Flow of government aid in question

Trying to pinpoint the amount of government aid collected by illegal immigrants in the United States is a daunting task.

Some agencies that dole out benefits cannot ask about a person's legal status. Some can, but don't. And then there is that other small problem: Just how many people are in this country, or state, illegally?

In a 2006 report, UNLV's Center for Business & Economic Research estimated there were 150,000 illegal immigrants in Nevada. That followed a 2005 U.S. Department for Homeland Security report that pegged the number at 240,000. (Reach your own conclusion about where the missing 90,000 people might have gone.)

Fortunately, Nevada has some hard numbers and facts.

State Department of Health and Human Services records can tell you precisely how many American-born children of illegal immigrants (or of legal immigrants who have lived in the country for less than five years) receive Temporary Assistance for Needy Families -- welfare -- and how much that cost taxpayers. Through April of the fiscal year that ended June 30, 1,881 children from 753 Nevada households received a little more than $2 million, an average of about $110 a month per child.

Nevada HHS officials also can tell you that a majority of these children are Hispanic. But the officials cannot tell you how many live in households with at least one illegal immigrant, a number that would be useful in the public policy debate over the costs of illegal immigration.

It makes no difference, said Tammy Dufresne, coordinator of research and statistics for Health and Human Services: "The children are U.S. citizens."

Charles Duarte, administrator for the Nevada Medicaid and Checkup programs, takes the issue a step further.

"We don't view that as our job, to police the citizenship of people," he said. "We do that for full Medicaid benefits but not for emergency services. ... If an individual applies for full Medicaid benefits, they have to provide documentation of citizenship, and it is a pretty rigorous application process."

Federal law forbids illegal immigrants from receiving federally provided food or cash aid, housing or health coverage. But emergency medical help must be provided regardless of legal status.

In Nevada, Hispanics represent between 20 percent and 30 percent of the recipients of welfare, Medicaid and food stamps.

Nevada HHS requires adult applicants to prove their legal status to receive full Medicaid health benefits, cash from Temporary Assistance for Needy Families (welfare) or food stamps.

CHILDREN GET HELP

American-born children of immigrants who have lived in the United States less than five years and American-born children of illegal immigrants are classified by the state as "nonqualified, noncitizen," but they qualify for the approximate $110 per child per month stipend from Temporary Assistance for Needy Families.

An average of about 2.5 children lived in each of those households for the past two years, statistics show, and the average monthly payment for those households was about $275.

The payments to "nonqualified, noncitizens" in the fiscal year ending June 30, 2006, represented about 8 percent of the $32 million paid to all Nevada welfare recipients.

Children of illegal immigrants, but not the immigrants themselves, also are eligible to receive food stamps. State statistics show that about 25 percent of food-stamp recipients are Hispanic and that about 50 percent are under 18 years old.

Illegal and newly arrived immigrants do not qualify for full Medicaid coverage, but a federal-state program pays some costs for their emergency care and helps pay for coverage for their American-born children under Nevada Checkup.

Checkup is part of the federal government's State Children's Health Insurance Program, which began in Nevada in 1998 and helps pay for health care for the state's poor children who do not qualify for Medicaid. The federal government pays about 68 percent of the costs, while the state picks up the remaining 32 percent.

Nevada budgeted $42.8 million for Checkup in the fiscal year that ended June 30, a $2.2 million increase over the previous fiscal year, and $22.2 million for emergency care for immigrants. Combined, those expenditures represent about 4.3 percent of the $1.5 billion budget for the state's Health and Human Services' Division of Health Care Financing and Policy and about 2.6 percent of the Health and Human Services $2.4 billion overall budget.

The program's caseload has jumped some 600 percent since it started, burgeoning from 3,862 participants in fiscal year 1999 to 27,492 recipients in the fiscal year that ended June 2006.

Of the 29,409 children enrolled in Checkup statewide in May, about 69 percent, 20,199 children, were Hispanic. In Clark County, the percentages were slightly higher.

Federal law allows states to charge a family up to 5 percent of its annual income to help cover the costs of programs such as Nevada Checkup. That would be about $800 for a low-income household earning about $16,000 per year, according to the state's Division of Health Care Financing and Policy Fact Book for 2007.

