Sponsored Noncitizens and Public Benefits: More Clarity in Federal Guidance and Better Access to Federal Information Could Improve Implementation of Income Eligibility Rules
Published: 2009-05-19T00:00:00

Fast Facts:

Highlights:
section_title: Why GAO Did This Study
paragraphs: 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.
section_title: What GAO Found
paragraphs: 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.

section_title: Letter
paragraphs: To ensure that the availability of public benefits does not provide an  incentive for immigration and that noncitizens residing in this country are  self-reliant, Congress significantly limited noncitizens’ access to public  benefits through the Personal Responsibility and Work Opportunity  Reconciliation Act of 1996 (PRWORA) and the Illegal Immigration Reform  and Immigrant Responsibility Act of 1996 (IIRIRA). Key federal means- tested public benefits involved are: Temporary Assistance for Needy  Families (TANF), Medicaid, the Supplemental Nutrition Assistance  Program (SNAP), and Supplemental Security Income (SSI). In many  cases, the 1996 legislation restricted entire categories of legal noncitizens,  such as those who have resided in the United States fewer than 5 years,  from receiving these benefits. For those legal noncitizens who obtained  their status through the financial sponsorship of a family member, there is  an additional restriction. Sponsored noncitizens generally cannot qualify  for benefits unless their incomes, combined with that of their sponsors,  are low enough to meet program eligibility thresholds—a process known  as “sponsor deeming.” Sponsors must sign affidavits of support, when  these noncitizens immigrate, which verify that the sponsors’ incomes are  at least 125 percent of the federal poverty guidelines and pledge financial  support for the noncitizens. Under the 1996 laws, this pledge of support  was made legally binding and enforceable, in part through the “sponsor  repayment” provision, which requires benefit granting agencies to seek  repayment of the cost of benefits provided to a sponsored noncitizen from  the sponsor. Sponsor repayment, in this context, is not related to error or  fraud and must be pursued after benefits are granted solely on the basis  that the sponsor agreed to be financially responsible for the noncitizen  when he or she immigrated.
Since these laws were passed and made effective, very little research has  examined how many people have been affected by the sponsor deeming  and repayment policies or how these policies have been implemented by  government agencies at the federal, regional, state, and local levels. In  light of the current economic downturn, this information may be of  growing importance, as increased numbers of sponsored noncitizens and  others may seek assistance from these benefits. Based on your request,  this report provides information on the following questions: (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 are agencies implementing sponsor deeming, and what  factors may hinder them? (3) To what extent are agencies implementing  sponsor repayment, and what factors may hinder them?
To answer these questions, we collected and analyzed information through  several methods. To gather relevant federal-level information, we  interviewed officials from  the Department of Health and Human Service’s (HHS) Administration for  Children and Families (ACF) and Centers for Medicare and Medicaid  Services (CMS), which, respectively, oversee TANF and Medicaid; the Department of Agriculture’s (USDA) Food and Nutrition Service,  which oversees SNAP;  the Social Security Administration (SSA), which oversees SSI; and  the Department of Homeland Security (DHS), which oversees immigration  and provides noncitizen information to benefit administering agencies  through its Systematic Alien Verification for Entitlements (SAVE) system.
As criteria for policy implementation, we reviewed relevant federal laws,  regulations, and agency guidance. We also reviewed available federal data  on noncitizens, as well as benefit applicants and recipients and, when  appropriate, used these to produce estimates related to sponsored  noncitizens. Through interviews with agency officials, as well as our own  analyses, we determined that these data were sufficiently reliable for the  purposes of this report.
To gather regional, state, and local information on sponsor deeming and  repayment implementation, we used several methods. First, to collect  information on TANF, Medicaid, and SNAP, which are administered by  states, we conducted a Web-based survey of state administrators of each  of these benefits in all 50 states and the District of Columbia between  August and October 2008. All administrators responded to our survey.  While we did not validate specific information that administrators  reported through our survey, we reviewed their responses, and we  conducted follow-up as necessary to determine that their responses were  complete, reasonable, and sufficiently reliable for the purposes of this  report. Second, we conducted site visits in five states selected because  they had significant populations of legal permanent residents and low- income, foreign born residents, as both of these populations include  sponsored noncitizens and are captured in federal data. The selected  states⎯California, Connecticut, Florida, Georgia, and Minnesota⎯also  provided geographic variation. In each state, we interviewed state-level  benefit administrators, as well as officials from two to five local offices  within a selected region that had experienced significant growth in its  legal permanent resident population in recent years. Through both the  survey and site visits, we collected data on sponsored noncitizen  applicants and recipients from the limited number of states and localities  that could provide such information, and we determined that these data  were sufficiently reliable to include in this report. Third, to collect  information on sponsor deeming and repayment in SSI, which is federally  administered by SSA, we interviewed officials from all 10 SSA regional  offices. We also interviewed researchers knowledgeable about immigrant  and public benefit issues.
We conducted this performance audit from March 2008 to May 2009, in  accordance with generally accepted government auditing standards. Those  standards require that we plan and perform the audit to obtain sufficient,  appropriate evidence to provide a reasonable basis for our findings and  conclusions based on our audit objectives. We believe that the evidence  obtained provides a reasonable basis for our findings and conclusions  based on our audit objectives. See appendix I for additional information  on our methodology.
subsections: section_title: Background
paragraphs: The passage of PRWORA significantly limited the conditions under which  legal permanent residents (LPR) are eligible for federal means-tested  public benefits. LPRs are noncitizens who are legally permitted to live  permanently in the United States and include those who obtain this status  through the sponsorship of a family member, an employer-based  preference, or are granted asylum or refugee status. Benefits affected by  the law include TANF, which provides time-limited cash assistance and  other support services; Medicaid, which provides health care assistance;  SNAP, which provides food assistance; and SSI, which provides cash  assistance to the aged, blind, and disabled.
One particular subgroup of LPRs affected by the PRWORA changes to  eligibility requirements for TANF, Medicaid, SNAP, and SSI includes those  who obtained their LPR status through sponsorship by a relative who is  also a LPR or U.S. citizen. Specifically, sponsored noncitizens who entered  the United States on or after the passage of PRWORA on August 22, 1996,  are generally only eligible for TANF, Medicaid, and SNAP after they have  been in the United States for 5 years and eligible for SSI after they have  been credited with 40 quarters of work. Certain veterans, active duty  military, and their spouses and children, are exempted from these time-  and work-related criteria, as are children under the age of 18 who apply  for SNAP benefits. As with all benefit applicants, after sponsored  noncitizens are determined to be qualified for benefits based on their  noncitizen status, their eligibility is assessed on other criteria. For  example, because these benefits are means-tested, applicants’ income and  asset information is reviewed to determine whether they fall below the  established financial eligibility threshold for each benefit.
