Denny Chan: Hi, everyone. Welcome to today’s webinar on a Bird’s Eye View: Issues Impacting Older Immigrants in 2025. Thank you so much for joining us today. I know people are still trickling into the virtual Zoom room, but we’re going to go ahead and get started. So by way of introduction, my name is Denny Chan. I’m the Managing Director for Equity Advocacy here at Justice in Aging, and I use he/him/his pronouns, based out of California. And I would love it for my colleagues, Tiffany and Sahar to introduce themselves as well.
Tiffany Huyenh-Cho: Hi, everybody, my name is Tiffany Huyenh-Cho, I use she/her pronouns. I’m also based in California and I’m the Director of our California Medicare and Medicaid Advocacy.
Sahar Takshi: Hi, everyone. My name is Sahar Takshi, she/her pronouns, and I’m based out of Washington DC. And I’m a Senior Attorney at Justice in Aging, working on equity advocacy.
Denny Chan: All right, thank you Tiffany and Sahar, they’re going to go off camera until they speak, but you’re with me at least for the beginning. So again, welcome to today’s webinar on issues impacting older immigrants. Next slide, please.
In case you don’t know who we are, we are Justice in Aging. We’re a national legal advocacy organization dedicated to using the power of law to fight senior poverty, and we focus on the social safety net programs that really secure a dignified future for older people, including healthcare, economic security, elder justice, and work around housing and access to the courts. We’ve been around since 1972, and we focus our efforts primarily on those older adults who have been marginalized and excluded from justice, including older women, older people of color, LGBTQ older adults, and older adults with limited English proficiency. You can read more about us at our website, justiceinaging.org. Next slide.
So for those of you joining us on the webinar listening live, you will note that all of you are on mute. You should feel free to use the questions function throughout the webinar to ask substantive questions. And for any tech issues that you might run into, we are going to have time at the end to get to as many questions as we can, and we will work hard afterward if we don’t answer all those questions to follow up with folks afterward via email. If you’re having problems getting onto the webinar, you can also send an email to trainings@justiceinaging.org. This is one of the most popular questions for each of our webinars, but we have a dedicated resource library available online, and then a recording to this training as well as past trainings is available at our Vimeo page and at the conclusion of the presentation, it’ll be uploaded to that page. For individuals who would prefer to use it, you can enable close captioning by selecting CC from the Zoom control panel. Next slide.
If you want more free trainings and materials, you can feel free to join our network. We try to be intentional about the volume of email that we send out. I know folks are getting a lot of emails, so we try to be intentional about that. You can go to justiceandaging.org and click sign up or send an email separately to info@justiceinaging.org, and we can get you signed up that way. Next slide.
So critical to our mission is really our commitment to justice for all older adults. We believe that in order to advance justice in aging, we have to ensure that everyone, no matter who they are, are able to access what they need as they age without discrimination and regardless of their racial identity, their gender, gender identity, sexual orientation, ability, their language that they speak, or the country that they come from. And we are committed to that part as bread and butter in our mission. That also means that in our advocacy work, we push for policies that will ensure those experiencing the greatest barriers to all those programs that we advocate on can exercise their rights and fully access the services and programs that they need. This is the future that we’re working toward here at Justice in Aging, and we are excited that you all are joining us for that. All right, next slide.
So in terms of our agenda today in the remaining 55 minutes that we have together, we have three chunks for our agenda. The first is we’re going to get to know a little bit more about you, the 728 folks who are on listening live. So, we’ll do that through a couple of poll questions. Then we’ll get to sort of the meat and potatoes of our time together. So you’re going to hear from Tiffany and Sahar about, who are older immigrants, issues around Medicaid data sharing, and issue around understanding the law behind protected areas and how that’s changed this year. We’ll do a high-level overview of other threats that older immigrants are experiencing, and then we’re going to get to some Q&A.
I do want to flag for you all before we get to those poll questions, that this is an issue of critical importance to us at Justice in Aging and really, to the country at large. We know that because of the change in administration, there has been a dramatic shift in how our country treats immigrants and the policies underlying those communities. And so, we acknowledge that this is a fast-moving, ever-changing area of law and policy. So what we’re telling you is really current as of August 25th. I’ve been based in California, so as of 11:07 AM. And would encourage you if you are listening at home later to make sure that things haven’t changed since we last did this webinar. We’ll of course keep you up to date through the Justice in Aging Listserv as much as possible, but we really wanted to acknowledge that this area is changing rapidly, even just developments yesterday that I’ll share a little bit more later.
