Tens of thousands of legal immigrants in New York State who are ineligible for Medicaid and Family Health Plus (FHP) because of welfare reform restrictions could be insured at minimal cost to the state, according to a new report by The Commonwealth Fund. The report estimates that more than 167,000 legal immigrants over age 18 whose incomes are low enough to qualify for Medicaid or FHP could be eligible for coverage immediately if the state acted to restore eligibility as it was before the 1996 welfare reform law. The law eliminated federal matching funds for Medicaid for almost all legal immigrants who entered the country after August 1996. At least ten states, including New York's neighbors New Jersey, Connecticut, and Pennsylvania, have already changed their policies on legal immigrants' eligibility for public health insurance. In joining them, the authors point out, New York would be recognizing the importance of immigrants to its economy and workforce. Both immigrants and citizens in New York pay on average the same percentage of their earnings in income taxes-about one-third. The report, "Expanding Access to Health Insurance Coverage for Low-Income Immigrants in New York State" by Deborah Bachrach, Karen Lipson, and Anthony Tassi of Kalkines, Arky, Zall & Bernstein LLP estimates likely enrollment figures and calculates the amount of federal funds that would be available to offset some of New York's costs for offering coverage to legal immigrants. The total new cost to the state of offering both Medicaid and FHP would be just $5.1 million in the first year, with costs rising incrementally as enrollment increases. Even after three years, when over 33,000 adults would be enrolled, the costs would be less than three-tenths of 1 percent of the state's $24 billion Medicaid budget. "The consequences of being uninsured are devastating, for immigrants, their families, providers, and the health system," said Karen Davis, president of The Commonwealth Fund. "New York's economy will clearly reap benefits by providing health care coverage to its immigrant population, in terms of improved health for vital members of the workforce, and more efficient use of the resources of New York's health care system." The authors outline various options and estimate enrollment and costs. The most comprehensive approach would restore full Medicaid coverage as it was before the welfare reform act, and expand Family Health Plus (FHP) to adult immigrants. Another option would expand only FHP coverage to low-income immigrants who meet income eligibility for Medicaid and FHP. Under this option, recipients would not be eligible for Medicaid's more generous benefits, such as long-term care. A third option would be to design a new program to provide a limited package of outpatient benefits to low-income legal immigrants. In all cases, coverage should be structured so the state would gain maximum benefit from federal funds available-such as those for emergency care and for the Prenatal Care Assistance Program (PCAP). In addition, a portion of the new state expenditures for immigrant health care coverage could be applied to New York's Temporary Assistance to Needy Families (TANF) Maintenance of Effort (MOE) requirements, thereby maximizing the availability of federal funds under welfare reform.* The federal government created this inequitable situation-but states can't wait for Washington to act," said David Sandman, senior program officer at The Commonwealth Fund. "Immigrants helped fuel New York's economic gains, and they shouldn't be left behind when it comes to access to basic health care." "Our analysis shows that with a small investment of money, New York can make a big difference in the lives of tens of thousands of its residents and also ease the financial burden on the hospitals and community health centers that serve them," said Deborah Bachrach, a partner at KAZB. "If our goal is to reduce the numbers of uninsured New Yorkers, and increase access to primary and preventive care, restoring health care coverage to legal immigrants is a critical next step." *In addition to drawing down federal Medicaid matching funds for its emergency and PCAP spending on federally-ineligible immigrants, the State may count other spending toward its Maintenance of Effort (MOE) requirements under the federal Temporary Assistance to Needy Families (TANF) program. By designating its spending on health coverage for immigrant families as MOE spending, New York can more easily meet its MOE requirement and maximize its collection of federal TANF funds.