At the same time that it limited the conditions under which sponsored  noncitizens are eligible for benefits, PRWORA, along with IIRIRA,  strengthened the requirement that sponsors demonstrate their ability to  provide financial support, if needed, to immigrating noncitizens.  Consequently, since December 19, 1997, a sponsor must sign a legally  binding affidavit of support as part of each sponsored noncitizen’s  immigration application, which proves that the sponsor’s income is at least  125 percent of the federal poverty guidelines. The affidavit, as a formal  contract between the sponsor and the noncitizen, also specifies that the  sponsor will provide necessary support to maintain the noncitizen at an  annual income of no less than 125 percent of the federal poverty  guidelines while the affidavit is enforceable. The goal of the strengthened  affidavit, as stated in PRWORA, is to ensure that sponsored noncitizens do  not become public charges.
subsections: section_title: Sponsor Deeming and Repayment in Federal Law
paragraphs: Sponsor deeming is the attribution of the income and resources of the  noncitizen’s sponsor (and that of the sponsor’s spouse, if any) as the  applicant’s own income when determining benefit eligibility and benefit  amounts. Specifically, when the sponsor’s income is deemed, it is added to  that of the applicant, and that sum is compared with the benefit’s financial  eligibility threshold. Therefore, if sponsor deeming occurs, benefits are  only granted to sponsored noncitizens when both they and their sponsors  are sufficiently low-income. Policies requiring sponsor deeming for  noncitizen benefit applicants existed prior to 1996. However, PRWORA  strengthened these deeming policies by generally extending the deeming  period from 3 years to when the noncitizen naturalizes or has been  credited with 40 quarters of work in the United States, or when the  sponsor dies. Medicaid was also later added as a benefit subject to  sponsor deeming, in addition to TANF, SSI, and SNAP.
IIRIRA, which was passed shortly after PRWORA, specified two  exceptions to sponsor deeming for battery and indigence. A battery  exception to sponsor deeming can be made by a benefit agency if a  sponsored noncitizen benefit applicant is a battered spouse, child, or  parent or child of a battered person. An indigence exception to sponsor  deeming can be made by a benefit agency if a sponsored noncitizen benefit  applicant is unable to obtain food and shelter despite any assistance  provided by the sponsor or others. These cases may include instances in  which the sponsor has abandoned the noncitizen or is otherwise unable to  provide the noncitizen with sufficient financial support. For any case in  which the indigence exception is applied, the administering agency  processing the application must send details related to the case, including  the name of the sponsored noncitizen and the sponsor, to DHS. Both  exceptions may be granted for 1 year, and agencies may extend the  exceptions in certain circumstances after reassessing the case at that time.
Sponsor repayment is the collection of benefit costs paid to a sponsored  noncitizen by a benefit administering agency from that person’s sponsor.  This provision, which originated with PRWORA, is designed to legally  enforce the affidavit of support, which pledges a sponsor’s continuous  financial support of the noncitizen. Accordingly, under the law, whenever  a sponsored noncitizen receives federal means-tested public benefits, the  administering agency that provided the benefit must request repayment of  the benefit costs from the sponsor. If sponsors do not repay benefits after  the agency’s request, the agency may also pursue repayment from the  sponsor through court action, if it so chooses. These sponsor repayment  provisions are separate from the traditional benefit recovery provisions  used in cases of benefit fraud or payment error.
section_title: Agency Roles in Implementing the Deeming and Repayment Policies
paragraphs: Federal and state agencies have different roles in overseeing and  administering the four federal means-tested public benefits. SSI is  overseen and administered by federal SSA staff across the country. In  contrast, TANF, Medicaid, and SNAP are generally overseen by the  relevant federal agencies and administered by states, although specific  roles vary by program (see table 1). For all four benefits, administering  agencies are responsible for deeming sponsor income during the  application process and pursuing sponsor repayment of benefits received  by sponsored noncitizens. In the case of SSI, these administering agencies  are SSA regional and field offices. For TANF, Medicaid, and SNAP, the  administering agencies are state and local benefit offices.
Sponsor deeming is implemented by staff at the administering agency as  part of the benefit application process. While agencies vary to some degree  in the methods used to process applications, the method used for  noncitizen applicants for whom deeming applies generally involves several  steps (see fig. 1). First, eligibility workers processing these cases typically  review an applicant’s documents, such as an LPR or green card, to  determine noncitizen status and verify the information they contain using  DHS’s U.S. Citizenship and Immigration Services (USCIS) automated  SAVE system. Workers may then determine whether an applicant has a  sponsor by obtaining verification from USCIS or by obtaining proof from  the noncitizen. Once workers determine that the noncitizen applicant is  sponsored, they assess the applicant’s benefit eligibility based on the  benefit-specific criteria. To assess income eligibility, the worker requests  proof of the applicant’s income and asset information, as well as that of  the sponsor, such as tax forms or other financial documents. Upon receipt  of that documentation, the worker performs the deeming step to  determine whether the applicant’s income, when coupled with the   the  sponsor’s, is below the benefit-specific financial eligibility thresholds.  sponsor’s, is below the benefit-specific financial eligibility thresholds.
Sponsor repayment is also implemented by staff at the administering  agency, though after benefits are received by the sponsored noncitizen.  Federal law and DHS regulations on affidavits of support define several  steps that agencies must follow when pursuing sponsor repayment.  Specifically, once benefits have been received by a sponsored noncitizen,  the administering agency must contact the sponsor in writing and request  repayment of the costs associated with those benefits. The written request  must include several elements, such as the name and address of the  noncitizen, dates benefits were provided, and amount of the benefits. If the  sponsor has not responded to the written request by either repaying the  benefit costs or indicating a willingness to pay after 45 days, the agency  may initiate litigation to recover benefit costs from the sponsor.
section_title: Restrictions on Sponsored Noncitizens’ Eligibility for Benefits, and Other Factors, Limit the Number Potentially Affected by Sponsor Deeming
paragraphs: The number of sponsored noncitizens potentially affected by sponsor  deeming is unknown; however, factors such as the restrictions on their  eligibility for TANF, Medicaid, SNAP, and SSI, as well as the deeming  process itself, likely limit the number affected. Overall, approximately 12.8  million legal noncitizens, including sponsored and nonsponsored, were  permanently residing in the United States as of January 1, 2007, according  to the most recent DHS estimates available. We estimate that around 4.2  million of those individuals obtained their legal noncitizen status via an  executed affidavit of support, whereby the sponsor assumed financial  responsibility for the noncitizen. Because demographic data for this  population, such as income and length of U.S. residency, are unavailable,  it is unknown how many of these individuals are eligible for TANF,  Medicaid, SNAP, or SSI.
