Immigrant Coverage Options

Kyle Fisherkfisher@phlp.org

November 2015

Session Topics

1. Medicaid & “Qualified” status The “5 year bar” GA-related Medical Assistance

2. “Lawfully Present”

3. Marketplace Coverage & Subsidies For Immigrants ineligible for Medicaid

4. Emergency Medical Assistance

5. Practice Tips

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Medicaid Basics

Four criteria:

ResidencyCategoryIncome LimitsImmigration Status

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Immigration Status Overview

For Medicaid – two standards:

“Lawfully Present” Standard for:

Children Pregnant women

“Qualified” Plus five year waiting period for most immigrants More narrow than “lawfully present” Standard for:

Adults

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Medicaid Eligibility

3-step analysis for each person1) What category does the person fit in?

2) What is the person’s household size?

3) Is the person under the income limit for that category and household size?

4th step for immigrants

4) What is the person’s immigration status and does it meet the relevant Medicaid standard?

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& THE “5 YEAR BAR”

“Qualified” Immigrants6

Immigration Status

“Qualified Alien” More narrow than “lawfully present” Medicaid Standard for:

Adults (unless pregnant)

Plus five year waiting period Depending on the status, may be subject to a “5 year

bar” Have to be in qualified status for 5 years before eligible

See Medical Assistance Elig. Handbook 322, Appendix A

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5 year bar

What is the 5-year bar?A waiting period that runs from date the

person obtains “qualified” status

Does not apply to certain immigration categories (generally humanitarian):Refugees & Asylees (even if later become LPR)Persons granted withholding of deportation/removal Cuban/Haitian entrants Iraqi or Afghan special immigration statusU.S. veterans or active duty military, spouses, or

children

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Example 110

Gary has been in the U.S. with LPR status (as an asylee) since 2008. He petitioned for a green card for his wife Nadia, who entered the country in 2011. They earn $19,000/yr (120% FPL).

Does either meet Medicaid’s immigration status standard?

Immigration Status AnalysisMedicaid-eligible?Qualified? Subject 5

year bar?Satisfy 5 year bar?

Gary Yes

Nadia No (but

HC.gov)

GA-related Medical Assistance

For very low-income immigrants subject to the ‘5 year bar’ and still in waiting period. This is state-funded MA that covers about 4,000 immigrants. GA/MA has no 5 year bar.

Category:1. Disability

Employability Assessment Form– Box 1, 2, or 3

2. Health-Sustaining Medications form, or3. Age 59+

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GA/MA Income Limits

GA-related MA (if disability/need for Rx)

Income limits vary slightly by region, see MAEH 368 Appendix A

GA-related MA (if age 59+)

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Household Income Limit (monthly)

Resource Limit

HH of 1 $205 $250

HH of 2 $316 $1000

Household Size

Income Limit (6 months)

Resource Limit

HH of 1 $2,550 $2,400

HH of 2 $2,650 $3,200

Example 213

Meena seeks insurance for her elderly parents (age 69 and 74), who recently arrived from India and have green cards. Her mother has Parkinson’s; her father has mobility issues. They have no income, some savings ($5,000), and are supported by their adult children.

Immigration Status AnalysisCoverageOptionsQualified? Subject 5

year bar?

Satisfy 5 year bar?

Meena’s parents

GA/MA (if reduce savings;

over age 59, no income)

HC.gov + subsidies another

option

CHILDREN & PREGNANT WOMEN

“Lawfully Present”14

Lawfully Present

“Lawfully Present” Legal term of art Medicaid Standard for:

Pregnant women Children

Under age 21

Marketplace standard for all enrollees Does not include DACA status

https://www.healthcare.gov/immigration-status-and-the-marketplace/

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FOR IMMIGRANTS NOT ELIGIBLE FOR MEDICAID

HealthCare.gov18

HealthCare.gov

Special rule for immigrants who do not qualify for Medicaid because of immigration status No income floor for PTC - Income: 0 - 400% FPL

To qualify for premium tax creditsNormally an income “floor”:

Income: 138 - 400% FPL

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  1 person 2 people 3 people

Adults 138% poverty $16,248 $21,984 $27,310

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HC.gov

Who does this affect (among the <138% FPL)?

“Qualified” immigrants not meeting the 5 year barLawfully present immigrants who are not qualified

May need to show a Medicaid denial notice Otherwise HC.gov screens as Medicaid eligible

For very low-income “qualified” immigrants inside 5 yrs Option:

1) GA-related MA, or 2) Marketplace coverage & subsidies

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Example 322

Gary has been in the U.S. with LPR status (lottery) since 2011. He has petitioned for a green card for his pregnant wife Nadia, who lives with him. They earn $19,000 annually (120% FPL).

Immigration Status AnalysisCoverag

eOption

Qualified?

Subject 5 year bar?

Satisfy 5 year bar?

Lawfully present?

Gary HC.gov

Nadia Medicaid

Example 423

Tomas and Ana, and their five year old daughter Sofia, survived an earthquake and are here under Temporary Protected Status. They have no income.

Immigration Status AnalysisCoverag

eOption

Qualified?

Subject 5 year bar?

Satisfy 5 year bar?

Lawfully present?

Tomas HC.gov

Ana HC.gov

Sofia Medicaid

Emergency Medical Assistance

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EMA

Emergency Medical Assistance no immigration status required must be otherwise eligible (meet category & income

req.) limited to time period of the emergency condition

Definition: An emergency medical condition is a medical

condition with acute symptoms of such severity including severe pain, that without immediate attention, the result may be: The patient’s health is in serious jeopardy. Serious impairment to bodily functions. Serious dysfunction of any body organ or part. (see

MAEH 322)

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EMA

Emergency Medical Assistance Covers labor & delivery Covers prenatal care only if high-risk pregnancy Can go backwards to cover ER visit/procedure

Requires specific start and end dates In general, shorter periods more likely to be approved

Emergency medical condition Application should be processed within 5 days See MAEH 303.13

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HELPING IMMIGRANTS APPLY FOR MEDICAID

Tips28

Verification

Medicaid and CHIP use “SAVE” system through Department of Homeland Security to verify immigration status Only used to verify status for benefits eligibility Not always verified in real time

DHS may still request documentation of status Type of document will depends on immigration status Caseworkers may need to be educated, if no SSN

See MAEH 322, Appendixes A and B

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Mixed Households

Individuals can be listed as a non-applicant

SSN and information on immigration status not required for non-applicants Especially important for ineligible parents applying

for their eligible children Required to include non-eligible household members

on the application (& relevant info: income, tax filing status, etc)

SSN generally required for applicants Unless immigration status does not make eligible for

SSN Or applying for EMA only

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Mixed Households31

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How to Apply for Medicaid

Online: COMPASSHealthCare.gov (likely slower)

By phone: 866-550-4355

By mail: paper applicationIn person:@ County Assistance Office

When: anytime

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Resources

Medical Assistance Eligibility Handbook Chapter 322 – Citizen/Noncitizen http://

services.dpw.state.pa.us/oimpolicymanuals/manuals/bop/ma/index.htm

HealthCare.gov https://www.healthcare.gov/immigrants/immigration-status/

Center on Budget and Policy Priorities – ‘Beyond the Basics’ http://www.healthreformbeyondthebasics.org/

National Immigration Law Center http://nilc.org/immigrantshcr.html

PHLP manual – Health Care for Immigrants http://

www.phlp.org/wp-content/uploads/2015/01/Immigrant-Health-Care-Manual-For-Advocates-2015.pdf

PHLP Helpline: 1-800-274-3258 Kfisher@phlp.org

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