We also know that this is an area where many people require individual assistance, and would encourage you all to get in touch with immigration lawyers and other experts who can help individuals who need assistance on the ground. We are discussing this as a topic both of national significance and as a community that we care about at Justice in Aging, because we are committed to justice for everyone. And that includes older immigrants, you’ll hear more about that from Sahar in just a minute. But also that immigration and issues of care are also intricately connected in this country and in our system. We are not eligibility experts, but we are experts in the programs that, as I’ve said before, older adults will rely on, including older immigrants as they age in this country. So, we’re going to really be focused on those issues. There are a lot of really wonky eligibility questions that we’re probably not going to get into, but if you should feel free to raise them in the chat and we can also get you in touch with the right people if it’s something that we don’t have internal expertise on.
So again, thank you for joining us on this really, really important webinar. We know this is a critical time for our country and the older immigrants and immigrant communities who reside here. All right, so we’re going to dive into our first poll question if I can get that launched.
So the question here is, what category best describes your work? Are you coming at us from a AAA or agent services provider area agency on aging, legal assistance provider? Are you a policymaker or work for a policymaker, or other advocate/stakeholder? And I’m going to give just a couple, maybe one more minute as the votes continue to come in, people to make their selection. Looks like the votes are slowing down, unless that’s a lag on my end. So we’re going to close the panel. And the results at closing are at about 25%, one in four of you are coming from a AAA. A little under 20% are with a legal assistance provider. About 5%, less than 5% policymaker, and many of you falling into that last bucket, other stakeholder or advocate.
And then the next and final poll question. So, what are you most interested in getting out of this webinar? An overview of emerging topics in immigration and particularly the issues facing older immigrants. Second, better understanding the connections between immigration and aging services. Resources for specific issues. And the catch-all when you can’t decide among one, all of the above. We’ll just give a little bit more time for people as they continue to vote. All right, I’m going to ask the poll to close now. So, it looks like we’re kind of in the low single digits or high, or I’m sorry, low double digits for high single digits for the first three categories, and then a bunch of you, 67% who are here for all of it.
So with that in mind, I’m going to ask Sahar to come back on and take us through older immigrants.
Sahar Takshi: Hi, everyone. Thank you so much, and thank you Denny for getting us started. Before we dive into the overview of everything that is happening in the world of immigration, I would love to take a second to contextualize this conversation by beginning to answer the question, who are older immigrants? So, there are 8.5 million older immigrants, immigrants that are age 60 or older, residing in the US. And this makes up close to 15% of our entire older adult population in this country. So clearly, we’re talking about a very significant fraction of our clients in the aging services space.
And as you can see in this graph, which is based on data from 2012 through 2016, the population of older immigrants in the US has been steadily on the rise and is expected to continue. What I like about this graph is that it really illustrates the connection between aging and immigration, both of which are increasing populations in the US. So, many of you know, especially if you come from an aging services background, that the older adult population in the US, both non-immigrants and immigrants, are expected to reach over 80 million by the year 2050. And as you can see on this graph, that the number of… sorry, the number of older adults is expected to reach 80 million by the year 2050. And as you can see on this graph, 20 million of those will be older immigrants. I.e., that’s about 25% of the entire older adult population in the year 2050.
So this really just shows us how important it is for aging services and aging advocates to be thinking about older immigrants, to be up-to-date on immigration issues, and vice versa, for immigration advocates to be thinking about older adults in their work as well.
I also want to take a moment to talk about the diversity of older immigrants in our country. The population of older adults, of immigrants and older immigrants are certainly not a monolith. And while it’s not on this slide, we can all appreciate that there is great diversity in terms of countries of origin, of languages and cultures of which older immigrants in the US have. But what I also want to talk about is the diversity of immigration statuses. So there are many pathways that foreign-born people end up in the US. These can include things like H-1B work visas, education visas, asylee and refugee status for people that are facing persecution in their home countries or fleeing a war. It can also include lawful permanent status, also known as Green Card holders. And all of these pathways come with their own burdens, both administrative, legal, and financial. And that can of course contribute to undocumented immigration statuses as well. These different statuses also matter in the context of access to federal benefits, which we will touch on a little bit later in the webinar.
And then for older immigrants specifically, we want to be thinking about when that individual came to our country. So, did they come here in younger age and age as an immigrant in the US, or did they immigrate in older age? That difference matters a little bit in the context of immigration status, but it also matters a lot in the context of the type of support the individual might need and the way they interact with the services that are available and the resources that are in their community.
