0434
P.02
TIIS OF RICHARD P. FAJARDO
FTH AVENUE 56. LOS ANGELES, CALIFORNIA 90042
NE (213) 254 4530, RACSIMILE (213) 259-0434, PAGER (213) 9015
-
MEMORANDUM
Mike Myers, Staff Director
Senate Minority Judiciary Committee
Richard Fajardo
The Personal Responsibility and Work Opportunity and Reconciliation Act of
1996 (hereinafter "Welfare Act").
Proposed regulation to allow Federal Qualified Health Centers to provide certain
Health Care Services.
September 10, 1996
Fins follows our telephone conversation regarding possible regulations implementing exceptions
Welfare Act which bar public benefits to persons who can not establish that they are U.S.
or
"qualified aliens." In particular we are most concerned about protecting the ability of
Qualified Health Centers ("FQHCs"), both rural and urban, to continue to provides
sevices to the indigent and uninsured, irrespective of their immigration status.
The Problem: Benefits for Undocumented Aliens
now, section 401 of the Welfare Act prohibits undocumented aliens from receiving
nublic benefits. On its face, sec. 401 would appear to prohibit FQHCs from providing
care and other services to clients who are can not establish U.S. citizenship or that they
republy residing in the United States. In addition, section 411 prohibits undocumented aliens
in
receiving state and local benefits, too.
some very good arguments that FQHCs can continue to provide some health services to
ented clients under some of the exceptions provided in the Welfare Act. However, the
can be read in several ways. More importantly, the Attorney General's provisional
2
are ambiguous. Thus, CHF seeks clarity on how the federal government seeks to
the regulations. CHF also seeks to clarify the regulations to allow FQHC to provide
divices to non citizens and non qualified aliens (to undocumented aliens).
like to be able to provide all services to such aliens, and so we will be suggesting
which is broad. However, at a minimum the clinic wants to provide prenatal care for
ented women. This is especially crucial because in many instances FQHCs have
Jily reduced infant mortality by encouraging women to get prenatal care. Denying
are to any woman will result in increased infant mortality, increased complications
ery, and increased potential for disabilities among children born without prenatal and
mre. This is especially critical since labor and delivery are covered as emergency
02:37P Richard P. Fajardo
(213) 259-0434
P.03
Mycis
to Welfare Act. SS 401 and 411
1996
rvices under Medicaid, 42 U.S.C. § 1936b(3), and the children born here will be U.S.
Potential Regulations to Exempt FQHCs and
Certain Medical Services from the Provisions of 401 and 411.
403
states that any alien who is not a qualified alien (undocumented aliens) are not eligible
"Federal public benefit." Sec. 401(a). A Federal public benefit is appears to includes any
benefit for which payments or assistance are given to the individual, household, or family
agency or by U.S. appropriation. Sec. 401(c). However, Sec. 401(b) provides several
S, including (1) emergency benefits, (3) public health assistance, and (4) programs and
secified by the Attorney General. See also sec 411(b)(4)(applying the attorney general
to the exclusion of undocumented aliens from state and local public benefits).
TWS is a wish list of possible exceptions which could be considered by the DHHS and
General. The question is whether any of these exceptions are possible, or even likely.
Thanket exception for FQHCs. Is it possible to exempt FQHCs under the Attorney general
option, listed below. Is it possible to except FQHCs from the provisions of secs. 401 and 411.
gency Medical Treatment. First, sec. 401(b)(1)(A) provides for an exception for
of an "emergency medical condition (as defined in section 1903(v)(3))" which is not
organ transplants. Sec. 1903(v)(3) defines a emergency medical condition to include
labor and delivery." 42 U.S.C. 1396b(3).
ne to carve out an exception for certain high risk pregnant women as being able to
erain pregnancy related services due to risky health conditions which may present a
the mother or child if left untreated. DHHS could describe certain health conditions,
found in a pregnant woman, would allow her to obtain certain pregnancy services on an
basis. Three such conditions which could be included are hypertension, diabetes, and
transmitted diseases.
