Social Worker's Immigration Presentation

1. "Making a Case for Social Justice -
Opening the Door of Access and
Opportunity for Everyone"
Alabama’s Immigration Law
Impacts on Health and Social Care
By John R. Wible
General Counsel (retired)
Alabama Department of Public Health
John R. Wible, 2012 All Rights Reserved 1

2. Acknowledgement/Caveat
 Based upon analysis of Greg
Locklier, Assistant General Counsel, ADPH
 Mr. Locklier is not responsible for my additions and
they do not necessarily represent his opinion
 Caveat: the author has elaborated and updated
 The author is not your lawyer, therefore this may not
be relied upon as legal advice
 No representation is made that this presentation
represents the opinion of the Alabama Department of
Public Health, its OGC, officers, agents or employees
John R. Wible, 2012 All Rights Reserved 2

3. We Are All Immigrants!
 We're all very different
people
 We're not Watusi
 We're not Spartans
 We're Americans with a
Capital “A”
 USA is the “Great Salad
Bowl”
John R. Wible, 2012 All Rights Reserved 3

4. Inmigración History 101
Historically, American immigration history
can be viewed in four periods:
 the colonial period,
 the mid-nineteenth century,
 the turn of the twentieth Ellis Island
century, and
 Post-1965.
John R. Wible, 2012 All Rights Reserved 4

5. Inmigración Laws
 Act of 1790
 Chinese Exclusion Act 1882
 Acts of the 1920s
 Mexican Deportation Acts of 1930s
 Immigration and Nationality Act of 1952
 “Operation Wetback”
 Immigration and Nationality Act of 1965
 Act of 1990
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6. A Strictly Federal Power
“States have no power to pass immigration
laws because it’s an attribute of foreign
affairs. Just as states can’t have their own
foreign policies or enter into treaties, they
can’t have their own immigration laws
either.”
-Karl Manheim, Program for Law & Technology,
Cal Tech and Loyola Law School.
John R. Wible, 2012 All Rights Reserved 6

7. The Arizona Law on Appeal
Arizona Sheriff Joe Arpaio
The “Support Our Law Enforcement
and Safe Neighborhoods Act”
 Police to check nationality of “reasonably
suspicious” person in traffic or other arrest
 Requires everyone to carry citizenship docs
 Police to stop any reasonably suspicious
vehicle to check for human smuggling
 On appeal to U.S. Supreme Court
John R. Wible, 2012 All Rights Reserved 7

8. The Alabama Law
• The Beason-Hammond
“Alabama Taxpayer and Citizen
Protection Act,” HB 56, (Act 2011-535)
was signed into law on June 9, 2011.
• Purpose: To discourage illegal
immigration, according to Section 2 of
the text and statements by the sponsor*
• Sponsor, Rep. Scott Beason wore a wire in
the “statehouse corruption” case and ran
unsuccessfully for Congress.
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9. The Act Dec & Def
 Declares “unlawfully present” aliens to be
ineligible to receive public benefits or to obtain
licenses/permits from state or local agencies.
 Requires employers to verify citizenship/lawful
presence of its employees.
 Makes it illegal to enter into a contract with an
unlawfully present alien.
 Proclaims it Illegal to assist such persons
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10. Attitude
 Many believe this is not a good law
 Many believe it addresses serious issues
 A very wise man once said, “render, therefore
unto Caesar that which is Caesar’s” *
 This fits that category, therefore . . .
* Matthew 22:21
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11. Litigation
Soon after the legislation was signed into
law, the U.S. Department of Justice and a
coalition of individuals and private interest
groups filed lawsuits which are pending.
 Status of Federal Litigation
 Status of State Litigation
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12. Hispanic Coalition of Ala.
et al. v. Governor, et al.
 October 14, the 11th Circuit appeals court approved the U.S.
Justice Department's request to temporarily block parts of
Alabama’s law pending the outcome of an appeal. Among them:
 Requirement that public schools determine the immigration status
of their students.
 But they did have to report back to the state information about
which students didn't have birth certificates or other documents
showing that they are here legally.
 The court is blocking enforcement a provision that makes it a
crime not to have documents proving you are in the country
legally. In other words, everybody had to have their papers on
them or they could be subjected to a misdemeanor charge.
John R. Wible, 2012 All Rights Reserved 12

