December 12, 2007
Pursuant to Elections Code Section 9005, we have
reviewed the proposed initiative entitled the “California Real ID Act of
2008” (A.G. File No. 07‑0074 Amendment #1S). The measure would (1)
require recipients of California Work Opportunity and Responsibility to
Kids (CalWORKs) and the California Medical Assistance Program (Medi-Cal)
to show passports or alien registration cards in order to receive
benefits, (2) make citizen children of undocumented parents ineligible
for CalWORKs benefits, and (3) create a new type of birth certificate
for the U.S. born children of undocumented parents.
Birth Certificates. A birth
certificate is issued by a county office and is generally based on birth
registration information submitted by hospitals and birthing centers, or
parents after a home birth. Under current law, the parents of a child
are not required to provide proof of their citizenship status in order
to register a birth and there is only one type of birth certificate.
CalWORKs. The CalWORKs program
provides cash benefits and welfare-to-work services to low-income
families with children. In order to receive CalWORKs benefits,
recipients must be citizens or legal noncitizens. Although undocumented
parents are not eligible for benefits, any of their children born in the
U.S. are citizens and therefore eligible for benefits. Recipients can
prove their identity and citizenship status through multiple means
including the presentation of a photo identification, birth
certificates, a U.S. passport, or other Immigration and Naturalization
documents. If applicants do not have the necessary documents, such as a
birth certificate, counties are required to assist applicants in
obtaining the necessary documents, including the payment of fees.
State and Local Health Care Programs.
In California, the federal Medicaid program is administered by the state
as Medi-Cal. Medi-Cal provides a wide range of health care services to
welfare recipients and other qualified low-income persons (primarily
children and their parents and the aged, blind, and disabled).
Undocumented immigrants currently receive a limited range of health care
services through Medi-Cal, including prenatal care, long-term care, and
Under federal law, states are required to verify
the citizenship status and personal identity of most Medi-Cal applicants
before granting new or ongoing eligibility for the program. Passports
are one form of acceptable documentation, but combinations of other
documents, such as a birth certificate and a driver’s license, are also
acceptable. When county workers perform eligibility determinations, they
verify that applicants have the required documents. However, some
persons are exempted from certain federal documentation requirements,
including the aged, blind, or disabled, who are automatically enrolled
in Medi-Cal through an automated process when they are determined by the
federal Social Security Administration (SSA) to be eligible for cash
assistance through the federal Supplemental Security Income program.
The state also operates the Access for Infants
and Mothers (AIM) program for pregnant women and the Healthy Families
Program (HFP) for infants or children in families that require families
to pay modest premiums or other payments for health services. The HFP
and AIM programs permit the enrollment of participants with family
incomes moderately higher than those permitted by Medi-Cal. Applicants
for HFP and AIM are not required to present passports as a condition of
Numerous county and local government agencies in
California operate a variety of health care facilities and programs that
provide health benefits to low-income persons, including in some cases
This measure makes several changes to the
CalWORKs and Medi-Cal programs and the issuance of birth certificates.
This measure creates Government Code Section 27 which would make any
“public benefit right or privilege” contingent upon showing either a
U.S. passport or an alien registration card. Section 27 would apply to
any benefit right or privilege where proof of citizenship or legal
status is required and when statute specifically requires the
application of Section 27. Because this measure makes specific reference
to CalWORKs and Medi-Cal, Section 27 would apply to these programs. No
other programs would be subject to Section 27 unless the Legislature
enacts subsequent legislation referencing Section 27.
Creates Two Types of Birth Certificates.
Effective January 1, 2009, the measure creates two types of
birth certificates. A “Type 1 Birth Certificate” would be issued to a
child born to parents either of whom is a citizen or national of the
U.S. or an alien lawfully admitted for permanent residence whose
residence is in the U.S. A “Type 2 Birth Certificate” would be issued to
a child born to parents who do not provide the required documentation to
obtain a Type 1 Birth Certificate.
This measure requires the county registrar’s
office to determine which type of birth certificate should be issued. To
do this, the registrar would inspect (and maintain a copy of) the
documentation necessary to determine citizenship status. Additionally,
Type 2 Birth Certificate must be issued, the registrar is required under
the measure to fingerprint and photograph the birth mother prior to
issuance. Finally, this measure imposes criminal sanctions on any
official who fraudulently issues a birth certificate to an individual
who is not a citizen or legal permanent resident of the U.S.
CalWORKs. The proposed measure has
two impacts on CalWORKs. First, as discussed above (pursuant to new
Section 27 of the Government Code), all adult applicants and recipients
must present either a U.S. passport or an alien registration card to
receive benefits. These requirements would take effect by September 1,
2009. Second, the measure provides to the extent permitted by federal
law, citizen children with undocumented parents or guardians would be
ineligible for CalWORKs benefits.
Medi-Cal. Beginning March 1, 2009,
the measure also requires all recipients (including children) of
Medi-Cal benefits to provide a U.S. passport or alien registration card.