conference language provides for a narrow reading of the emergency provision,¹ there
Merent contradictions in the language. For example, the legislative history suggests
aries might be excluded from emergency services, yet the statute clearly provides that
leliveries are to be considered as emergency services. 42 U.S.C. §191396(v)(3).
recever, there is clear evidence which demonstrates that certain conditions, especially
Presion, can create a life threatening situation for a pregnant woman if left untreated.
he allowance for emergency medical services under Medicaid is very narrow. The conferces intend that it
medical care that is strictly of an emergency nature, such as medial treatment administered in an emergency
care unit, or intensive care unit. The conferees do not intend that emergency medical services include
livery care assistance that is not strictly of an emergency nature as specified herein." Personal
and Work Opportunity Reconciliation Act of 1996, H.R. Conf. Rep. No. 104-725, 104th Cong., 2d Sess.
ercinafter "Conference Report") (Emphasis added).
02:38P Richard P. Fajardo
(213) 259-0434
P.04
Myers
'n: to Welfare Act. §§ 401 and 411
1590
orney General Exceptions. The Welfare Act gives the Attorney General the discretion
certain services and assistance from the provisions of sections 401 and 411. Sec.
D) and sec. 411(b)(4). The welfare bill provides an exception for "programs, services
ce
specified by the [U.S.] Attorney General " The programs must meet three
requirements: (1) deliver in-kind services at community level (including those through
non-profit agencies; (2) "not condition the provision of assistance, the amount of
provided, or the cost of assistance provided on the individual recipient's income or
nurces," and (3) are necessary for the protection of life or safety.
care could fall under this category. FQHCs provide in-kind services at the community
atal care), and such services are necessary to protect not only the life and safety of the
also of the child, who will be born a U.S. citizen. The question is whether such care
with the second condition: do FQHC condition the provision, amount or cost of
on the recipient's income or resources?
answer is no. Once a woman is determined to be pregnant, she will receive prenatal
Norther the provision nor the amount of the services is determined by the woman's income
osources. However, federal and state regulations require all Medicaid and Medi-Cal recipients
rged for services on a sliding fee scale, which does depend on the recipient's income and
However, even here, the provision of the services (prenatal care) is not denied or
the payment is tendered or made. If a woman does not have the fee attributed to her
1 resources, she is nevertheless provided the service, and the amount charged is kept on
as a receivable.
Blinics do not feel they condition the provision or cost of services on the recipient's
resources, the Attorney General's provisional regulations would appear to preclude our
the statute. Paragraph 3 of the Attorney General's provisional regulations provides, in
Included withing the specified programs, services or assistance
determined to be necessary for the protection of life and safety are:
***
(e) Medical and public health services (including treatment and
prevention of diseases and injuries) and mental health, disability or
substance abuse assistance necessary to protect life or safety;
***
(G) any other programs, services, or assistance necessary for the
protection of life or safety.
leg. 45,985 (August 23, 1996). While prenatal care is not specifically named within
(c), it is clearly necessary for the protection of the life and safety of both mother and
Hally for high risk pregnancies.
by General appears, however, to restrict the application of paragraph 3 above, through
: 38P Richard P. Fajardo
(213) 259-0434
P.05
Welfare Act. IS 401 and 411
1796
on restricting programs to those open only to individuals without regard to income or
In particular, Reno provides that:
Programs. services or assistance delivered at this community level,
even if they serve purposes of the type described in paragraph 3
above, are not within this specification if they condition (a) the
provision of assistance, (b) the amount of assistance provided, or
(c) the cost of the assistance provided on the individual recipient's
income or resources.
g. At 45,986. Since federal and state regulations currently require FQHCs to require a
a sliding fee scale to all health care recipients, including women receiving prenatal care,
ppear that the cost of the prenatal services depends on the income and resources of the
recipient.
Recommendations
ould appear to be three alternative ways of dealing with this issue. First, is for the
General to simply eliminate item (c). A second related alternative is to clarify the
of (c) to all FQHCs practices to fall within the exception.
iternative is to have DHHS change its regulation related to the provision of prenatal
Mer services), such that undocumented pregnant women (or other undocumented
exempted from the regulations requiring sliding fee charges for services.
