 Following the enactment of PRWORA in 1996, existing gaps in health care coverage between immigrants and citizens have increased significantly.PRWORA, in particular, created stricter requirements for immigrants' eligibility for Medicaid and similar federal insurance programs.This legislative move largely shifted responsibility for immigrant health care from the federal government to the state and local levels; as such, its impact varies across states.Generally, the provisions of PRWORA prevent immigrants from accessing federal benefits like the State Children's Health Insurance Program (SCHIP) until after they have held lawful permanent residency for five years (except in cases of emergency).