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needs, however, there is a shortage of such facilities. While federal law excludesundocumented children from Medicaid and SCHIP enrollment, states may use SCHIP funds toprovide “health services initiatives” that do not screen for immigration status, including programsaimed at migrant farm worker communities, low-income immigrant communities, newbornscreening, lead testing, health education, and school health programs. 24Additionally, the Maternal and Child Health Block Grant (Title V), which provides health carefunds for pregnant women, mothers, infants, and children who do not have access to adequatehealth care, is a significant source of health care for undocumented women in Texas. Theprogram only requires beneficiaries to be Texas residents, not necessarily citizens, to receiveprenatal care. 25Undocumented “Responsibility?”Due to the limited access to primary and preventive care for over a quarter of all Texans,growing numbers of individuals, including large numbers of immigrants, must rely on hospitalemergency departments for all of their care. A recent estimate put the national figure foremergency room admissions which did not involve an actual emergency at 50 percent. 26 Inrecent years, emergency departments have consequently been increasingly unable to meetcare demands.In July 2001, then-Texas Attorney General John Cornyn ruled on an inquiry from Harris Countyregarding the legality of using local public funds to provide nonemergency health care forundocumented immigrants. Cornyn ruled that it was illegal. * The attorney general’s opinionwas not legally binding, and the majority of Texas hospital districts continued their policy ofserving residents without regard to immigration status. In the 2003 legislative session, state andlocal entities were granted permission to provide services to undocumented immigrants.In January 2004, the Tarrant County District Attorney ruled that this legislation “required” itscounty hospital district to provide nonemergency care to undocumented immigrants, which ithad not done since 1997. In February 2004, the Montgomery County Hospital District, alsoconsidering discontinuing nonemergency services to undocumented immigrants, sought a newopinion from Attorney General Greg Abbott. Abbott ruled that while undocumented workers areeligible for public health services, they are not entitled to receive services from state funds, butmay be entitled to receive services from local funds if the given hospital district permits it. 27Tarrant County hospital district again discontinued preventive care services to undocumentedimmigrants following the attorney general’s ruling. 28Medicare Prescription Drug, Improvement, and Modernization ActThe Emergency Medical Treatment and Labor Act (EMTALA) of 1985 requires hospitalsparticipating in Medicare to medically screen all persons seeking care in hospital emergencydepartments, and to provide the treatment necessary to stabilize those determined to have anemergency condition, regardless of income, insurance, or immigration status. 29Currently, hospitals and other providers must absorb the costs associated with this care.Section 1011 (Federal Reimbursement of Emergency Health Services Furnished to* The opinion stems from a provision in the PRWORA that required state legislatures to actively affirm theirintention to provide public benefits to undocumented and other “not qualified” immigrants. Those who took issuewith the Cornyn opinion claimed that the Texas Legislature had complied with PRWORA in 1997 by amending astatute requiring hospital districts to provide medical care for all indigent residents.B-52