Diaz
Torres
11-18-1996 6:55PM
FROM
P. 1
SERVICE
DATE: 11/18/96
U.S. DEPARTMENT OF HEAL TH AND HUMAN SERVICES
200 INDEPENDENCE AVE., SW
o'
WASHINGTON. D.C. 20201
'HONE: (202) 690-6786
FAX: (202) 690-6351
OFFICE OF THE ASSISTANT SECRETARY FOR LEGISLATION
CONGRESSIONAL LIAISON OFFICE
ROOM 406G HUMPHREY BUILDING
FROM:
Diana Fortune
X IRENE BUENO
10
[ ] Mark Magana
OFFICE :
(
] GERI GOINS
ROOM NO
[
) JOE WARDEN
PHONE NO :
[
) CYNTHIA JOYCE
FAX NO 456-7028
(
1
TIJUANA TRIPPLET
(
)
STACEYE WHITE
[
] BEATRICE BUTLER
TOTAL PAGES
INCLUDING COVER)
5
REMARKS
Info on Prenatal meeting.
11-18-1996 6: 55PM
FROM
P.2
County Health Executives Association
of California
Post-It' Fax Note
7671
Date
of
seled
/
November 15, 1996
To Co./Dept. ANDY Hyman
From
H+HS
Co.
Phone #
Phone #
EXECUTIVE COMMITTEE
Fax ,
Fax #
Donna E. Sha!ala, Secretary
President
Department of Health and Hum
Ceorge Bleth
Fresno County
200 independence Avenue, SW
Washington, D.C. 20201
Vice President
Thomas Peters. PhD
Mann County
Dear Secretary Shalala:
Secretary/Treasurer
Tom Uram
The County Health Executives Association of California (CHEAC) represents county
Orange County
public health officials who are responsible for providing for the public health and
welfare of the residents of California. We are concerned about the implications of
Immediate Past President
David Kears
Section 411 of the Personal Responsibility and Work Opportunity Reconciliation Act
Alameda County
(Act).
Diana M. Bonta. RN, DIPH
We have noted that Section 411 of the Act does not include & deadline for compliance
City of Long Beach
by States and local governments with its provisions. We also understand that the Ac:
Michael Ford
gives the Attomey General discretion to grant exceptions.
Merced County
We are asking for clarification as to when the Attorney General will be issuing
Robert Melton, MD
Monterey County
regulations pursuant to this section. Also, we need to know when Section 411
compliance dates for States and local governments will be established. Specifically.
Phyllis Murdock
is there any deadline by which States or counties must come into compliance?
Madera County
Ronald Probasco
Any guidance you can give us in this matter would be most appreciated. Given that
Tulare County
California's Department of Health Services is moving to implement Section 411 on an
Margare: Taylor
emergency basis, a prompt response would be appreciated.
San Mateo County
Susan Zepeda, PhC
Please call me at (415) 499-3696 if you have any questions.
Son LLis Obispo County
Sincerely,
EXECUTIVE OFFICER
Mickey Richie
Summ Lite
Thomas Peters, PhD
President
C:
Bruce Viadeck. Administrator, Health Care Financing Administration
A CSAC AFFILIATE
1100 K Street, Suite 101
Sacramento, CA 95814-3941
ATSS 467-7540
(916) 327-7540
FAX(916) 441-4093
11-18-1996 56PM
FROM
P.3
Torres & Torres
POLICY CONSULTANTS
926 J STREET, SUITE 1016
SACRAMENTO. CA 95814
Arnoldo Torres
(916) 442-2207
Rodrigo Torres
Memorandum
To: Rodelfo Diaz, Executive Director
CHFELA
From: Arnoldo S. Torres
Policy Consultant
RF: Prenstal Care Lawsuit
Date: 11-13-96
I am very happy to report to you that Richard just informed me of the following positive results:
1.) Judge accepted our complaint and agreed that he would hear our arguments requesting a
Temporary Restraining Order (TRO) against the denial of prenatal care services for undocumented
mothers on November 22, 1996. The Governor intended to issue notices to individual mothers on
November 21, 1996 in order for the repeal of these services to begin December 1, 1996. Should
the court rule in favor of the State, pre-natal care services could not be terminated until January
1997. 10 days must elapse after notice is issued in order for regulations to become effective. As a
result of the case being heard 8 November 22, 1996 the State has not allowed for ten days for
implementation on December 1. 1996.