It’s also important for us to be thinking about the importance of older immigrants in all of our communities. So, immigrant communities as a whole contribute to the rich diversity of our country in terms of ideas, skills and culture. But older immigrants specifically are often the ones that pass down cultural and linguistic knowledge to younger generations, and that allows for that rich diversity to continue and to grow and become enmeshed in our neighborhoods. Older immigrants are also an important part of family units and that can be an opportunity for family unification.
So for example, an older immigrant coming to the US to join their children and grandchildren who are already living here. This is certainly beneficial for the older adults who by being with their loved ones can combat isolation and have just better overall health outcomes. But it also benefits families and our society as a whole, because older immigrants are often the ones that can provide both paid and unpaid caregiving support. So for example, child care for their family unit or providing paid caregiving support to other older adults or disabled individuals in their communities. And all of this supports the ability for people to be able to age in place and to have a robust network of support as they age.
Unfortunately though, older immigrants do face significant inequities in aging in the US. So, some of those systemic barriers include things like the five-year bar, which prevents certain groups of immigrants from receiving benefits such as Medicaid or Social Security income, SSI, Supplemental Security income, SSI, until they have reached five years of residency. There are also a lot of other barriers such as lack of or insufficient language access, discrimination in accessing services, hostile behavior. And these barriers, these inequities contribute to health and wealth disparities. So, one example is that first bullet on the slide, which is that older immigrants experience poverty at twice the rates of non-immigrants, and this is an even higher statistic for older women immigrants and older immigrants of color.
So, in addition to these existing barriers and inequities, we are at a time where we are seeing a lot of new hostilities and threats for older immigrants. So, one is the overall anti-immigrant rhetoric that is so prevalent in our country. We see it through statements made by policymakers and our government officials, we see it through headlines, and even sometimes through members of our own community. We’ve seen multiple executive orders over the last six months specifically talking about immigrant communities and threatening the safety and access to resources for many of those immigrant communities. We’ve of course all seen the significant increase in ICE raids and enforcement all throughout the country but concentrated in areas with significant immigrant populations. And then we’re beginning to see law and policy changes as well. So, sort of taking this rhetoric and these conversations and trying to solidify them into our laws. We’ll be touching on all of these topics throughout the webinar, but of course there’s so much to discuss. So if you have questions, I do encourage you to reach out to us and we’ll also be sharing some resources at the end that might be of interest.
We will be talking about the specific impacts of a few of the emerging threats to older immigrants, but there are a few overall themes of impacts that I would like to touch on now. The first one is what we call the chilling effect. And that is in response to this overall anti-immigrant rhetoric that’s out there, proposed changes in law and policy, the way information is presented through the government agencies or in the news. All of this contributes to a hesitancy of older immigrants enrolling in necessary services that they might actually be eligible for but are worried about, for example, if their information is shared or if ICE is going to come after them. So we call that a chilling effect, and that’s sort of across the board happens during… We’re seeing that happen in these times.
Another barrier is increasing difficulties navigating legal processes and understanding individual rights. This is tied closely to both the erosion of these individual rights, as well as decreased emphasis on things like language access and targeting, which would otherwise help communities, immigrant communities or non-English speaking communities, access services.
And then of course, we are seeing a lot of pushbacks from advocates both through the courts but also through the administrative process, such as submitting comments to proposed rule-makings.
And I’m going to pass it now to Tiffany to talk about Medicaid data sharing.
Tiffany Huyenh-Cho: All right, thanks, Sahar. Next we will discuss the recent sharing of private Medicaid information that happened this summer. So this past summer, we learned that the Center for Medicare and Medicaid Services, or CMS, shared the personal data of Medicaid enrollees with the Department of Homeland Security. So as a reminder, Medicaid is the health insurance program for people in families with low incomes. There are millions of immigrants and older immigrants that rely on Medicaid. Medicaid is administered by both states and the federal government, and CMS is the federal agency overseeing the Medicaid program. So as background, all states do routinely share Medicaid enrollee data with CMS. This has been ongoing for years and it is part of the state’s duty to administer the Medicaid program and verify eligibility for federal funding.