Certain Medi-Cal recipients and applicants who currently are not
required to show passports or legal resident cards for Medi-Cal
eligibility would need to obtain and present these documents.
The measure specifically prohibits the state from
paying for prenatal care services or other nonemergency medical services
unless the recipient meets the documentation requirements described
The measure exempts from these documentation
requirements the recipients of mental health services, developmental
disability services, long-term care services, or nursing home care
services who applied for benefits prior to March 1, 2009.
Birth Certificate Costs. This
measure would result in unknown local government costs, potentially in
the tens of millions of dollars annually, to administer the issuance of
two types of birth certificates instead of one. The increased costs
include (1) photography and fingerprinting equipment and operations, (2)
additional personnel and facility space, and (3) data storage services.
In addition, this measure would result in unknown, but probably minor,
state costs to provide technical assistance to counties on how to
administer the issuance of two types of birth certificates.
Finally, there could be unknown, but probably
minor, local and state law enforcement costs to the extent state or
local employees are charged with issuing a fraudulent or false birth
certificate, a new crime created by this measure. These costs would
likely be partially offset by revenue from the collection of the fines
that can be imposed under this measure on violators.
County CalWORKs Costs. This measure
is likely to result in initial costs of about $45 million for providing
existing CalWORKs adult recipients with passports. This is because
current law requires counties to assist CalWORKs recipients and
applicants in obtaining eligibility documents, including the payment of
any required fees. In each subsequent year, the annual costs would be
about $15 million for CalWORKs applicants. Although it is possible that
some recipients would not seek a passport and forgo eligibility for cash
and other benefits, we think virtually all recipients would continue to
seek CalWORKs, especially considering the county financial assistance in
obtaining passports. (There is no corresponding state requirement for
county financial assistance for Medi-Cal recipients.)
The measure also would make citizen children with
undocumented parents ineligible for CalWORKs benefits. If this
eligibility restriction were enforceable, it would result in annual
savings of about $400 million. However, it is unlikely that this
provision can be enforced because there does not appear to be a
legitimate basis for discriminating against citizen children, with
respect to the provision of public services, based on the citizenship
status of their parents. Among other precedents, the U.S. Supreme Court
has ruled that although states may attempt to control costs for public
services, they cannot do so by making “invidious distinctions between
classes of its citizens” in violation of the equal protection clause of
the U.S. Constitution.
Health Care Programs Costs and Savings.
It is possible that the courts would determine that some or all of
this measure’s requirements with respect to Medi-Cal are not allowed
by federal law. In particular, it is likely that the state would
still be required under federal law to provide emergency services to
undocumented immigrants. If the measure’s other Medi-Cal
requirements are federally permissible, however, the measure could
have the following fiscal effects for Medi-Cal and other state and
local health care programs:
Medi-Cal Eligibility Administrative
Costs. Some persons are currently enrolled in Medi-Cal
through an automated enrollment process operated by the state in
cooperation with the federal SSA, which may not be permissible
following implementation of this measure. Shifting the processing of
eligibility reviews from the federal SSA to the state for the
existing beneficiaries in this group could result in one-time
state costs of up to the low hundreds of millions of dollars. There
also could be other relatively minor one-time and annual
Short-Term Medi-Cal Cost Reductions for Services to Citizens.
To the extent that persons are temporarily denied eligibility for
Medi-Cal while seeking the documents required under this measure,
there would be one-time unknown state savings potentially totaling
up to the low hundreds of millions of dollars.
Shift of Medi-Cal Spending to Other State
Programs. Certain persons whom this measure would prohibit
from receiving Medi-Cal services, such as pregnant women and
children without passports, could potentially enroll and obtain
similar services in other state programs such as AIM or HFP. The
increased costs incurred by the state under these programs could
offset to an unknown extent any Medi-Cal cost reductions for these
Reduction in Medi-Cal Costs for Services to Undocumented Immigrants.
The measure would likely result in ongoing reduced costs up to the
tens of millions of dollars annually because the state would no
longer provide prenatal care and other nonemergency health care
services to undocumented immigrants.
Increased Costs for County Health
Services. Any persons who are unable to obtain eligibility
in Medi-Cal because of a lack of documentation required by this
measure may seek health care from a health care facility or program
operated by a county or other local government agency. Thus, the
measure could result in unknown ongoing increases in county health
Summary of Fiscal Effects
Birth Certificate Costs. Unknown
local government costs, potentially in the tens of millions of
dollars annually, to administer two types of birth certificates
instead of one.
CalWORKs Costs. One-time county
costs of approximately $45 million and annual ongoing costs of about
$15 million for assisting CalWORKs recipients in obtaining
Health Program Costs and Savings.
Unknown one-time net state savings or costs, depending on whether
temporary benefit reduction savings exceed new eligibility
administrative costs. Ongoing state savings up to the tens of
millions of dollars annually resulting from reduced costs for health
care benefits for undocumented immigrants, plus potential unknown
ongoing increases in annual local government health costs.
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