2.) Richard feels relatively comfortable that our chances of winning our argument are excellent
based 8 the comments made by the Judge hearing the case. The judge stated that he did not
understand how these regulations could be deemed emergency regulations when they do not meet
the state standards for "emergency regulations". This issue is a major point in our arguing against
the Governor's action. Richard will focus a great deal on this matter when he makes his oral
argument On Friday of next week.
3.) Richard appears to feel comfortable with the other attorney's which represent the Western
Center on Law and Poverty, and the City/County of San Francisco Department of Health Richard
will probably take a larger role during oral arguments because we are representing providers and
the medical consequences of not providing these services which need to be considered and heard in
full blown administrative hearings on these regulations. Should we win next week, it would take
another 6 to 8 months before the state could terminate these services.
11-18-1996 6:56PM
FROM
P.4
Nov-14-96 04:23P Richard P. Fajardo
(213) 259-0434
P.02
LAW OFFICES or RICHARD P. FAJARDO
11a) % NORTH AVENUE & 1.05 ANGELES, CALIFORNIA 90042
TELEPHONE Qty 250 asso, PACSIMILE (213) 219 0434, PACER (213) 917-0015
MEMORANDUM
To
Enrique Valensuela, do CHFELA
Rudy Diaz CHFELA Executive Director
Amold Torres. Policy Consultant
From:
Richard Fajardo
Re
Update on TRO Hearing
Prenatal Care Emergency Regulations
Date:
November 14, 1996
On Wednesday. November 13, 1996 a hearing was held in department 8, Judge William H. Cahill
presiding.
THE PARTIES.
Two cases have been filed, with numerous lawyers: Carmen Doe, et al., V. Wilson, et al., (filed
November 13, 1996) Case No. 582521, and CHFELA. et al. V. Wilson. el al., (filed November
13, 1996) Case No. 582521.
in essence, there are three groups of plaintiffs. The Carmen Doe plaintiffs include:
Individual beneficiaries. Carmen Doe plaintiffs include undocumented women¹ for whom
the state will seek to terminate prenatal care benefits as of December 1. 1996. This case is
filed as a class action. These plaintiffs are represented by a number of attorneys. the
primary counsel is Bob Newman, Western Center on Law and Poverty.
San Francisco City and County: The county provides prenatal care services and other
public health services to undocumented aliens, among others. This plaintiff is represented
by Jean Frasier, S.F. City Attorney's Office.
CHFELA plaintiffs:
CHFELA: CHF is 8 Federally Qualified Health Clinic, plaintiffs in this action also include
doctors working at the Clinic. This is not a class action case.
The California Medical Association (CMA) will seek Amicus Curiae status. which the court said
1
There are some legal resident worken who have been included in "SM" codes who would also be cut off
from benefits which in included in the action.
11-18-1996 6:56PM
FROM
P.5
Nov-14-96 04:24P Richard P. Fajardo
(213) 259-0434
P.03
Preased Carr Care Team
Re: Recogency Medical Condinges
Origier 24. 1296
neg 2
would grant.
PROCEDURAL MOTIONS
CHFELA filed a motion to consolidate the cases into a single action. The state attorney general
agreed to the consolidation. and a stipulation was signed to that effect.
TRO HEARING
The defendant made a number of representations in open court.
Defendants have agreed not to implement the regulations any earlier than December 1,
1996.
Defendants have agreed not to send out any notices to beneficiaries or providers regarding
the termination of prenatal care until after a bearing on the Preliminary injunction.
Defendants agreed to send an E mail message by the end of the day (November 13) to all
counties indicating that the counties have no obligation to send out notices terminating
prenatal benefits until after the preliminary injunction hearing
The court, relying on these representations, denied the TRO as premature and unnecessary at this
time. A hearing on plaintiffs application for a preliminary injunction will be held on Friday,
November 22, 1996, at 11:00.
