Hawaii and Maryland are two states considering providing some health care coverage to those legal immigrants banned from the Medicaid program under the new welfare reform law. Hawaii is considering providing future legal immigrants with a limited set of health-care benefits and Maryland is considering providing state-only funded Medicaid benefits to pregnant women and children under the age of 18. Legislatures in both states are considering 1997-98 administrative budgets that include money for these immigrant health services. Under the new federal welfare law, legal immigrants arriving after Aug. 22, 1996 are banned from receiving federally funded benefits, including Medicaid, for five years, with exceptions for some groups such as asylees, refugees, veterans of active military duty, etc. For legal immigrants before that date, states have the option of discontinuing benefits, but, so far, no state has exercised its option to discontinue Medicaid benefits for its current immigrant population, according to the Health Care Financing Administration (HCFA). States can file an amendment to their welfare plans at any time and their option not to provide Medicaid coverage to current immigrants would become retroactive to the beginning of the quarter. Steve Kawada, from the MedQuest policy and program development office for Hawaii’s Department of Human Services, says Hawaii’s limited benefit package for future illegal immigrants, as currently proposed, would include: •12 outpatient physician visits; •10 inpatient days; •10 inpatient physician visits; • emergency services; • emergency dental care; and • limited prescription coverage for antibiotics and contraceptive drugs. This set of benefits is similar to what is offered under the the state’s Quest-Net program, says Mr. Kawada. When eligibility standards were tightened for Hawaii’s Medicaid managed care program, QUEST, the state provided more limited Quest-Net coverage to "protect people who fell out of the program." For future legal immigrants, Mr. Kawada says, only those who are under 100% of the federal poverty level and meet Medicaid eligibility requirements and assets test will get Quest-Net. Those above 100% of the federal poverty level will be able to get Quest-Net if they pay the full premium which has not yet been determined. The state will consider the immigrant’s sponsor’s income and assets in determining eligibility for Quest-Net. An estimated 8,300 are entering Hawaii every year, and about 10% are expected to participate in the state-funded program. In Maryland, the governor has proposed that the state continue to provide Medicaid coverage and other welfare benefits to legal immigrant children after the federal cut-off date of Aug. 22. Of the 12,447 legal immigrants receiving Medicaid benefits in Maryland, the state estimates that about 2,519 are under the age of 20. Of the $37 million spent to provide Medicaid to legal immigrants in 1996, about $3 million was spent on those under the age of 20. David Romans, of the Department of Fiscal Services for the Maryland General Assembly, says that to decrease the likelihood that immigrants will come to Maryland just to become eligible for benefits for their children, there is a stipulation that in the first 12 months assistance will be limited to that provided by the previous state of residence or Maryland’s benefit level, whichever is the lesser amount. Hawaii’s attorney general recently issued an opinion on the constitutionality of the state excluding legal immigrants from welfare benefits. The attorney general concluded that the state is unlikely to run into constitutional problems when it is "required" to ban benefits for legal immigrants under the federal Welfare Reform Act. The problem comes in when the state can exercise an option to cover or not cover legal immigrants. A federal court would "most likely find it unconstitutional if the State were to exercise its option," the opinion finds. Congress is not constitutionally bound to provide immigrants with the same welfare benefits as U.S. citizens, but a problem occurs when a state is asked to discriminate among groups of aliens. HCFA says it will soon issue a policy on whether states must cover all current legal immigrants (before Aug. 22) or whether they can choose to cover some groups, but not others. Contact the Hawaii Department of the Attorney General, Social Services Division, 808-587-2929; Mr. Kawada at 808-586-5883 or Mr. Romans at 410-841-3761.