13. United States v. Alabama
On appeal, 11th Circuit Court of Appeals holds:
 Enjoined Sections 10 and 28, which permit law enforcement
to charge immigrants, unable to demonstrate lawful presence
in the United States, with a misdemeanor and require
schools to check new students' immigration status.
 However, the court denied injunction on Sections 12, 18, 27
and 30, provisions that:
 Allow police to check immigration status during traffic
stops, based on reasonable suspicion.
 Bar Alabama courts from enforcing contracts involving an
illegal immigrant party.
 Make it a felony for an illegal immigrant to apply for a driver's
license, license plate or nondriver identification card.
John R. Wible, 2012 All Rights Reserved 13

14. U.S. v. Alabama (cont.)
 The court refused to halt a provision that would
require police in Alabama to do immigration
status checks under certain circumstances.
 Did not deal with section 13 “giving assistance”
to undocumented persons (lower court denied
injunction as moot for want of standing
 On Appeal, enjoined §§ 27 and 30
 Awaiting S. Ct. decision in Arizona case.
John R. Wible, 2012 All Rights Reserved 14

15. Enjoined Sections
 10 Need to carry ID
 27 Inability to make contracts
 28 School reporting requirements
 30 Inability to obtain state permits
There are also less important state court
actions pending. See paper.
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16. Recent Developments
 German born Manager of Mercedes-Benz plant
arrested in Tuscaloosa for having no driver’s license.
Case dismissed.
 Japanese-born employee of Honda plant arrested in
North Alabama. Case dismissed, employee had a valid
international D/L
 Governor has apologized to Germany and
Japan and stated “we want your business.”
 No one yet arrested for giving assistance to
undocumented person
John R. Wible, 2012 All Rights Reserved 16

17. General Effects on Public Health
"I don't want to spread fear, but any time
people are afraid to get medical care there
are potential complications.” - Dr. Jim
McVay, ADPH.
 Children may not get required
immunizations.
 Communicable diseases may spread
 Mothers may not get adequate
prenatal care
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18. More Detrimental Effects
 Citizen children and those in lawful
status may not get adequate health care
 Water may be less safe
 Restaurants may be unable to get
permits and food may be less safe
 Public health costs may increase
 The people of Alabama may suffer
negative health consequences
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19. Sections of the Act Impacting
Health Care & Social Work
 Section 7: Public Benefits
 Section 9: Contracts
 Section 15: E-verification of Employees
(effective 4/1/12)
 Section 29: Birth Certificates
 Section 30: Business Transactions w/State
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20. Health Care & Social Services
 An alien not legally present in the U.S. is not
entitled to receive certain public benefits.
 An alien is a person who is not a U.S. citizen or
national.
 The term “public benefits” includes certain
healthcare services
 Many services/programs are excluded or
exempt from the citizenship/lawful presence
verification requirements pursuant to state or
federal law/rules/guidance.
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21. Exempt Programs/Services
Act 2011-535 expressly exempts the following
programs/services from citizenship/lawful presence
verification requirements:
 WIC
 Immunizations
 In kind disaster relief
 Communicable disease
 Pre-natal care
 Emergency medical treatment
 Child or adult protective services
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22. Excluded Federal Benefit Programs
The following services/programs are federal
public benefits and excluded from the
citizenship/lawful presence verification
requirements by federal law/rules/guidance:
 Family planning
 Cancer Detection
 Tobacco Cessation
Here, there is a direct conflict between State
and Federal law.
John R. Wible, 2012 All Rights Reserved 22