NOV-14-1996 09:07
KENYON & EDELSTEIN
9164436445
P.02
ADDRESS
State Capitol
Sacramento, CA 95814
Assembly
CHAIRMAN:
RULES
(916)445-8253
California Legislature
COMMITTEES:
DISTRICT OFFICE
HEALTH
455 Golden Gate Avenue
State Building, Suite 2202
JOHN BURTON
WAYS AND MEANS
San Francisco, CA 94102
MEMBER OF THE ASSEMBLY
(415) 557-2253
Twelfth District
STATE
VINHO
November 12, 1996
STATE
Kimberly Belshe, Director
California Department of Health Services
714/744 "P" Street
Sacramento, California 95814
RE:
Prenatal Care for Undocumented Women
Dear Director Belshe:
We are writing on a matter of great concern to each of us, and to Our respective districts.
It is our understanding that your Department is planning to write to persons that you believe are undocumented,
and recipients of Medi-Cal prenatal care benefits, advising each of them that the benefit will no longer be
publicly available after December 1. The purpose of our letter is not to argue over the proven benefits of
prenatal care, nor our concerns with the inconsistency between the denial of the benefits and existing state law.
Rather, we write to urge that you refrain from sending these notifications and instead allow each of the counties
to notify their clients of the possible pending change in benefits. as is required by law.
We have concerns with the State's proposed letter to prenatal recipients:
I.
The simple fact of receiving the notification is likely to have an adverse effect on recipients, some of
whom are here legally. As the Department states in its all-county letter of November 1, 1996, the
notifications will be sent to recipients in certain Medi-Cal aid categories which include persons here
legally and persons who fall into one of the immigration categories that are protected by the federal
welfare reform bill. In sum, the letter would undoubtedly have a chilling effect on women who are
legally entitled to prenatal care services as well as to undocumented women.
2.
The letter is unnecessary. It does not provide legal notice of termination of benefits; current law
requires that counties send such notices. Therefore, the
letter serves no useful purpose, and in fact will have adverse consequences.
3.
The letter will interfere with the proper referrals of women to providers willing to provide services
without state reimbursement.
4.
The issuance of the emergency regulations allowing for a cutoff date of December I is being challenged
in court. It would be irresponsible for the State to presuppose the outcome of the lawsuit, and
prematurely advise clients of the pending loss in benefits. A proper transition period is critical for
women with high-risk pregnancies.
5.
The entire issue of prenatal care is one that the Legislature plans to address when it reconvenes. In our
view, any action by the Administration without proper legislative action and consultation would be ill-
advised.
Peace and friendship,
Printed on Recycled Paper
NOV-14-1996 09:08
KENYON & EDELSTEIN
9164436445 P.03
John Assemblyman But John Burton
Assemb ywoman. Cardle Mige
Barbara fee
Assemblywoman Barbara Lee
Jackie Assemblywoman Sprien Jackie
Speier
Martin Assemblyman Gallegor Martin
Im Botes
Gallegos
Assemblyman Tom Bates
Teresa Senator Teresa P. Hugher Hughes
Senator Richard Polanco
Sand Assemblywoman Knely Shelia Kuehl
Assemblywoman MEscutia Martha Escutia
NOV-14-1996 09:08
KENYON & EDELSTEIN
9164436445 P.04
New Hayden
Assemblyman John Vasconcellos
Michael Honda Kenin Smilly
Michael Honda
Kevin Shelley
Assemblyman Elect
Assemblyman Elect
σ
Deans Assemblywoman Marly Diane Martinez Assemblyman Louis Caldera
Assemb lywoman Liz Figueroa We@ree Assemblyman Mike Machado
antRve Hilda L. Soles
Assemblyman Antonio Villaraigosa Senator Hilda L. Solis
NOV-14-1996 09:08
KENYON & EDELSTEIN
9164436445 P.05
Assemblyman Mike Sweeney
NOV-14-1996 09:09
KENYON & EDELSTEIN
9164436445
P.06
STATE CAPITOL
STANDING COMMITTEES
95614
California State Senate
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NO 2 ON RESOURCES
ENVIRONMENTAL
PROTECTION AND
JUDICIARY CHAIRMAN
November 13, 1996
JOINT COMMITTEES
JOINT COMMITTEE ON RULES
Ms. Kimberly Belshei, Director
California Department of Health Services
714/744 P Street
Sacramento, CA 95814
RE: Prenatal Care for Undocumented Women
Dear Director Belshe':
I write on a matter of great concern to numerous constituents and me.