But in Nevada, state officials instead have a far less expensive sliding fee based on household size and income. A family of four that makes less than $30,000 per year would pay $60 a year, Duarte said. A family that size can earn up to $36,135 annually and pay $140, or up to $41,300 and pay about $280 a year.

The state has not calculated how much could be saved by charging the higher premium permitted by law. In fact, a fee increase has never been considered.

Duarte said that the low rates are designed to encourage uninsured, working families to get coverage for their children, in part because medical bills are a primary cause of bankruptcy in the United States. A sick child can lead to a loss of work for parents, and the child could end up in a local emergency room where charity care is far more expensive than the managed care offered by the program, he said.

"We already have a high number of uninsured children who qualify for Nevada Checkup or Medicaid who are not enrolled. What we don't want to do is provide another deterrent to enrollment because we want these kids to have coverage," Duarte said.

"There are a whole host of related issues, and raising premiums is not the way to go."

EMERGENCY CARE

Last fiscal year, the state allocated $22.2 million for emergency treatment for illegal adult immigrants and poor people not eligible for full Medicaid benefits, such as legal immigrants in the United States less than five years, Duarte said.

The funding was shared equally by the federal and state governments. The program pays hospitals such as Clark County's University Medical Center roughly 32 cents for every $1 of billable charges, Duarte said.

"Without that payment, the hospital would have to eat those costs, or pass it on to other patients -- insured, paying patients," he said. "It has to be an emergency, which would be something like trauma, a birth or a heart attack."

The $22.2 million went for 5,488 cases statewide, for an average cost per case of $4,045.

Duarte said the number of cases and the costs have increased year-to-year at about the same rate as the state's overall population.

The emergency-care funding was divided into three groups, based on need. Some $2.3 million went to elderly patients who received "end-of-life" care, and disabled patients, such as those with a chronic disease, got $4.1 million. The remaining $15.8 million went to patients classified as "other."

A breakdown of the "other" category was unavailable, but Duarte said his staff thinks most were maternity cases.

Maria Ochoa Silva, an illegal immigrant who arrived in the United States eight years ago from Jalisco, Mexico, said that the birth of her second daughter six months ago at UMC was covered by Medicaid. But during the delivery, doctors found the 35-year-old mother had a cyst they suspected could be cancer.

"They took my ovary," Ochoa Silva said. "Then I started getting bills. I owe about $2,000 for that procedure."

She did not qualify for any aid to pay her doctor's bill, so she is paying off the bill in monthly $50 to $100 installments.

Ochoa Silva's first priority is to cover rent and utility bills, she said, but the mother of two occasionally will skimp on food to make the payments.

RENTAL ASSISTANCE

Because the American-born children of illegal immigrants qualify for rental assistance or public housing, illegal immigrants can live in public housing, but very few do, Southern Nevada public-housing administrators said.

A little more than 11,600 apartments here are either public housing or have tenants who receive federal rental aid. Of those units, 79 of them, a fraction of 1 percent, have tenants listed as "ineligible" for the subsidies. That could mean the apartments are home to illegal immigrants or legal immigrants who have lived in the United States less than five years, local housing agencies said.

But Deloris Sawyer, director of housing programs for the Las Vegas Housing Authority, and Nancy Wesoff, director of the Clark County Housing Authority, said most illegal immigrants do not bother applying for housing aid because applicants are put through a legal status check from Immigration and Customs Enforcement and a criminal-background check. The North Las Vegas authority has similar procedures.

If in a family of four, two members are illegal immigrants, the rent would be the same as on the regular market, Sawyer said. "And once they find that out, they say they are not interested in the process."

Public housing tenants are required to pay 30 percent of their household income for rent. The average monthly assistance provided by the Clark County Housing Authority is $630.

Lease holders who do not accurately disclose the number of tenants run the risk of losing their rental assistance or public-housing unit designation, Wesoff said.

She added that demand for units is so high, there is a long waiting list and turnover is only about 30 households per month. That means landlords do not need to tolerate the abuse that comes from having more tenants than an apartment can handle, she said, or taking the risk of having unqualified residents.

"If you have other people living in your household and you don't report them, it is fraud."