1 El Eligi gibility f ty for H Hea ealth th I Insurance For or Immi Immigrants a s and T The heir F Families November 17, 2016 Angel Padilla, National Immigration Law Center Ben D’Avanzo, Asian & Pacific Islander American Health Forum Sonya Schwartz, Georgetown University, Center for Children and Families Presentation adapted from an earlier version developed in partnership with the Center on Budget and Policy Priorities
2 Roadmap 1. Immigrant Eligibility for Medicaid, CHIP and the Health Insurance Marketplace 2. Common Immigration Documents 3. Challenges for Families That Include Immigrants and Tips 4. Rights and Tools for Limited English Proficient Individuals
3 Part I: IMMIGRANT ELIGIBILITY FOR MEDICAID, CHIP AND THE HEALTH INSURANCE MARKETPLACE
MEDICAID, CHIP AND MARKETPLACE Many of these eligibility slides were made in ELIGIBILITY FOR partnership with the National Immigration Law IMMIGRANTS Center and The Center on Budget and Policy Priorities “Qualified” Immigrants for Medicaid and CHIP • “Lawfully Present” immigrants for the Marketplace, • APTC, CSR “Lawfully Residing” = Lawfully Present + Residency • Health Coverage for All •
5 General Immigrant Eligibility Rules for Medicaid and CHIP Under the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996, the following groups may be eligible for Medicaid and CHIP: “Qualified" immigrants who "Qualified" immigrants who "Qualified" immigrants entered the U.S. before entered on or after 8/22/96 exempt from the 5-year 8/22/96 who reach the end of a 5- waiting period year waiting period For example: Refugees For example: • Asylees Lawful permanent residents • • Cuban/Haitian entrants (LPRs or “green card” • Trafficking survivors holders) • Veteran families • NOTE: Immigrants who do not meet these immigrant eligibility rules (i.e. “qualified” immigrants in the 5-year bar and “not qualified” immigrants) may be eligible for Medicaid payment of limited emergency services (Emergency Medical Assistance or EMA) if they otherwise meet all Medicaid eligibility standards
6 “ Qualified” Immigrants for Medicaid and CHIP “Qualified” Immigrants Categories defined by statute; many of these, as well as others, are exempt from the 5-year bar—please see next slide • Lawful Permanent Residents (LPRs/green card holders) • Refugees • Asylees • Cuban/Haitian entrants • Persons who were paroled into the U.S. for more than a year • Conditional entrants • Persons granted withholding of deportation/removal • Certain domestic violence and trafficking survivors and their derivatives • Member of a federally-recognized Indian tribe or American Indian Born in Canada
7 Five-Year Waiting Period for Medicaid & CHIP Many “qualified” Some people with a “qualified” immigration status are not immigrants are subject to the five-year bar: subject to a five- year waiting period (also know as “the five-year bar”) The five years • Immigrants who physically entered the U.S. before 8/22/96 and • begin when an remained in the U.S. continuously until obtaining a qualified status immigrant • Refugees, asylees, persons granted withholding of obtains a deportation/removal (even if they later become LPRs) “qualified” • Cuban/Haitian entrants, certain Amerasian immigrants, immigration individuals granted Iraqi or Afghan special immigrant status, status trafficking survivors (even if they later become LPRs) • Qualified immigrants who are U.S. veterans or on active military duty and their spouses or children • Children (at state option) • Pregnant women (at state option)
8 State Flexibility to Vary from the General Eligibility Rules Federal Medicaid/CHIP Options • CHIPRA 2009 gave states the option to cover children and/or pregnant women: Who are lawfully residing (lawfully present + state residency) and otherwise eligible Without a 5-year waiting period Regardless of date of entry into the U.S. • Through CHIP, states can also opt to provide certain medical services to pregnant women (including prenatal care), regardless of immigration status, if they are not otherwise eligible for Medicaid State-Funded Options • States can cover additional immigrants with state -only funds
Medicaid/ CHIP for Lawfully Residing Children Without the 5-Year Wait (CHIPRA § 214) VT WA* ME MT ND NH MN MA* OR NY* WI SD ID MI RI CT WY PA NJ IA NE OH DE IL* IN NV MD UT WV VA CO DC* KS MO KY CA* NC TN SC OK AR NM AZ GA AL MS LA TX AK FL HI 31 states, including the District of Columbia, cover lawfully residing children in the five year waiting period. Note: Florida and Utah passed legislation to take up this option in March 2016. Note: 6 states, including the District of Columbia that provide coverage to all children regardless of immigration status, are indicated with a *. SOURCE: Georgetown Center for Children and Families and Kaiser Family Foundation’s Commission on Medicaid and the Uninsured, “ Medicaid and CHIP Eligibility, Enrollment, Renewal and Cost-Sharing Policies as of January 2016: Findings from a 50-State Survey” (January 2016).
