This report analyzes qualitative data to examine factors influencing changes in the health care systems for immigrants in these four cities, including immigrant eligibility changes under federal welfare reform, immigration enforcement issues, and language and cultural differences. [35 PDF pages]
The writing of this paper and the case study site visits to Miami and Houston were supported by the Kaiser Commission on Medicaid and the Uninsured. Data collection and site visits to New York City and Los Angeles were supported by a cooperative agreement funded by the Office of the Assistant Secretary for Planning and Evaluation (ASPE), the Health Care Financing Administration, the Administration for Children and Families (all of the U.S. Department of Health and Human Services), the Food and Nutrition Service and the Economic Research Service (both of the U.S. Department of Agriculture), and the Immigration and Naturalization Service (U.S. Department of Justice). Michael Fix and Grant Miller of the Urban Institute participated in the site visits and provided invaluable comments and advice on this paper. Dozens of local and state officials, hospital and clinic administrators, physicians, nurses, advocates, community service providers and other experts patiently gave of their time and effort to help us understand the circumstances in the four cities. We were grateful for guidance and advice from the two project officers, Julie Hudman of The Kaiser Commission on Medicaid and the Uninsured, and David Nielsen of ASPE, and other federal officials, including Lorna Aldrich, Julia Paradise, Lisa Roney, and Caroline Taplin.