The total number of sponsored noncitizens that apply for these benefits is  also unknown, in part because most federal benefit agencies do not collect  this data. However, during 2007, TANF, Medicaid, and SNAP administering  agency staff used DHS’s SAVE system to verify the noncitizen status of  approximately 473,000 applicants who were sponsored—a step typically  taken when noncitizens apply for benefits. This is approximately   11 percent of the estimated sponsored noncitizen population in the United  States as of January 1, 2007, and it is the best proxy available for the  number of sponsored noncitizen applicants for these three programs. In  addition, approximately 29,000 (0.7 percent) sponsored noncitizens  applied for SSI benefits in that year, according to SSA data.
Local benefit agency staff we spoke with during our five site visits  reported that sponsored noncitizens currently constitute a small  proportion of the people they encounter applying for benefits. For  example, staff in many of the local offices we visited said that they  encounter only a few sponsored noncitizen applicants each month, though  staff in other offices said they saw these applicants more frequently. Some  staff noted that the number of sponsored noncitizens seeking TANF,  Medicaid, or SNAP benefits noticeably dropped, and has remained low,  since PRWORA became effective. Specifically, staff cited the PRWORA  requirement that sponsored noncitizens live in the United States for 5  years before they become eligible for those benefits as a significant  contributor to this change.
Likewise, SSA officials we spoke to reported that eligibility restrictions  imposed by PRWORA caused a similar drop in the number of sponsored  noncitizens pursuing SSI benefits. The requirement that most sponsored  noncitizens obtain credit for at least 40 quarters of work to be eligible for  SSI benefits was frequently cited by staff at regional SSA offices as causing  this decrease. Staff at all regional offices reported that they continue to  encounter few sponsored noncitizens applying for SSI.
When sponsored noncitizens do apply for benefits, staff at most of the  local offices we visited during our site visits told us that very few of these  applications for TANF, Medicaid, and SNAP progress to the point where  local staff deem sponsor income. The perceived low incidence of  deeming was also supported by state administering agency officials  through our survey, as 69 percent indicated that cases involving sponsor  deeming had seldom or never occurred in their states during the past 2  years. Local officials in several offices indicated that applicants often  withdraw their applications after they are made aware of the sponsor  deeming rules. State and local staff also cited the reluctance or inability of  the sponsored noncitizen applicant to obtain sponsor income information  as a reason that the application process frequently ends before deeming  occurs. Staff reported the following examples of situations:    some applicants withdraw their applications because they do not wish to  bother their sponsor with a request for income documentation;    some withdraw because they are concerned about how their pursuit of  benefits will impact their sponsors’ ability to remain in the United States  or naturalize, if their sponsors are legal noncitizens themselves;   some withdraw after being told their sponsor may be asked to repay the  benefits in the future, as specified by federal law;   some applicants’ sponsors cannot be located, resulting in denial of the  application due to lack of sponsor income information; and,    some applicants’ sponsors refuse to provide income information, also  resulting in denial of the application.
Officials from SSA also reported a low incidence of sponsor deeming  during the processing of SSI benefits. For example, officials from all 10  SSA regional offices reported that deeming has occurred either rarely or  never since PRWORA became effective. Specifically, because the sponsor  deeming policy does not apply to sponsored noncitizens credited with 40  quarters of work, and most sponsored noncitizens are only eligible for SSI  if they have satisfied the 40-quarter work eligibility requirement, deeming  is inevitably rare. As a result, only sponsored noncitizens who apply for  SSI and are exempted from the 40-quarter work eligibility criteria, such as  those with military connections, are subject to sponsor deeming.
While local staff from our five site visit states reported that sponsor  deeming has been applied in a limited number of cases at their offices, the  extent to which deeming has affected whether sponsored noncitizens  receive benefits or the amount of benefits they receive is unknown.  However, selected federal and state data that we were able to obtain  provide some insight into the proportion of benefit recipients that are  sponsored noncitizens. For instance, less than 0.4 percent of SSI  recipients were sponsored noncitizens during the years 2004 through 2007,  according to SSA. Similarly, Florida, which has a relatively large  noncitizen population, reported that, in December 2008, less than 0.05  percent of TANF, Medicaid, or SNAP recipients were sponsored  noncitizens. Utah and Minnesota also have few sponsored noncitizens  receiving TANF and SNAP, with their proportions ranging from zero to 0.9  percent of each benefit’s total recipients. Figure 2 shows the progression  of sponsored noncitizens through the benefit application and sponsor  deeming processes to become recipients.
section_title: Most Agencies Have Taken Steps to Implement Sponsor Deeming, but Gaps in Federal Guidance and Noncitizen Information Hinder Full Implementation
subsections: section_title: Most Administering Agencies Have Established Sponsor Deeming Policies but Report Needing Additional Federal Guidance
paragraphs: Although benefit administering agencies have generally established  sponsor deeming policies for TANF, Medicaid, SNAP, and SSI, based on  federal regulations and federal guidance, inaction by CMS has stalled  some states’ implementation of sponsor deeming in Medicaid. SSA  disseminated SSI guidance to staff nationwide in 2000 addressing the  sponsor deeming provisions under the 1996 legislation. As a result, field  office staff nationwide have implemented sponsor deeming in SSI by  following procedures and using automated systems established by SSA  headquarters. Similarly, USDA and HHS issued guidance to state benefit  administering agencies in 2003 on sponsor deeming for SNAP and TANF,  respectively. Accordingly, all state agencies administering SNAP reported  in our survey that they have established sponsor deeming policies, and  administering agencies in all but five states reported having established  sponsor deeming policies for TANF. In contrast, CMS has not issued  formal guidance regarding sponsor deeming for Medicaid, and CMS  officials stated that the agency does not currently have plans to do so.  Thus, fewer administering agencies (31) have established policies for  Medicaid, and officials from a few states cited the lack of guidance from  CMS as a reason for their unwillingness to establish sponsor deeming  policies in their Medicaid programs. Officials in one state referred to the  issue’s political sensitivity and the high cost of reworking automated  eligibility systems to include sponsor deeming as reasons they would not  act without clear federal guidance. (See fig. 3.)