What is new, however, is that this data was sent to a separate agency. It was sent to the Department of Homeland Security, or DHS, and the Department of Homeland Security also includes Immigration and Customs Enforcement, or ice. So we learned that CMS first sent this Medicaid data in June 2025, and later in July it was reported that DHS, the Department of Homeland Security could access a database daily to directly view the personal info of all people enrolled in Medicaid. This access lasts for two months. It started July 9th and it goes until September 9th. And the sharing of this data with the Department of Homeland Security goes against long-standing policy. And in response to its violation, 20 states sued to stop the sharing of this data. And why was this data shared? It was done under the pretense of rooting out fraud and ensuring that undocumented immigrants are not accessing Medicaid. However, undocumented immigrants do not qualify for federally funded Medicaid and never have. This group can access emergency Medicaid services, and that has been allowed for years. Next slide.
So the data that the Department of Homeland Security can see includes info like names, addresses, citizenship and immigration info, as well as social security numbers. And the Department of Homeland Security is allowed to use this info for immigration enforcement. And the sharing of such sensitive info like your address or your social security number with immigration officials violates privacy laws and instills fear in immigrant communities. Communities that we know are already facing discrimination and anti-immigrant attacks under the current administration. States and community organizations have spent decades to build trust with immigrant communities to enroll in Medicaid, and these recent events erodes or completely erases that trust. Next slide, please.
So, who is impacted? All 79 million people enrolled in Medicaid are impacted. That includes US citizens, Green Card holders, other lawfully present immigrants, as well as people who are undocumented and enrolled in emergency Medicaid. So, these are all people that are allowed to be on Medicaid either as lawfully present immigrants or people that are undocumented and then access Medicaid for emergency lifesaving services. Lawfully present immigrants have long qualified for full Medicaid benefits, and these include people like refugees, asylees, or trafficking victims. So, Medicaid has long been a safety net health insurance program for low-income immigrants.
And with the sharing of this personal information, Medicaid use has been weaponized and it will create a chilling effect for all immigrants and others who use the Medicaid program. Older immigrants who need healthcare may hesitate to enroll in Medicaid because of the fear of what will be done with their personal information. People currently enrolled in Medicaid may choose to dis-enroll, knowing that their personal information is being shared. Or older immigrants may limit the medical services that they need for fear of their information being shared. So all of this, all it does is lead to poor health incomes and harm public health, overall. Next slide, please.
And what can people do? What we know is that dis-enrolling or canceling Medicaid coverage will not erase the data that’s already been shared. The Department of Homeland Security does have access to this information and dis-enrolling will not delete that data. All it will do is lead someone to lose health coverage, but it will not erase any data that’s already been shared. Advocates should also know that applicants do not need to share more information than necessary. So sharing the immigration status of a household member who is not applying for Medicaid benefits on behalf of themselves is not necessary.
And I just want to acknowledge how terrible the sharing of such private, personal data is. And the fear and uncertainty that is being wrought on immigrant communities, people are being put in a very difficult position to decide whether to forgo healthcare when they need it or to continue on despite of it. And to be put in this position as both appalling and punishing.
The good news is that the lawsuit that was filed by states did win a preliminary injunction in their favor last week on August 12. And what that means is that CMS is prohibited from sharing data from the plaintiff states, the states that are involved in the lawsuit. And the Department of Homeland Security is prohibited from using the data already acquired from the plaintiff states involved in the lawsuit. The tricky part is, is that this preliminary injunction, this pause on the use of the data and the pause on the sharing of Medicaid data only applies to the states that are part of the lawsuit. So states that are not part of the lawsuit, this preliminary injunction does not apply. And so the data of Medicaid recipients in those states will continue to be shared and viewed by the Department of Homeland Security.
So, the 20 states where the preliminary injunctions do apply are listed on the slide. This temporary relief is not a decision on the merits itself over the legality of the sharing of this private data, but it will remain in effect until the lawsuit ends, or 14 days after the federal government creates a reasoned decision-making process to explain their change in policy about sharing this very private Medicaid info with the Department of Homeland Security. So with that, I’ll turn it back to Sahar.
Sahar Takshi: Thank you, Tiffany. Next, I’m going to talk about protected areas. And this relates to what I mentioned earlier as an emerging threat which are increased immigration enforcement actions, ICE presence, and ICE raids throughout the country.
So first, what are protected areas? Well, protected areas are spaces that have historically been free from immigration enforcement through understandings with, through guidance from the federal government. Historically, spaces such as healthcare facilities, religious spaces, social services agencies, and schools were areas in which immigration enforcement could not just readily enter. However, as of January of this year, the Department of Homeland Security has done away with this longstanding guidance and has terminated the protected areas policies. And this means that these spaces that I mentioned, healthcare spaces, religious spaces, social services spaces, and schools, do not receive those special protections from immigration enforcement presence. However, it’s important to recognize that although the protected areas policies is gone, constitutional rights and other legal protections do still apply to these spaces. So over the next few slides, I will be talking a little more about the constitutional protections and some of the other protections and how you might want to change some of your policies to ensure that you’re taking full advantage of these protections.