23. Medicaid Programs
Verification of U.S. Citizenship and lawful
presence of aliens participating in the
following programs is also NOT required as the
Alabama Medicaid Agency determines
eligibility to receive the services:
 Patient First
 Plan First
 EPSDT
 Dental (Medicaid clients)
 Home Health (Medicaid/Medicare clients).
John R. Wible, 2012 All Rights Reserved 23

24. Private Providers
 Programs that do not received federal
assistance are not subject to the Act and may
offer services without “carding” or verifying.
 However, after April 1, they must E-verify their
employees
John R. Wible, 2012 All Rights Reserved 24

25. Verification of U.S. citizenship
and lawful presence IS
REQUIRED for:
 Non-Medicaid dental services
 Private pay or indigent Home Health services
 Prostate screenings
 Non-Medicaid covered services provided to
walk-in clients. Example: blood pressure
check; administration of patient carried
medication prescribed by outside provider.
John R. Wible, 2012 All Rights Reserved 25

26. Children’s Health Insurance
Program (CHIP)
•CHIP is already required to verify
citizenship or lawful presence of aliens but
is authorized by Act 2011-535 to utilize
other means approved by the Federal
government
•CHIP already has an account with SAVE
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27. John R. Wible, 2012 All Rights Reserved 27

28. Means of Verifying U.S. Citizen-
ship or Lawful Presence
 Completion of a declaration form by
client/applicant.
 Provision of documents demonstrating U.S.
citizenship.
 Provision of documents demonstrating lawful
presence of an alien AND verification of lawful
presence through the federal government’s
Systematic Alien Verification for Entitlements
(SAVE) Program.
John R. Wible, 2012 All Rights Reserved 28

29. Means of Verifying Citizenship or
Lawful Presence of an Alien
 Must rely on documents provided by
client/applicant and determinations made
by SAVE. Determinations of U.S. citizenship
cannot be made based upon race, color, or
national origin.
“Imagine” a Green Card
John R. Wible, 2012 All Rights Reserved 29

30. ALABAMA DEPARTMENT OF PUBLIC HEALTH
DECLARATION OF CITIZENSHIP AND LAWFUL PRESENCE OF AN
ALIEN FOR PUBLIC BENEFITS AND LICENSING/PERMITTING PROGRAMS
Title IV of the federal Personal Responsibility and Work Opportunity Reconciliation Act of 1996,
8 U.S.C. § 1621, provides that, with certain exceptions, only United States citizens, United States non -citizen nationals,
non-exempt “qualified aliens” (and sometimes only particular categories of qualified aliens), nonimmigrants, and certain
aliens paroled into the United States are eligible to receive covered state or local public benefits.
With certain exceptions, Alabama Act 2011-535 prohibits aliens unlawfully present in the U.S. from receiving state or local
benefits. Every U.S. Citizen applying for a state or local public benefit must sign a declaration of Citizenship, and the
lawful presence of an alien in the U.S. must be verified by the Federal Government.
Act 2011-535 also requires every individual applying for a permit or license to demonstrate his/her U.S. citizenship or if the
applicant is an alien, he/she must demonstrate his/her lawful presence in the United States.
Directions: This form must be completed and submitted by applicants for health care benefits/services that are not
exempt or excluded from citizenship/lawful presence verification requirements. Medicaid/Medicare clients are not
required to complete this form as eligibility to receive services has already been determined by Medicaid/Medicare.
This form must also be completed by individuals applying for licenses or permits. An individual includes a sole
proprietorship, but does not include other business entities such as corporations.
SECTION 1 --- APPLICANT INFORMATION
NAME: ___________________________________________________________________________________________
(Print or Type) (Last) (First) (M.I.)
DATE OF BIRTH: ______________________________________________________________________________
SECTION II --- U.S. CITIZENSHIP OR NATIONAL STATUS
Are you a citizen or national of the United States (check one) ___ Yes ___ No
If you answered YES: (1) Provide an original or legible copy of document from attached List A or other document that
demonstrates U.S. citizenship or nationality and (2) Complete Section IV.
If you answered No: Complete Sections III and IV.
Name of document provided: __________________________________________________________________
SECTION III – ALIEN STATUS
Are you an alien lawfully present in the United States? ___ Yes ___ No
If you answered Yes: (1) Provide an original or legible copy of the front and back (if any) of a document from attached
List B or other document that demonstrates lawful presence in the United States. (2) Complete Section IV. Information
from the documentation provided will be used to verify lawful presence through the United States Government.
If you answered No: Complete Section IV.
Name of document provided: _________________________________________________________________.
SECTION IV -- DECLARATION
I declare under penalty of perjury under the laws of the State of Alabama that the answers and evidence I provided are true
and correct to the best of my knowledge.
__________________________________________________ _______________
APPLICANT’S/ LEGAL REPRESENTATIVE’S SIGNATURE DATE
______________________________________________ _________________________________
If signed by legal representative, Relationship to Patient Health Dept. Employee
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33. Licensing and Permitting Programs
 Alien not lawfully present
in U.S. may not enter into
“business transaction” with the state.
 Every “person” entering into a business
transaction shall be required to demonstrate
U.S. citizenship or lawful presence in the U.S.
 A “business transaction” includes licenses/
permits issued to individuals by ADPH
 However, AG Opinion 2011-01 – enforce only
when “SAVEd” and ADPH is still “lost”
 Enjoined and on appeal awaiting S. Ct.
John R. Wible, 2012 All Rights Reserved 33