Although most administering agencies have established sponsor deeming  policies, agency officials reported that additional guidance in certain areas  would be helpful. Specifically, between 60 and 70 percent of state  administering agencies with sponsor deeming policies for TANF,  Medicaid, or SNAP expressed some desire for more guidance on various  aspects of deeming (see fig. 4). For example, about 70 percent reported  that clarification on how to handle cases where information on the  sponsor’s income is determined to be unobtainable would be moderately,  extremely, or very useful. In addition, many reported that additional  federal guidance on areas related to the indigence exception to deeming  would be useful. Guidance in these areas is particularly important  because how administering agencies handle applicants who are unable to  obtain sponsor income information can have implications for how  agencies apply the indigence exception, as well as whether these  applicants are determined to be eligible for benefits. SSI guidance, as w as recently issued SNAP guidance, indicate that when sponsor income  at when sponsor income  information is unobtainable an indigence exception is to be considere information is unobtainable an indigence exception is to be considere however, federal TANF guidance does not clearly address this issue.  however, federal TANF guidance does not clearly address this issue.
Similarly, about 62 percent of state administering agencies reporte clarification on how to define indigence and who qualifies for the  indigence exception would be moderately, very, or extremely useful.  Although SSI guidance and recently issued SNAP guidance indicate at  what point in the eligibility screening process indigence should be  considered, and whether those who qualify for indigence must provide fu sponsor income and asset information, federal guidance for TANF again  does not clearly address this issue. During our site visits to five states, we  ll  found that states and localities sometimes proceed differently, which can  directly affect who is determined eligible for benefits. In some case staff are directed to consider whether an applicant qualifies for an  indigence exception before deeming occurs. Accordingly, if the agency’s  indigence criteria are met, the applicant can qualify for benefits regardl of the applicant’s ability or willingness to provide full sponsor income  information and without deeming the sponsor’s income. In these cases, th eligibility worker counts only the actual amount of income or assistance  the applicant receives from the sponsor, rather than deeming all or most the sponsor’s income and assets. One local official stated that eligibi lity  staff in his locality assess an applicant’s eligibility for the indigence  exception before deeming and, though staff do not serve many sponsored  noncitizens, those that do apply typically qualify for benefits this way.  In  contrast, the policy in some other localities is to require applicants to  provide sponsor income information before considering an exception. For  these agencies, applicants who are unable or unwilling to provide sponso r  income information are not considered for an indigence exception. One  local official expressed concern that this requirement results in applicants whose sponsors have essentially abandoned them, being den (See fig. 5 for one example of how this process could vary.)  ied benefits.
This official and other local officials we interviewed, however, said that some sponsored  noncitizens who may qualify for benefits through the indigence exception ultimately  withdraw their application when they are told that their names and those of their sponsors  must be reported to the federal government, as required by law.
section_title: Administering Agencies Also Reported Needing Assistance Accessing Federal Information Needed to Determine Who Is Sponsored
paragraphs: Administering agency officials reported that additional federal assistance  on accessing DHS information needed to determine who is sponsored  would also help them implement sponsor deeming policies. Specifically,  state or local officials in each of the five states we visited reported  difficulties accessing DHS information needed to determine whether a  noncitizen applicant has a sponsor, and 65 percent of agencies  administering these benefits nationwide reported that more specific  policies on using SAVE in determining sponsorship would be useful.  Agencies’ difficulties in using SAVE could leave them vulnerable to fraud  or improper payments because SAVE is a key mechanism for verifying  eligibility and sponsorship status. DHS officials stated that the agency  provided SAVE users with technical assistance focused on using the  automated system to obtain sponsorship information when this feature  became available in 2005, and it continues to offer SAVE technical  assistance through user-directed online tools and instructor-led seminars  or webinars upon request. However, 30 to 40 percent of administering  agencies for TANF, Medicaid, and SNAP reported that they had not  received any technical assistance or communication from DHS on  determining if a noncitizen applicant has a sponsor.
As a result, benefit agencies report that staff commonly use SAVE to verify  noncitizen information, but not all staff are aware of how to use SAVE to  obtain sponsorship information. As an initial step, staff in all local offices  we visited use DHS’s automated SAVE system to verify the applicant’s  basic noncitizen information, such as name and admission code. Some  local officials said SAVE provides this information quickly and easily.  However, not all local offices we visited were aware that, by taking an  additional step, the automated SAVE system can provide information on  whether that person is sponsored. Specifically, the system can provide the  sponsor’s name and address to administering agencies, usually within a  few days. Instead, staff in some local offices used methods to verify  sponsorship that either took longer or were less reliable, sometimes  because they were unaware of the option to use SAVE. For example, some  local officials said eligibility staff manually submit paper request forms to  DHS, which usually results in a response within a few weeks but may take  several months. In other local offices, staff use the noncitizen’s admission  code provided by SAVE to determine whether the applicant has a sponsor.  However, many different codes indicate that a noncitizen is sponsored,  and DHS has not provided administering agencies with an official list  specifying which group of codes indicate sponsorship. Thus, eligibility  staff sometimes rely on lists of codes developed in their own offices,  which may not be fully accurate. Some state and local officials said that  maintaining such lists is challenging because admission codes are  numerous and can change.
section_title: Agencies Generally Have Not Implemented Sponsor Repayment, Due in Part to Unclear Federal Guidance and Other Factors
subsections: section_title: Federal Regulations and Guidance Suggest Pursuit of Sponsor Repayment Is Optional, and Very Few Administering Agencies Pursue Repayment
paragraphs: Although federal law states that benefit granting agencies must  administratively pursue sponsor repayment, DHS regulations on affidavits  of support, as well as some federal benefit agency guidance, suggest that  administrative pursuit of sponsor repayment is optional. Specifically, the  law states that benefit administering agencies that have granted a means- tested public benefit to a sponsored noncitizen “shall request  reimbursement by the sponsor.” The law also states that if the sponsor  does not respond to this request within 45 days, “an action may be brought  against the sponsor” in court to enforce the affidavit of support. The DHS  regulations on affidavits of support, however, simply describe the process  a benefit agency must go through if the agency “wants to seek  reimbursement” from a sponsor. In addition, the Federal Register notice  accompanying the issuance of the DHS regulations, states that “the agency  may seek reimbursement” if a sponsored noncitizen receives a means- tested benefit.