So, we’ll begin with an overview of Fourth Amendment protections. The Fourth Amendment protects against unreasonable searches and seizures. So, this means that areas that are considered private, an area in which a person would have a reasonable expectation of privacy, cannot just be readily entered by an immigration enforcement agent. So what that means is if ICE agents intend to search a private area, a non-public area, they must do so in accordance with the Fourth Amendment. However, if that space is a public space, then they are able to enter and search.
So, what makes a space private versus public? Well, an area might be considered public if it is in plain view. So an example of this might be a area in which like a waiting room or a lobby to a hospital in which anybody can enter. It could potentially include spaces such as a congregate meal hall, an activity room, an adult day center, the main space at your local rec center in your neighborhood. However, while these spaces might generally fall under plain view and might be considered public, they can be considered private if you essentially make them so. For example, through marking them as being private, limiting entry and just adding additional barriers that would indicate the space is a private space.
Similarly, information can be considered public if it is in plain hearing. Right? So if it’s something that can be seen or heard in a public space. So for example, if you’re waiting in a lobby and you hear someone speaking, maybe they’re sharing some information about their medical history but they’re doing so in the lobby, that might be considered plain hearing and that is therefore public. But the same thought applies that that could be made private by putting it behind closed doors and adding additional restrictions in how that information is accessed.
So, there are a few exceptions to this difference between private and public. So, although a private space generally cannot be accessed by immigration agents, it can be accessed under three circumstances. That is one, if the ICE agents have a valid warrant. This must be a judicial warrant signed by a federal court that specifies the area to be searched. This is different than an administrative warrant that comes from an immigration court. So if an ICE agent comes to, for example, a adult day center and presents a warrant, you want to make sure you’re reviewing it to ensure that it’s coming from the appropriate court, that it’s signed by a federal judge, and that it includes a description of the specific space that is to be searched.
Another exception is if the owner or an authorized representative of that private space consents to a search. So, you might be in a, let’s say adult day center where there’s a room that’s marked private, but if the owner of the center says, “Actually, it’s okay for ICE agent center here,” then that would be consent to that search.
And then the third exception is in situations in which the ICE agents, immigration enforcement, or other law enforcement believe that there’s an emergency. This is determined on a case-by-case basis by that enforcement official. So in those situations, what might be best is for people in the area to safely document what is happening. That might be writing it down, if you feel comfortable, that might be recording what’s going on, and then that information can later be used to combat whatever action was taken.
So, I’m going to share just a few tips regarding bolstering your Fourth Amendment Rights, particularly if you are in a position where you work with older immigrants and you have some level of control over how the space is marked and the policies surrounding that space.
So one tip as I mentioned would be clarifying which spaces are public versus private. So if you would like to increase some of your protections for the older immigrant clients that come in through your doors, you might consider labeling an area such as a waiting room or a lobby that would typically be public, you might want to label it as private. You also might consider additional entrance requirements. So for example, if a space has typically been walk-in, you can institute appointment-only processes or maybe a call-in before you come in, kind of process. And then you can take additional steps for areas that are private, especially areas where information is being held. Right? If you have files on individuals, if you have photographs of people, you want to make sure that those doors are locked, they’re shut, cabinet doors are locked, things of that nature, things that are best practices.
I do want to recognize that some of these actions, while they do increase, they might help increase those Fourth Amendment protections and that feeling of safety, they do also create additional barriers for people, right? So if you’re typically a walk-in type of office or a walk-in type of adult day center, this definitely does create an additional barrier for those clients, and that can be something where you have to think creatively about how to manage that.
The second tip are just general best practices that I think most folks do engage in regardless, but it’s worth reminding that these best practices also can help protect older immigrants in the event of immigration action. So, things like ensuring that documents that have personally identifying information are not left out in public areas, they’re put away in folders in a cabinet, lock the cabinet. If you have, for example, a lobby with somebody that has a computer that’s taking down information, ensuring that that computer screen is not facing the public, that somebody that is looking and won’t be able to see the computer screen. Similarly, if you’re leaving the area, turning off the monitor, putting the files away, so that it can’t just be seen from out in public. And then also, if you’re discussing information, for example, about an older immigrant client where you’re discussing their name, their immigration status, their address, you want to make sure you’re doing that in a private area behind closed doors where other people can’t hear you.