34. Licensing and Permitting Programs
 Act 2011-535 only impacts the licensing and
permitting of individuals
 It does not impact the licensing or permitting
of business entities, other than sole
proprietorships
 Thus, partnership or Inc.
Restaurant, licensed day care or
other potential permitee not = “SAVing”
 Enjoined and on appeal.
John R. Wible, 2012 All Rights Reserved 34

35. Licensing and Permitting Programs
 For purposes of implementing Act 2011-535, an
applicant for a license/permit is the individual to
whom a permit/license is issued, not necessarily
the person signing or submitting the application.
 Thus, agents do not need to be “SAVEd”
 The applicant’s citizenship/lawful presence
must be determined.
John R. Wible, 2012 All Rights Reserved 35

36. How to determine if an applicant
is a business entity other than
sole proprietorship?
 Check the application for the name of the
business to which the permit/license is issued
- Inc., LLC, and LLP indicate types of business
entities other than sole proprietorships.
 Require applicant to provide the legal name
of the business on the application and the
type of business entity.
John R. Wible, 2012 All Rights Reserved 36

37. Section 15 Employment Verify
 Beginning in April, 2012, all employers,
including state agencies must E-verify all new
hires.
 The next section deal with how to do that
 This section is not before the court and is OK
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38. Means of Verifying U.S. Citizenship or
Lawful Presence of an Alien
 Completion of a declaration form by
client/applicant.
 Provision of documents demonstrating U.S.
citizenship.
 Provision of documents demonstrating lawful
presence of an alien AND verification of lawful
presence through the SAVE Program.
 Must rely on documents provided by
client/applicant and determinations
made by SAVE.
John R. Wible, 2012 All Rights Reserved 38

39. Means of Verifying U.S. Citizenship or
Lawful Presence of an Alien
Determinations of U.S. citizenship/lawful
presence cannot be made based upon race,
color, or national origin.
* Duh, of course!
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40. The Declaration Form
 When implemented, form Must be
submitted when initially presenting for
services & applying for or renewing permits or
licenses.
 Ensure that all sections are completed.
 The application process is incomplete without a
properly completed declaration form. Do not
issue license or provide service if incomplete.
 Again, this is subject to SAVE implementation
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41. U.S. Citizen Declaration/Verification
• If applicant declares to be U.S. citizen,
he/she must present a document
demonstrating such from List A.
• A valid Alabama driver’s license is
acceptable. A valid driver’s license from
another state may not be
•Legislation may change this
• A legible copy of a document indicating
U.S. citizenship is acceptable.
John R. Wible, 2012 All Rights Reserved 41