1 understand that the Department plans to write persons it believes are
undocumented or illegal aliens and recipients of MediCal prenatal care
benefits, advising each of them that the benefit will no longer be publicly
available after December 1, 1996. The purpose of my letter is not to argue
the benefits of prenatal care or my concerns with the inconsistency between
the denial of the benefits and existing state law. Rather, I write to urge that
you refrain from sending such notifications and instead allow each county to
law. notify its clients of the possible pending change in benefits as is required by
Several concerns with the State's proposed letter to prenatal
recipients exist, as follows:
1. The simple fact of receiving the notification is likely to have an
adverse effect on recipients, some of whom are here legally. As the
Department states in its all-county letter of November 1, 1996, the
notifications will be sent to recipients in certain MediCal aid categories which
include persons here legally and persons who qualify for one of the
immigration categories protected by the federal welfare reform bill. In sum
NOV-14-1996 09:09
KENYON & EDELSTEIN
9164436445 P.07
)
the letter would undoubtedly have an adverse effect on women who are
legally entitled to prenatal care services as well as to undocumented women.
2. The letter is unnecessary. It does not provide legal notice of
termination of benefits; current law requires that counties send such notices.
Therefore, the letter serves no requisite purpose, and in fact will have
adverse consequences.
3. The letter will interfere with the proper referrals of women to other
providers. The transition period will be critical for women with high-risk
pregnancies.
4. The issuance of the emergency regulations establishing a transition
date of December 1, 1996 is being challenged in court. It would be
imprudent for the State to presuppose the outcome of this lawsuit and
prematurely advise clients of the pending loss in benefits.
5. The entire issue of prenatal care is one that the Legislature aims to
address after it reconvenes. In my view, any action by the Department
without proper legislative action would be injudicious.
Sincerely yours,
QLK:tb
CC: Hon. Willie L. Brown, Jr.
EDWARD M. KENNEDY
MASSACHUSETTS
United States Senate
WASHINGTON, DC 20510
November 19, 1996
The Honorable Janet Reno
Attorney General
Department of Justice
Washington, DC 20530
Dear Attorney General Reno:
As you know, the new welfare reform law contains numcrous restrictions
on the ability of immigrants to obtain government-funded assistance. I
sponsored a provision in that law (Section 101(b)(1)(E)), which gives you the
authority to waive assistance restrictions on immigrants for programs and
activities that you find are "necessary for the protection of life or safety."
My provision was adopted by the Senate without objection in September
1995 and was retained in every version of welfare reform adopted by Congress
over the past year. Congress recognized that it was impossible to itemize every
program or activity that should be exempted from the broad restrictions on
immigrant benefits contained in the legislation. My amendment contained a few
examples to provide guidance in exercising your waiver authority, including
soup kitchens, shelters, and crisis intervention programs. But it was clear there
would be other circumstances for which the bill's restrictions should be waived.
My amendment was viewed as a safety valve to permit flexibility in addressing
these situations without having to seek remedial legislation each time, and I urge
you to use the authority as Congress intended.
One such case involves the important role of community health centers
and clinics in providing pre-natal care. As you know, some states have
interpreted the new welfare law as authorizing them to decline this important
care to mothers regardless of their immigration status, even though their infants
will be American citizens at birth. This pre-natal care is a lifesaver, for without
it, the risks to mothers and children rise dramatically. The clinics may charge a
sliding fee based on the income of their patients, but they generally do not
condition the provision of their assistance on their patients' incomes, thereby
meeting another requirement of my amendment.
I urge you to use your authority to exempt pre-natal care and other life-
saving care. If I may assist in further clarifying the amendment's intent in any
way, please let me know.
Sincerely,
fid
Edward M. Kennedy