When asked about this apparent discrepancy between the language in the  statute and that in the regulations and Federal Register notice, a USCIS  Associate Counsel explained that the regulations are intended to describe  the process agencies must use when they pursue sponsor repayment  rather than address whether they are required to do so. As stated in the  Federal Register notice, “the request for reimbursement  a prerequisite  to suit,” but the act “does not require the agency to sue.” Accordingly, DHS  concluded that a request for reimbursement does not have to be made if  the agency has no intention to sue. Agencies generally have enforcement  discretion in carrying out laws, and the USCIS Associate Counsel noted  that the decision of whether to pursue sponsor repayment involves an  exercise of the federal benefit agencies’ discretion. He added that federal  benefit agencies may require their benefit administering agencies to  pursue sponsor repayment by issuing their own pertinent regulations.  While the federal benefit agencies have not issued related regulations,  some have issued federal guidance that also suggests pursuit of sponsor  repayment is optional.
The importance of this issue was noted by state administering agency  officials. Specifically, over two-thirds of the TANF, Medicaid, and SNAP  state agency officials responding to our survey reported that clarification  on whether it is mandatory or optional for agencies to administratively  pursue sponsor repayment would be moderately, very, or extremely  useful. A few benefit administering agency officials we spoke with noted  that their state policies indicate locals “may” pursue sponsor repayment  and, in those states, local staff are not pursuing repayment.
Nationwide, most state benefit administering agencies reported that they  have not established policies on sponsor repayment for TANF, Medicaid,  or SNAP. In contrast, SSA has established a sponsor repayment policy for  sor repayment policy for  SSI benefits, which applies nationwide. (See fig. 6.)  SSI benefits, which applies nationwide. (See fig. 6.)
However, even in states with sponsor repayment policies formally in place,  state and local staff do not always understand the unique characteristics of  the sponsor repayment provisions. For example, a few staff we spoke to  during one of our site visits thought that the 1996 sponsor repayment  provisions apply only when sponsored noncitizens receive benefits  erroneously or in greater amounts than they are eligible for, as is the case  with traditional benefit recovery provisions. A few others believed that  the provisions require the federal government, rather than state or local  administering agencies, to pursue sponsor repayment of benefits. In  addition, some of the state and local officials we interviewed in one state  were unaware of the sponsor repayment provisions and surprised to see  that they were included in their state’s policy manuals.
Officials from only two states reported in our survey that they have  pursued sponsor repayment of TANF, Medicaid, or SNAP benefits.  Similarly, SSA officials told us that neither its regional nor field offices  have pursued sponsor repayment of SSI benefits. With the exception of  SSA, federal benefit agency officials we interviewed did not know if their  administering agencies had pursued sponsor repayment, as neither federal  law nor regulations require that these efforts be monitored. In addition,  neither federal law nor federal regulations impose penalties on  administering agencies that do not pursue sponsor repayment.
Of the two states that reported pursuing sponsor repayment, neither was  doing so for all cases. Specifically, Connecticut and New York state  officials reported that some of their local offices have pursued sponsor  repayment of TANF, Medicaid, or SNAP benefits received by sponsored  noncitizens. In addition, these states have pursued repayment in different  ways, and the full extent of their implementation is unknown.
Connecticut’s sponsor repayment policy requires that after local staff  grant a sponsored noncitizen TANF, Medicaid, or SNAP benefits, they  refer the case to local resource recovery staff. According to officials, the  resource recovery staff are expected to initiate an investigation, which  involves obtaining a copy of the affidavit of support and assessing the  amount of benefits paid to the noncitizen, and then send a letter to the  sponsor requesting repayment. If the sponsor does not respond to this  request, local staff are to submit the case to the Connecticut Attorney  General. However, while Connecticut officials consider this to be the  state’s sponsor repayment policy, it is still in draft, and they report that not  all offices have pursued repayment. In addition, sponsor repayment in  Connecticut has been on hold statewide since March 2007, when several  legal services organizations questioned the legality of this policy in a  complaint letter. Connecticut state officials did not know how many  cases were pursued prior to that time or how many benefits were repaid  by sponsors.
In New York, a state official reported that sponsor repayment is to be  pursued when noncitizens receive TANF or SNAP benefits after qualifying  for the indigence exception to deeming. In these cases, local staff are to  send a request for repayment to the sponsor. The official noted that New  York’s policies for TANF and SNAP indicate that counties should pursue  sponsor repayment of benefits paid to sponsored noncitizens; however,  individual counties have some discretion in determining whether to pursue  sponsor repayment in each specific case. He indicated that repayment has  been pursued administratively by several counties, but he did not know for  how many cases.
section_title: Administering Agencies Reported That High Relative Costs, Competing Priorities, and Limited Federal Guidance Hinder Their Pursuit of Sponsor Repayment
paragraphs: During our site visits, some state and local TANF, Medicaid, and SNAP  officials suggested that pursuing sponsor repayment has clear costs and  unclear financial benefits. Specifically, if a sponsored noncitizen qualifies  to receive benefits after sponsor deeming occurs, it is because both the  noncitizen and the sponsor are low-income. Agencies that pursue  repayment of benefits from those sponsors may, therefore, expend more in  administrative and potential court costs than they are able to recover from  the sponsors. Because of these high relative costs, several officials we  spoke to indicated that sponsor repayment, as it is currently defined in  federal law, does not make sense for administering agencies to pursue.
Some state and local TANF, Medicaid, and SNAP officials told us that the  staff who pursue sponsor repayment sometimes have competing priorities  that also discourage the pursuit of sponsors for repayment. Local recovery  staff we spoke to in one state noted that their office is significantly  understaffed for the investigations it is required to perform for cases of  benefit fraud and overpayment. While benefit agencies have access to DHS  information on sponsors, including their names and addresses, the local  recovery staff we spoke to said that pursuing sponsor repayment is  particularly labor intensive because there is no national- or state- established infrastructure to efficiently and effectively track down and bill  sponsors for repayment. Other state officials we spoke to reported that  administering agencies would like to pursue sponsor repayment through  the courts, but the state or county attorneys who need to litigate these  cases have other higher priority cases to pursue.