And the third tip would be staff training. I think this is becoming increasingly important for spaces where older immigrants frequent, whether that’s adult day centers, nursing facilities, PACE centers, others where staff should be aware of how they can act in the event of immigration enforcement. So, a part of that staff training might involve designating which staff will be communicating with law enforcement or ICE agents in the event of immigration action. You also want to make sure that those designated staff are trained up on how to review a warrant, how to answer questions, how they can safely document ICE’s actions. And then for all staff, even if they’re not the designated folks, training them on how to keep clients, older immigrants, and all of the staff even, calm and safe in the event of enforcement action. So for example, it might be someone’s job as the designated staff to communicate with the ICE agent if they come knocking on your door, and the other staff can quietly have older immigrants go to another room where they can be calm and safe for the time being.
So, I’ll talk through a hypothetical scenario. So in the scenario, after ICE raids in the area, an adult day center creates new policies to protect immigrant clients. This includes limiting the lobby to registered clients and placing signs that say private on the doors to the activity room and to the clinic. The adult day center also designates a locked room to hold all of the client files, and they decided that they’re not going to collect immigration statuses unless it’s required by law. The center’s managers all receive training on how they would review warrants and how they would answer questions from immigration agents if they were to come. So, that’s one scenario. That’s one hypothetical of how you might want to implement some of these tips.
In addition to Fourth Amendment protections, there are other protections that might apply. One of these is HIPAA, which is the Health Insurance Privacy Act. This is the federal law that sets the standard for protecting sensitive patient health information. So patient information cannot be shared with anyone, unless that patient consents or that there is a valid warrant or a subpoena. So in the event of immigration enforcement, for example at a health clinic or a health center, if those agents are asking to see a client’s or a patient’s medical file, HIPAA protects them from doing that unless those agents have a warrant or that patient has said, “It’s okay, share it.”
There are also state laws that can add additional privacy protections. Sometimes they reflect the federal HIPAA law, but there can also be additional ones. So I encourage you to look up your specific state’s privacy laws and see what other protections might apply.
I also do want to emphasize that what we’re sharing today is an overview of the Fourth Amendment and of these protections, but it is really important if you have questions about how to implement new policies to protect older immigrants, especially if you’re an organization that receives federal funding. I do encourage you to speak with a lawyer in your state to talk through what you can do and what your options are specific to your states. And with that, I’m going to pass it back to Denny to present on other threats to older immigrants. Oh no, I’m sorry, passing it to Tiffany. My bad.
Tiffany Huyenh-Cho: No worries. Thanks, Sahar. So next up, we will discuss some other recent developments that impact older immigrants. Next slide, please.
You may have heard of H.R.1. It is the federal budget bill that makes sweeping and drastic changes to Medicare and Medicaid, the health insurance programs that millions of older immigrants rely on for care. H.R.1 was passed this summer by the Republican-led Congress and signed into law on July 4th. This bill is also referred to as the One Big Beautiful Act, but that name was stripped just before it passed. So we refer to it as H.R.1 for short. So H.R.1 makes sweeping changes to Medicaid and Medicare, and over 15 million people are estimated to become uninsured. For immigrants specifically, H.R.1 directly terminates eligibility for Medicaid, Medicare, and Affordable Care Act tax credits for many groups of people who are here as lawfully present immigrants.
And as a reminder, Medicaid is the health insurance program for people with limited incomes, and Medicare is the federal health insurance program for people that are over 65 or people younger than 65 with a disability. And Medicaid is particularly crucial for older adults because it provides the wraparound services that Medicare does not cover, like long-term care, transportation to and from medical appointments, as well as personal care services that many older adults rely on to remain living at home and instead of institutions. Next slide, please.
So prior to H.R.1, many lawfully present immigrants qualified for Medicare or Medicaid, if they otherwise met other program requirements like age or income. Lawfully present immigrants is an umbrella term for a wide variety of immigrants who have been granted residency and status to live in the US. So some examples are refugees, or people who have fled persecution and have been granted asylum in the United States, or people with temporary protected status.
So under H.R.1, lawfully present immigrants no longer qualify for Medicare or Medicaid, unless they fall under three specific categories. And those are lawful permanent residents or Green Card holders, certain Cuban and Haitians that entered under a family reunification program, and people residing under the Compacts of Free Association. So these are people from select countries in the Pacific Ocean like Palau or Micronesia. And outside of those three categories, all other lawfully present immigrants will no longer qualify for Medicare or Medicaid.
