The Department of Health and Human Services (HHS) issued a Notice on July 14 that will restrict the ability of certain federal grantees to serve immigrant populations under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA). As a result of the Notice, non-qualified aliens are not eligible to receive services through a broader range of HHS grant programs, including the health center program, than previously. Grantees administering these programs—other than nonprofit charitable organizations, which are exempt from the law’s verification requirements—will be required to verify whether individuals seeking such services are qualified aliens. Although the Notice was effective immediately upon publication, in response to a complaint filed by 21 states, the government has agreed to stay enforcement of the Notice until September 11, 2025 in the plaintiff states.
The expanded list of HHS programs subject to these restrictions includes an additional 12 programs, such as the health center program and substance abuse and mental health grants administered by the Substance Abuse and Mental Health Services Administration (SAMHSA). The following HHS grants and programs are subject to the restrictions:
- Title X Family Planning Program;
- Head Start;
- Title IV-E Educational and Training Voucher Program;
- Community Services Block Grant;
- Health Center Program;
- Substance Use Prevention, Treatment, and Recovery Services Block Grant;
- Community Mental Health Services Block Grant;
- Projects for Assistance in Transition from Homelessness Grant Program;
- Certified Community Behavioral Health Clinics;
- Mental Health and Substance Use Disorder Treatment, Prevention, and Recovery Support Services Programs administered by SAMHSA;
- Title IV-E Prevention Services Program;
- Title IV-E Kinship Guardianship Assistance Program; and
- Health Workforce Programs not otherwise covered.
HHS’s Notice Lacks Guidance for Public Health Centers and Other Providers Regarding Compliance
Federal law exempts nonprofit charitable organizations from the law’s eligibility verification requirements. As a result, nonprofit health centers providing benefits through these programs are not required to verify that an individual is a qualified alien and is eligible to receive such benefits. However, PRWORA requires states and local governments administering covered programs to establish verification systems. The law, and HHS’s Notice, are silent regarding whether public entities, such as public hospital districts and health systems, operating health centers, including those doing so in partnership with a separately incorporated Board of Directors, will be required to verify individual eligibility based on immigration status. Further, the Notice is silent regarding whether, in the case of block grants, only the entity that receives the federal grant award is responsible for verification or whether any subgrantees, contractors, and delegated entities also must undertake verification.
As of August 1st, neither HHS nor its component agencies have provided guidance regarding how entities administering programs supported through these grants are to verify eligibility. Further, neither HHS nor the Health Resources and Services Administration (HRSA), which administers the health center program, has provided guidance to grantees regarding how to comply with the Notice’s restrictions, while also complying with the health center program’s statutory requirement to serve all individuals in the health center’s service area.
Eyman Partners is monitoring developments relating to the Notice. If you have questions regarding how the Notice may affect your provision of health care services, please contact any Eyman Partners attorney.