Benefit administering agencies also reported that additional federal  guidance on sponsor repayment is needed to assist implementation. For  example, approximately two-thirds of the TANF, Medicaid, and SNAP state  benefit administering agency officials responding to our survey reported  that specific federal guidance on how to pursue sponsor repayment  administratively, and when to pursue sponsor repayment administratively  or in the courts, would be moderately, very, or extremely useful. While  HHS guidance for TANF administering agencies notes that states may  want to consider the sponsor’s particular circumstances, such as financial  status, and other feasibility factors in determining whether to pursue  sponsor repayment of TANF benefits, other federal benefit agencies’  guidance does not address this issue. In addition, during one of our site  visits, state administering agency officials indicated that they would  benefit from additional federal guidance on pursuing sponsor repayment  for cases involving a battery exception to deeming. In these cases, the  batterer may be the sponsor. However, DHS regulations require that  agencies pursuing sponsor repayment send a letter to the sponsor  containing several elements, including the noncitizen benefit recipient’s  address.
section_title: Conclusions
paragraphs: The PRWORA and IIRIRA changes to sponsor deeming and repayment in  TANF, Medicaid, SNAP, and SSI, coupled with simultaneous changes to  noncitizen eligibility for these benefits, were intended in part to “assure  that aliens be self-reliant in accordance with national immigration policy.”  While the laws’ restrictions on noncitizen benefit eligibility directly work  toward this goal, sponsor deeming and repayment efforts have not been as  effective, in part because benefit administering agencies do not have the  information and guidance they need to implement these provisions as  intended.
Specifically, agencies lack clear federal guidance on implementing  deeming in Medicaid and also struggle to obtain federal information on a  noncitizen’s sponsorship status from DHS. As a consequence, certain  sponsored noncitizens may receive means-tested public benefits based on  their income and assets alone, even though they have sponsors who signed  legally enforceable affidavits agreeing to support them when they became  permanent residents in this country. In addition, agencies that are  unaware of the most efficient and reliable method of accessing a  noncitizen’s sponsorship status from DHS are vulnerable to benefit fraud  and improper payments. Medicaid and TANF agencies’ efforts to  implement sponsor deeming have also been affected by a lack of clear  federal guidance on applying the indigence exception to deeming. Because  some low-income sponsored noncitizens have sponsors who choose not to  provide them financial assistance, or are unable to, inconsistencies in  implementation of the law’s indigence exception to sponsor deeming may  cause these noncitizens unintended harm if they are prevented from  obtaining benefits.
In addition, while very few administering agencies currently are pursuing  sponsor repayment, agencies seem to be considering reasonable factors  when deciding whether to pursue repayment. Specifically, because the  sponsored noncitizens who receive means-tested benefits after deeming  occurs are those that have low-income sponsors, full implementation of  repayment may yield less than would be expended to achieve this  outcome. While the costs of pursuing repayment may be a significant  deterrent to agencies in most cases, there may be some cases in which the  monetary benefits of pursuing repayment are substantial enough to  outweigh the costs. For example, when sponsored noncitizens receive  benefits after qualifying for the indigence exception to sponsor deeming  because their sponsors have sufficient financial means but choose not to  support them, agencies may be able to recover the costs of benefits from  these sponsors. Under the current law, federal regulations, and federal  guidance, though there appears to be inconsistency in whether pursuit of  sponsor repayment is a requirement, this does not in any way bar an  administering agency from pursuing sponsor repayment.
Because of the potentially high relative costs associated with pursuing  sponsor repayment, efforts to improve benefit administering agencies’  implementation of sponsor deeming may yield greater results. While the  limited available data suggest that sponsor deeming currently affects  relatively few people, ensuring that agencies have the federal guidance  needed to administer these provisions is of increasing importance in the  current economic environment. Specifically, it is possible that the number  of sponsored noncitizens, like citizens, applying for and receiving these  benefits will increase in the near term. If such an increase occurs at the  same time that federal and state budgets are stretched, it will be even  more important for the government to ensure that the sponsor deeming  provisions, in particular, are being implemented in the way they were  intended. If administering agencies are better able to determine which  benefit applicants are sponsored and appropriately deem their sponsors’  income, or grant related exceptions, agencies will be less likely to either  issue improper payments or unintentionally harm noncitizens who have  been abandoned by their sponsors.
section_title: Recommendations for Executive Action
paragraphs: To help ensure sponsor deeming is implemented for Medicaid, we  recommend that the Administrator of CMS issue guidance to help  administering agencies implement the law in this area.
To improve consistency of benefit administering agencies’ application of  the indigence exception to sponsor deeming, we recommend that the  Secretary of Health and Human Services clarify in the guidance for TANF a  suggested process for determining an applicant’s eligibility for that  exception.
To help benefit administering agencies access information on sponsored  noncitizens, we recommend that the Secretary of Homeland Security take  the following two actions:  Improve information on sponsorship status of noncitizens provided  through the automated 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.
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.
section_title: Agency Comments and Our Evaluation
paragraphs: We provided a draft of this report to HHS, USDA, SSA, and DHS for review  and comment. HHS and DHS provided written comments, which appear in  appendix II and III, respectively, of the report. SSA provided no comments.
In oral comments, HHS concurred with our recommendation that the  Administrator of CMS issue guidance on sponsor deeming for Medicaid.  However, in its written comments, HHS disagreed with our  recommendation that the Secretary of HHS clarify in the TANF guidance  the process for determining indigence exceptions to sponsor deeming.  HHS stated that, unless there is an express law to the contrary, states have  flexibility in determining TANF eligibility procedures and also asserted  that it already addresses this issue in its guidance. We agree with HHS’s  comments, in part, and revised the recommendation to add the word  “suggested” before “process” to clarify that states have flexibility in  establishing their own TANF processes for determining eligibility for the  indigence exception. However, we continue to believe that additional  federal guidance is needed, as over 60 percent of state administering  agencies reported through our survey that federal clarification on who  qualifies for the indigence exception would be useful. In addition,  procedures for determining indigence exceptions varied in the states we  visited, including whether states require applicants to provide full sponsor  income and asset information before assessing their eligibility for this  exception. While a federal HHS official previously stated that the law  suggests full sponsor income and asset information does not need to be  provided to determine an applicant’s eligibility for the indigence  exception, the TANF guidance does not clearly state this. We believe  adding this clarification to the TANF guidance would help address the  inconsistencies among states and prevent unintended harm to noncitizens  who lack the support of their sponsors.
DHS concurred with both our recommendations to help benefit  administering agencies access information on sponsored noncitizens and  indicated that it plans to take actions to address these in the coming  months. HHS, USDA, and DHS also provided technical comments, which  we incorporated into the report as appropriate.
As agreed with your office, unless you publicly announce the contents of  this report earlier, we plan no further distribution until 30 days from the  report date. At that time, we will send copies to relevant congressional  committees; the Secretaries of Agriculture, Health and Human Services,  and Homeland Security; the Administrator of the Centers for Medicare and  Medicaid Services; the Commissioner of SSA; and other interested parties.  The report also will be available at no charge on the GAO Web site at  http://www.gao.gov.
