AMERICA'S NEWCOMERS Funding Prenatal Care for Unauthorized Immigrants: Challenges Lie Ahead for States
EXECUTIVE SUMMARY Prenatal care is widely acknowledged as the most cost-effective way to improve the outcome of pregnancy for all women and infants. The care is especially beneficial for undocumented women, many of whom live in poverty, are uninsured, have a number of risk factors for poor birth outcomes and are likely to initiate prenatal care with unmet health needs. States and localities typically combine their own funds with funds from a variety of federal programs to make prenatal care and perinatal nutrition support available to undocumented women. These programs include: State-Federal Programs - Emergency Medicaid (labor and delivery services only);
- Medicaid-financed prenatal care (New York only);
- Medicaid presumptive eligibility; and
- The Maternal and Child Health Services Block Grant.
Federal Grant Programs - Community and Migrant Health Centers;
- The Supplemental Food Program for Women, Infants and Children (WIC); and
- Targeted federal grants.
State Funded Programs - State and local health department appropriations;
- Special state-funded prenatal care initiatives; and
- Restricted Medical (California only).
Concern about the impact of illegal migration on federal, state and local budgets, coupled with the belief that withholding public benefits is a deterrent to such migration, are prompting policymakers to reconsider the wisdom of providing publicly-funded benefits, including prenatal care, to unauthorized immigrants, even though the Fourteenth Amendment to the U.S. Constitution confers citizenship upon their United States-born children. The recent enacted federal welfare reform law, the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, has a number of provisions that make it possible for federal, state and local governments to deny prenatal care and nutrition support to undocumented women. Specifically, the law bars all not qualified aliens, including unauthorized immigrants, from receiving federal public benefits with the important exception of benefits designed to meet emergency needs and protect the public health. In addition, the federal law attempts to nullify existing state laws and prohibit state and local governments from providing public benefits, including prenatal care, to not qualified aliens. States are permitted to provide their own benefits to undocumented persons only if they enact new laws affirming an intent to do so. Finally, states are given the option to provide or deny federally funded nutrition support (WIC) to pregnant undocumented women. The prohibition on federal public benefits may shift the entire burden of providing prenatal care for undocumented women onto states. States in turn are left to decide whether to assume the costs of making this care available and to assess whether provisions of the law or their decisions relative to them will face Constitutional challenges. As state policymakers prepare to make these important decisions it is important that they are mindful of the health- and cost-benefits of prenatal care for women, newborns and communities. Early and continuous prenatal care provides women with opportunities for ongoing assessment for one of the most significant complications of pregnancy -- low birth weight. Low birth weight and very low birth weight which result from a failure of the fetus to fully develop (intrauterine growth retardation), the infant being born too soon (pre-term) or a combination of both, contribute substantially to infant mortality and childhood disabilities. Studies estimate that every dollar spent on prenatal care yields between $1.70 and $3.38 in savings by reducing neonatal complications. The savings increase dramatically when the long-term costs of caring for newborns with physical and developmental disabilities are considered, and are even greater when unforeseen maternal complications are avoided. In addition to the cost savings associated with prenatal care, such care offers many undocumented women their first exposure to the United States health care system as well as their first opportunity since entering the United States to be screened and treated for communicable diseases. Perinatal identification and effective treatment of communicable diseases, such as TB, chlamydia (a sexually transmitted disease or STD) and HIV, can be lifesaving for both the mother and infant, protect communities from epidemics and save hundreds of thousands of dollars in remedial care. Epidemiologists have found that every dollar spent on prevention care for undocumented women, including prenatal care with screening for STD's, saves over $13; and each prevented case of fetal HIV saves an estimated $400. To order this America's Newcomers publication, please call NCSL's Marketing Department at 303-364-7700.  Immigrant Policy Project Home Page |