And the timelines for these changes vary. For Medicare, these changes are already in effect and for Medicaid, it will start in October 2026. So, what this means is that healthcare will be stripped from many older adult immigrants in the next few years. People who have lived and worked in the US for decades. And for older immigrants on Medicare or soon turning 65, this is particularly punishing. Immigrants pay into Medicare through federal payroll taxes. And with H.R.1, they will lose access to Medicare despite paying into the program for years. Next slide, please.
The stripping of immigrant eligibility for Medicare and Medicaid is harmful for many reasons, for most, simply because immigrants are being targeted and barred from accessing affordable health coverage. Another provision of H.R.1 also separately limits immigrant eligibility for the Affordable Care Act tax credits that offset the cost of private health insurance that’s bought through the marketplace exchanges. So the culmination of all of these changes means that older immigrants, a lot of them will be left uninsured. There will be few to little options if you cannot afford the full cost of private health insurance, or you don’t have coverage through an employer. An immigrant is already significantly more likely to be low income compared to US citizens, and even if employed are more likely to work in low wage jobs that do not provide health coverage. So H.R.1 dismantles access to affordable healthcare and undermines the immigrant communities that live and work in the United States.
And while not directly targeted, older adult US citizens who use personal caregivers are also impacted. Caregivers in the US are often immigrants and make up 32% of the home care workforce. So, immigrant caregivers either paid or unpaid, who lose health coverage through Medicaid may need to find other employment that will offer them health insurance. And this will leave many older adults in jeopardy if the direct care workforce shrinks.
And to learn more about the specific provisions of H.R.1, as well as timelines and tips for advocates, please visit our website. We recently had a webinar covering these changes. And later when the PowerPoint is shared, you’ll see a link to the resources slide and our webinar materials. And with that, I’ll turn it to Denny.
Denny Chan: Thank you, Tiffany and Sahar, I’m going to close this out with a couple of other issues that we are watching and wanted to flag for you all. Although before I dig into that, I just wanted to flag on the protected areas policy. One thing just to make sure everyone’s clear on, we know that there is an increase in ICE enforcement actions across the country. We have not yet heard of enforcement in those types of facilities in places where older adults either receive or reside, receive services or reside. However, we wanted to spend some time talking about it today in part because we’ve gotten a lot of inquiries and we don’t quite know what future immigration enforcement will look like. So we thought it was really important to flag for you all and for people to understand what rights, what constitutional law applies in that specific context. But we have not yet quite seen wide scale enforcement in those settings. So, it is an FYI.
In terms of other issues that we’re watching and just to back up a little bit, we had to really pick and choose how much we were going to fit into the 60 minutes. But one thing that we wanted to flag for you all outside of some of these other issues, is that last month the Department of Health and Human Services issued a change, a notice of reinterpretation regarding the Personal Responsibility and Work Opportunity Reconciliation Act of 1996. This was followed or came at a time last month where other agencies also issued similar notices and some you might have heard called this the Head Start memo. But what this memo set forth was really a change in how HHS was interpreting the Personal Responsibility and Work Opportunity Reconciliation Act from 1996. It was a shift in decades of policy. And what it did was it added 13 services where the federal government would consider someone’s immigration status in order to receive those services. One of those being Head Start.
Head Start was the one that really got a lot of attention in the press, but there were a number of other services that also were to be included under the HHS notice, including other services where older adults receive. So for example, community health centers, community services block grants, etc.
As with many things under this administration, states sued state attorneys general sued. And at least in the 20 states plus DC who are plaintiffs in the current lawsuit, there is a stay from enforcement of this memo until next month, and then litigation will continue at least on the merits. Important to note that this memo was effective immediately and is currently in effect in those states that aren’t plaintiffs to the lawsuit. But HHS did offer a 30-day comment window, and you can go to Justice in Aging’s website to find our comments on how this reinterpretation impacts older people, including older immigrants but also older adults who are not immigrants.