If you or your staff have any questions about this report, please contact me  at (202) 512-7215 or brownke@gao.gov. Contact points for our Offices of  Congressional Relations and Public Affairs may be found on the last page  of this report. Key contributors to this report are listed in appendix IV.
section_title: Appendix I: Objectives, Scope, and Methodology
paragraphs: To obtain information on agency implementation of sponsor deeming and  repayment, as well as the population affected, we  reviewed available federal data on noncitizens, as well as available federal  and state data on benefit applicants and recipients, to develop estimates of  the sponsored noncitizen population and noncitizen applicants and  recipients;   conducted a nationwide survey of states regarding Temporary Assistance  for Needy Families (TANF), Medicaid, and the Supplemental Nutritional  Assistance Program (SNAP);   visited five states and selected localities within each state and interviewed  officials administering TANF, Medicaid, and SNAP; interviewed officials from all 10 regional offices of the Social Security  Administration (SSA) regarding relevant Supplemental Security Income  (SSI) policies, implementation processes and challenges, and the  frequency that officials had encountered related cases; interviewed officials from relevant federal agencies and reviewed  pertinent federal laws, regulations, and agency guidance; and interviewed researchers knowledgeable in immigrant and public benefit  issues.
We conducted this performance audit from March 2008 to May 2009, in  accordance with generally accepted government auditing standards. Those  standards require that we plan and perform the audit to obtain sufficient,  appropriate evidence to provide a reasonable basis for our findings and  conclusions based on our audit objectives. We believe that the evidence  obtained provides a reasonable basis for our findings and conclusions  based on our audit objectives.
subsections: section_title: Sponsored Noncitizen Population Estimate
paragraphs: In determining the size of the sponsored noncitizen population, we  reviewed potential data sources from Department of Homeland Security  (DHS) and the U.S. Census Bureau. We concluded that no single federal  data source contained the relevant information necessary to generate a  precise measure of this population. However, by combining data from  several DHS sources we were able to produce an estimate of the number  of sponsored noncitizens in the United States as of January 1, 2007.
Beginning with the overall noncitizen population, the DHS Office of  Immigration Statistics (OIS) reports annually on the estimated number of  legal permanent residents (LPR) residing in the United States. Recently,  OIS reported that approximately 12.8 million LPRs were residing in the  United States as of January 1, 2007. Upon our request, OIS officials  calculated that approximately 6.7 million of those LPRs entered the United  States after the legally enforceable sponsor affidavit of support became  effective in December 1997.
In order to estimate how many of the 6.7 million LPRs were sponsored by  a family member, we used two additional sources of DHS data. First, from  DHS, we requested a list of all admission codes denoting sponsorship.  While DHS does not have a list of all admission codes ever issued for this  group, we worked with subject matter experts in DHS to compile a list of  the codes that applied to noncitizens sponsored by a family member  during 2006 and 2007. We determined that the codes from these 2 years  would be sufficient for our analysis, as the DHS experts attested that the  resulting list would include most of the codes applied to the sponsored  noncitizens relevant to our analysis. OIS then matched this list of codes  with their records of noncitizens who obtained LPR status in 2006 and  2007 to estimate the percentage that were sponsored. OIS estimated that  62.5 percent of LPRs obtaining this status in 2006 and 2007 were  sponsored.
By applying OIS’s sponsored LPR percentage of 62.5 percent to their  estimate of 6.7 million potentially sponsored LPRs, we estimate that 4.2  million sponsored noncitizens were residing in the United States as of  January 1, 2007. The data used in this estimate are limited by assumptions  made about emigration, mortality, and naturalization, which are discussed  in OIS’s report, “Estimates of the Legal Permanent Resident Population in  2007.” The estimate is also limited by our assumption that the LPR  percentage for new noncitizens in 2006 and 2007 reasonably reflects that  of past years. Despite these limitations, we determined, in collaboration  with an OIS official knowledgeable of the data, that our methodology and  the data used are sufficiently reliable for establishing a rough estimate of  the size of the sponsored noncitizen population.
section_title: Noncitizen Applicant and Recipient Estimates
paragraphs: In determining the number of sponsored noncitizens applying for TANF,  Medicaid, and SNAP benefits during 2007, we reviewed federal data from  the U.S. Department of Health and Human Services (HHS) and the U.S.  Department of Agriculture (USDA) and found no source that contained  information specific to sponsored noncitizen applicants. We instead  determined, and United States Citizenship and Immigration Services  (USCIS) officials confirmed, that DHS’s Systematic Alien Verification for  Entitlements (SAVE) system database is the best available proxy for  noncitizen applicants. Benefit administering agency staff from all states  typically access SAVE to obtain and verify citizenship status for noncitizen  TANF, Medicaid, and SNAP applicants. Each time that a benefit agency  staff member accesses SAVE to obtain noncitizen information, the system  captures several pieces of data, including the date of the query and the  admission code of the applicant.
Therefore, to estimate the number of sponsored noncitizen applicants,  USCIS examined data on SAVE usage by benefit agency staff in 2007.  Specifically, USCIS matched the SAVE database with the list of admission  codes applied to noncitizens sponsored by a family member during 2006  and 2007. Through this analysis, USCIS estimated that benefit agency staff  obtained information from SAVE on approximately 473,000 sponsored  noncitizens in 2007. As noted previously, because SAVE is typically  accessed by benefit agency staff when they are assessing noncitizen  applicants, 473,000 is our proxy for sponsored noncitizen TANF, Medicaid,  and SNAP applicants. Limitations on this estimate include the possibility  that SAVE is not used by benefit agency staff 100 percent of the time,  which would result in this being an underestimation. Conversely, benefit  agency staff may access SAVE multiple times for the same applicant,  which would result in this being an overestimation. While we are not able  to estimate how often either of these situations occurs, we determined  that the SAVE data are sufficiently reliable to use as a proxy for sponsored  noncitizen applicants of TANF, Medicaid, and SNAP nationwide.
