Federal law restricts noncitizens' access to public benefits, including Temporary Assistance for Needy Families (TANF), Medicaid, the Supplemental Nutrition Assistance Program (SNAP), and Supplemental Security Income (SSI). Further, when noncitizens who legally reside in this country through sponsorship of a family member apply for these benefits, they are subject to sponsor deeming, which requires benefit agencies to combine noncitizens' incomes with those of their sponsors to determine eligibility. Sponsors are also financially liable for benefits paid to the noncitizen, and benefit agencies must seek repayment for these costs. GAO was asked to analyze (1) what is known about the size of the noncitizen population potentially affected by the sponsor deeming requirements for TANF, Medicaid, SNAP, and SSI; (2) to what extent have agencies implemented sponsor deeming; (3) to what extent have agencies implemented sponsor repayment. To address these, GAO analyzed federal data, surveyed states, and interviewed federal, state, and local officials.

The number of sponsored noncitizens potentially affected by sponsor deeming is unknown; however, federal restrictions on their eligibility for TANF, Medicaid, SNAP, and SSI, as well as other factors, likely limit the number affected. The most recent data available suggest that 11 percent (473,000) of sponsored noncitizens applied for TANF, Medicaid, or SNAP during the course of 2007, and less than 1 percent (29,000) applied for SSI. In addition to federal restrictions, benefit agency officials reported that applicants' reluctance or inability to obtain sponsor income information further reduces instances of deeming. Nationwide, most benefit administering agencies have established sponsor deeming policies for TANF, SNAP, and SSI. However, agencies in 20 states have not done so for Medicaid, due in part to the lack of federal guidance for Medicaid on this requirement. Yet, even among administering agencies that have established policies, many expressed the desire for more federal guidance on various aspects of deeming. For example, over 60 percent of state officials reported that additional clarification on applying an exception to deeming when noncitizen applicants are indigent would be useful. Local officials also reported difficulties accessing information from the Department of Homeland Security needed to determine whether an applicant is sponsored--an essential part of the deeming process. Few agencies have taken steps to implement sponsor repayment of TANF, Medicaid, SNAP, and SSI, due in part to inconsistent federal guidance. While law requires that agencies administratively pursue repayment, federal regulations and guidance suggest it is optional. In total, only two states have pursued sponsor repayment. Benefit agency officials reported that several factors discourage pursuit of repayment. Specifically, they reported that the process involves high relative costs since noncitizens who receive benefits after deeming only qualify because both they and their sponsors have very low incomes. Officials also reported that local staff who pursue repayment for these benefits sometimes have competing priorities.

Status Legend:

Review Pending-GAO has not yet assessed implementation status.

Open-Actions to satisfy the intent of the recommendation have not been taken or are being planned, or actions that partially satisfy the intent of the recommendation have been taken.

Closed-implemented-Actions that satisfy the intent of the recommendation have been taken.

Closed-not implemented-While the intent of the recommendation has not been satisfied, time or circumstances have rendered the recommendation invalid.

• Review Pending
• Open
• Closed - implemented
• Closed - not implemented

Recommendations for Executive Action

Recommendation: To help benefit administering agencies access information on sponsored noncitizens, the Secretary of Homeland Security should improve information on sponsorship status of noncitizens provided through the automated Systematic Alien Verification for Entitlements (SAVE) system. For example, a class of admission code list that indicates sponsored noncitizens could be added to the SAVE technical assistance tools or effectively distributed to SAVE users.

Agency Affected: Department of Homeland Security

Status: Closed - Implemented

Comments: The Department of Homeland Security (DHS) posted an updated list of class of admission codes indicating sponsorship within its Systematic Alien Verification for Entitlements (SAVE) online system in April 2009. DHS also posted an online notice to inform SAVE users of the availability of the sponsorship list.

Recommendation: To improve consistency of benefit administering agencies' application of the indigence exception to sponsor deeming, the Secretary of Health and Human Services should clarify in the guidance for TANF a suggested process for determining an applicant's eligibility for that exception.

Agency Affected: Department of Health and Human Services

Status: Open

Comments: In September 2012, HHS indicated that it has not clarified its 2003 TANF guidance on sponsor deeming. HHS stated that the content of the 2003 guidance has been sufficient to resolve related requests for technical assistance.

Recommendation: To help ensure sponsor deeming is implemented for Medicaid, the Administrator of CMS should issue guidance to help administering agencies implement the law in this area.

Agency Affected: Department of Health and Human Services

Status: Open

Comments: As of September 2012, CMS has not issued guidance to help agencies administering Medicaid implement sponsor deeming. However, in July 2010, CMS issued guidance to states on implementation of related provisions included in the Children's Health Insurance Program Reauthorization Act of 2009. Those provisions permit states to provide Medicaid benefits to certain sponsored noncitizen children and pregnant women without deeming sponsor income to determine eligibility.

Recommendation: To help benefit administering agencies access information on sponsored noncitizens, the Secretary of Homeland Security should provide guidance to SAVE users that improves their understanding of how to request sponsor information through the automated SAVE system rather than through manual submission of paper request forms.

Agency Affected: Department of Homeland Security

Status: Closed - Implemented

Comments: The Department of Homeland Security (DHS) released an enhanced version of the Systematic Alien Verification for Entitlements (SAVE) system in August 2009. The enhanced system includes additional features on obtaining sponsorship information. As part of its outreach effort, DHS sent notification letters to SAVE users announcing the system enhancement, specifying that sponsorship information will be available through the online system after the enhancement, and providing customer service contact information for assistance.