There are also just to flag for you all, some executive actions pertaining to language access. So this really matters to those immigrants who are limited English proficient or may not speak English as their first language. There was an executive order issued earlier this year declaring English as the official language. That same EO also undid decades worth of policy laid forth by the Clinton Administration around meaningful access for individuals with limited English proficiency. Just last month, we saw a new guidance from the DOJ Attorney General Bondi that further clarified what this would look like for federal agencies and departments. And just yesterday, we saw Housing and Urban Development indicate that they were going to take down materials offered in other languages, as well as limit access to interpretation services. Important to know that Title VI still applies, that Lau v. Nichols and some of the case law about this still applies. But right now, are seeing that attempt to limit access for individuals with limited English proficiency.
And then what I flagged earlier at the beginning was that just yesterday, Health and Human Services indicated that they would begin sharing with states, individuals who they believe have unsatisfactory immigration statuses for Medicaid purposes. We are still learning more about what that will entail, but they’ve indicated that they’re going to do monthly sharing. This is my point earlier that this stuff is changing really quickly, and so as we learn more, we’ll make sure to keep our network up to date on that as well. Okay, next slide.
We wanted to get to some resources. A couple from Justice in Aging, including one that connects immigration and older adults. Another about immigration enforcement in settings, really talking through the protected areas policy that Sahar walked through. A link to the webinar that Tiffany mentioned about H.R.1. And some other resources from partners, all related to some of the things that we’ve discussed today.
Okay, so I know I promised that we would have some time for questions. You should also feel free to reach out to us online and via email. Our email addresses are here on this slide. But I’m going to first start, I’m going to ask both Sahar and Tiffany to come back on camera. And I know that at least there’s the issues around Medicaid data sharing, Tiffany, there were some questions around the timeline, as well as the sort of timeline specific for the injunction that was issued. So, if you can walk us through that part again just to make sure that folks are clear about the timeline and the timing of it, that would great.
Tiffany Huyenh-Cho: Yeah. So, the database that was created that allows DHS, Department of Homeland Security to view the data of Medicaid enrollees, they were given access to this database for two months, from July 9th to September 9th. What happens after that? We don’t know, but that is the timeline for this access. And then there’s the preliminary injunction that prevents both CMS from sharing data and DHS from viewing data on this database, that is in place for those 20 states that are part of the lawsuit only. And that preliminary injunction will last until either the lawsuit ends or 14 days after the federal government has come up with a reasoned decision-making process to explain this change in their policy about sharing this type of personal data. So, there’s two different timelines happening.
Denny Chan: Great, thank you for that. I’m going to Sahar, we got a number of questions on protected areas and I wondered if you could talk a little bit more about the different considerations, what’s private, what’s public, particularly in nursing homes?
Sahar Takshi: Yes, of course. And I hope that you all can hear me. I think having a couple internet issues. But as I discussed, public and private do have implications in terms of whether immigration enforcement and law enforcement is able to come in and search. And the difference between the two largely comes down to just the facts of the situation, and whether there is enough evidence that the space that we’re talking about would be considered private by all reasonable standards. Right?
So in the context of a nursing facility, if you consider the layout, right? You might have the parking lot that’s outside. Generally, that would be considered a public space. Something like the lobby or the waiting area would generally be considered a public space. However, like I mentioned, the nursing facility could take steps to indicate that those spaces are private. So for the lobby specifically, rather than having it be open door policy, you might institute something like call-ahead requirements or register online requirements before you’re able to enter. You might put signs on the door. You might even have the door’s locked and somebody has to come open it for you if you’re coming into that space.
Thinking further into a context like a nursing facility, you might have things like activity rooms, areas where generally it’s mostly the clients but maybe other people can come in from time to time. You might also want to consider clearly marking those spaces as again being private or for nursing facility residents only. Whatever verbiage you want to use to ensure that those spaces continue to be something that you wouldn’t normally consider to be public.
And then further into that, you might consider the individual person’s rooms if there’s a clinic on site. Those generally would be considered private, but again, it does not hurt to emphasize that. Again, with those signage, with those efforts like closing the door, additional requirements before you’re even able to get to that part of the facility. All of these steps work towards bolstering those protections. And in the event that there is an immigration enforcement, as Denny said, we have not heard of that happening, but of course we know that immigration enforcement is happening in our communities and it creates a lot of uncertainty. So, it does not hurt to think about what policies you might want to pursue in spaces where older immigrants are present. Just so that they can feel safe and that you can also feel like you’re doing the best that you can.
Denny Chan: All right, thank you, Sahar. I know we have a bunch of other questions in the Q&A, and we will follow up with folks offline to the extent that we can and have answers. I want to thank Sahar and Tiffany for co-presenting with me today. Thank you all for coming, and we’ll keep you all posted as developments continue. Thank you.