To provide estimates on the number of noncitizens, both sponsored and  nonsponsored, receiving TANF, Medicaid, and SNAP benefits, we relied on  data we were able to obtain from the limited number of states that  maintain relevant recipient information for those benefits. Florida  officials, after analyzing state benefit data for December 2008, reported  that approximately 5.20, 8.12, and 9.50 percent of TANF, Medicaid, and  SNAP benefit recipients, respectively, were noncitizens in that month.  Further, they reported the corresponding percentages for sponsored  noncitizens were approximately 0.01, 0.04, and 0.03. Utah and Minnesota  officials were also able to provide us with information on TANF and SNAP  recipients in their states, based on analysis of state benefit data for fiscal  year 2008. Utah officials reported that approximately 0.33 percent and 0.87  percent, respectively, of TANF and SNAP recipients were sponsored  noncitizens. Minnesota reported that no sponsored noncitizen received  TANF or SNAP benefits in that state during fiscal year 2008. Based on our  conversations with officials in each state that provided the data, we  determined that the data are sufficiently reliable for the purposes of this  report.
SSA is the only federal benefit agency to collect and maintain applicant  and recipient data on sponsored noncitizens. To estimate the number of  sponsored noncitizen SSI applicants and recipients during 2007, SSA  officials analyzed agency data on SSI applicants for that year. Specifically,  officials analyzed citizenship and sponsorship codes for each SSI applicant  in order to identify noncitizen applicants. Based on this analysis, SSA  officials reported that approximately 5.5 percent of SSI applicants were  noncitizens in 2007, and approximately 1.1 percent were sponsored  noncitizens. Similar analysis on recipient data found that approximately   9 percent of SSI recipients were noncitizens in that year, and  approximately 0.3 percent were sponsored noncitizens. However, these  are overestimates of our target group of sponsored noncitizens because  they include all sponsored noncitizens, both those who entered the United  States before the legally enforceable affidavit of support was required and  those who entered after. Because SSA does not maintain data on each  noncitizen applicant’s or recipient’s date of entry into the United States,  we were unable to isolate our target group of sponsored noncitizens.  Despite this limitation, and based on our conversations with the SSA  official who provided the data, we determined that the data are sufficiently  reliable for the purposes of this report.
section_title: Survey
paragraphs: To better understand state implementation of sponsor deeming and  repayment for TANF, Medicaid, and SNAP, we conducted a Web-based  survey of state administrators of each of these benefits in all 50 states and  the District of Columbia. The survey was conducted between August and  October 2008 with 100 percent of state administrators responding (a total  of 153). The survey included questions about the extent that states have  encountered benefit cases involving sponsor deeming, state policies on  sponsor deeming and repayment, state efforts to pursue repayment  administratively and through the courts, the availability of relevant data on  sponsored noncitizen applicants and recipients, implementation  challenges, and areas of assistance from federal agencies that have been or  may be useful.
Because this was not a sample survey, there are no sampling errors.  However, the practical difficulties of conducting any survey may introduce  nonsampling errors, such as variations in how respondents interpret  questions and their willingness to offer accurate responses. We took steps  to minimize nonsampling errors, including pretesting draft instruments  and using a Web-based administration system. Specifically, during survey  development, we pretested draft instruments with TANF, Medicaid, and  SNAP administrators from six states (Arizona, Connecticut, Florida,  Mississippi, South Dakota, and Texas) between June and July 2008. We  selected the pretest states to provide variation in the proportion of state  residents that are LPRs, as well as geographic location. In the pretests, we  were generally interested in the clarity, precision, and objectivity of the  questions, as well as the flow and layout of the survey. For example, we  wanted to ensure definitions used in the surveys were clear and known to  the respondents, categories provided in closed-ended questions were  complete and exclusive, and the ordering of survey sections and the  questions within each section was appropriate. We revised the final survey  based on pretest results. Another step we took to minimize nonsampling  errors was using a Web-based survey. By allowing respondents to enter  their responses directly into an electronic instrument, this method  automatically created a record for each respondent in a data file and  eliminated the need for and the errors associated with a manual data entry  process. To further minimize errors, programs used to analyze the survey  data and make estimations were independently verified to ensure the  accuracy of this work.
While we did not fully validate specific information that states reported  through our survey, we took several steps to ensure that the information  was sufficiently reliable for the purposes of this report. For example, we  reviewed the responses and identified those that required further  clarification and, subsequently, conducted follow-up interviews with those  respondents to ensure the information they provided was reasonable and  reliable. In our review of the data, we also identified and logically fixed  skip pattern errors⎯questions that respondents should have skipped but  did not. On the basis of these checks, we believe our survey data are  sufficiently reliable for the purposes of our work.
section_title: Site Visits
paragraphs: To better understand administering agency implementation of sponsor  deeming and repayment in TANF, Medicaid, and SNAP, we conducted site  visits to five states, and selected localities in those states, between May  and September 2008. The states and localities visited included California— Los Angeles and Orange Counties; Connecticut—Cities of Bridgeport and  Stamford; Florida—Broward and Miami-Dade Counties; Georgia—DeKalb,  Fulton, and Gwinnett Counties; and Minnesota—Hennepin and Ramsey  Counties. The five states were selected primarily because they had  significant populations of LPRs and low-income foreign-born residents,  and they provided geographic variation. In addition, the states selected  varied in the proportion of their cash assistance recipients that were  noncitizens and in their provision of state-funded assistance programs for  noncitizens. The localities were selected because they were within a  region of the relevant state that had experienced significant growth in its  LPR population in recent years or had a historically large base LPR  population in the state. We visited two to five local benefit agency offices  in each state. We cannot generalize our findings beyond the states and  localities we visited.
During the site visits, we interviewed state and local administering agency  officials. Through interviews with state officials, we collected information  on states’ sponsor deeming and repayment policies, possible variation in  local office implementation, challenges to implementation, and areas in  which officials thought federal assistance has been or would be useful.  Through interviews with local officials, we gathered information on the  processes staff use to determine eligibility for noncitizens, the frequency  that they have encountered cases involving sponsored noncitizens and  sponsor deeming, implementation of sponsor repayment policies,  implementation challenges, and areas that staff indicated they would like  additional assistance. During some site visits, we observed the systems  and tools eligibility staff use to process an application. During our  interviews with both state and local officials, we also inquired about the  availability of data on sponsored noncitizen benefit applicants and  recipients.
section_title: Appendix II: Comments from the Department of Health and Human Services
section_title: Appendix III: Comments from the Department of Homeland Security
section_title: Appendix IV: GAO Contact and Staff Acknowledgments
subsections: section_title: Staff Acknowledgments
paragraphs: Heather McCallum Hahn, Assistant Director; Rachel Frisk, Analyst-in- Charge; Theresa Lo; David Perkins; Heather Whitehead; Jean McSween;  Cathy Hurley; Kirsten Lauber; Doreen Feldman; Alexander Galuten; Susan  Bernstein; and Mimi Nguyen also made significant contributions to this  report.