42. U.S. Citizen Declaration/Verification
 If the form is properly completed and
acceptable documentation provided,
services may be provided or permit
issued to the U.S. citizen.
 Maintain the declaration form and a copy
of the document presented in the client’s
file
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43. Alien Declaration/Verification
 If applicant declares to be a lawfully present
alien, he/she must present a document
demonstrating such.
 Federal law requires non-citizens 18 years
or older to have immigration
documentation in their possession at all
times.
 Acceptable forms of documentation are
found in List B and include green cards.
John R. Wible, 2012 All Rights Reserved 43

44. Acceptable
Documentation
Not Acceptable
Documentation
John R. Wible, 2012 All Rights Reserved 44

45. Alien Declaration/Verification
 If the applicant declares to be a lawfully
present alien and provides supporting
documentation from List B, provide
information from the document to the
designated SAVE user for your office to verify
lawful presence through SAVE
 The SAVE response is generally instantaneous
John R. Wible, 2012 All Rights Reserved 45

46. Alien Declaration/Verification
 If for any reason the verification through
SAVE is delayed or is inconclusive, the alien
is eligible to receive health services or
other public benefits in the interim period
if the alien signs the declaration indicating
that he or she is an alien lawfully present in
the U.S
John R. Wible, 2012 All Rights Reserved 46

47. SAVE
 The SAVE Program uses electronic and paper
records for accessing information to verify an
applicant’s immigration status.
 ADPH is in the process of registering to use
SAVE.
 The process may take 60-90 days.
 Only designated users may access the SAVE
Program.
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48. Nondiscrimination
 The eligibility of an applicant
cannot be based upon an applicant’s race,
color, or national origin.
 Do not single out individuals who look or
sound foreign for closer scrutiny or require
them to provide more documentation of
citizenship or immigration status than what
is required.
 Decisions about U.S. citizenship shall only be
based upon documentation provided.
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49. Conflict with EMTALA
 Duties under EMTALA
 Emergency screening examination
 EMC until the condition is resolved or
stabilized and the patient is able to provide
self-care following discharge, or if unable,
can receive needed continual care
 Must transfer if unable to care for the pt.
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50. Conflict with EMTALA
 Emergency exception – hospital may not turn
away any person regardless of nationality or
immigration status if such person needs
emergency care
 May not discharge such person until stable,
though law enforcement may be used to keep
them secure
 Also applies to hospital-based clinics/services
(EMS)
 EMTALA does not apply to other H/C providers
 HB 56 excludes “emergency treatment”
John R. Wible, 2012 All Rights Reserved 50

51. HIPAA Consequences
 Covered Entity may, but is not required to
disclose under HIPAA w/o pt. consent if required by
law to:
 Follow court order or comply with subpoena
 Locate a fugitive or suspect
 Alert LE of a crime taking place on premises (I.E.
violating Alabama Immigration Law)
 HIPAA, itself does not require disclosure,
 permissive only
 Disclose only “minimum necessary” PHI
John R. Wible, 2012 All Rights Reserved 51

52. Required Reporters
 State employees, only, are required reporters
 Required reporters have a legal duty to inform the
authorities of violations of the law.
 13A-10-2, Code of Alabama 1975, misdemeanor
 This does not apply to private citizens
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53. For A Copy of Presentation
and a Paper
►See “Alabama’s Immigration Law Impacts on Health
and Social Care”
►See several presentations & documents also:
http://www.slideshare.net/jwible
►Blog: http://www.johnwible.blogspot.com
►Also on Facebook
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54. For a Video See:
November 15, 2011 “Rock Center with Brian Williams”
http://www.bing.com/videos/watch/video/help-not-
wanted-alabama-immigration-law-sparks-
feud/60bci5h
John R. Wible, 2012 All Rights Reserved 54

55. QUESTIONS OR COMMENTS?
John R. Wible, 2012 All Rights Reserved 55