Medicaid/ CHIP for Lawfully Residing Pregnant Women without the 5-Year Wait (CHIPRA § 214) VT WA* ME MT ND NH MN* MA* NY OR* WI* SD ID MI* RI* CT WY PA NJ IA NE* OH DE IL* IN NV MD CO UT WV VA DC KS MO KY CA* NC TN* SC OK* AZ AR* NM GA AL MS LA* TX* AK FL HI 23 states, including the District of Columbia, cover lawfully residing pregnant women. Note: 15 states that provide coverage through CHIP “unborn child” option are indicated with an * SOURCE: Georgetown Center for Children and Families and Kaiser Family Foundation’s Commission on Medicaid and the Uninsured, “ Medicaid and CHIP Eligibility, Enrollment, Renewal and Cost-Sharing Policies as of January 2016: Findings from a 50-State Survey” (January 2016).
11 Immigration Categories Eligible for Marketplace Coverage “Qualified” Immigrants: Other “Lawfully Present” Immigrants: Lawful Permanent Resident (LPR/green card holder) Granted relief under the Convention Against Torture • • (CAT) Refugee • Temporary Protected Status (TPS) Asylee • • Deferred Enforced Departure (DED) Cuban/Haitian Entrant • • Deferred Action (except DACA)* Paroled into the U.S. for at least one year • • Paroled into the US for less than one year Conditional Entrant • • Certain individuals with Nonimmigrant Status Granted Withholding of Deportation or Withholding • • (includes worker visas; student visas; U visas; citizens of Removal of Micronesia, the Marshall Islands, and Palau; and Battered Spouse, Child and Parent • many others) Trafficking Survivor and his/her Spouse, Child, Sibling • Administrative order staying removal issued by the • or Parent Department of Homeland Security Others: Lawful Temporary Resident • Member of a federally-recognized Indian tribe or • Family Unity • American Indian Born in Canada *EXCEPTION: Individuals granted deferred action under the 2012 Deferred Action for Childhood Arrivals (DACA) program are not eligible to enroll in coverage in the Marketplace. See National Immigration Law Center, “Lawfully present” individuals under the Affordable Care Act, https://www.nilc.org/issues/health-care/lawfullypresent/
12 Immigration Categories Eligible for Marketplace Coverage APPLICANT for Any of These Statuses: Must Also Have Employment Authorization: Lawful Permanent Resident (with an Applicant for Temporary Protected Status • • approved visa petition) Registry Applicants • Asylum* • Order of Supervision • Special Immigrant Juvenile Status • Applicant for Cancellation of Removal or • Victim of Trafficking Visa Suspension of Deportation • Withholding of deportation or withholding of Applicant for Legalization under IRCA • • removal, under the immigration laws or Applicant for LPR under the LIFE Act • under the Convention Against Torture (CAT)* *Only those who have been granted employment authorization or are under the age of 14 and have had an application pending for at least 180 days are eligible See National Immigration Law Center, “Lawfully present” individuals under the Affordable Care Act,https://www.nilc.org/issues/health-care/lawfullypresent/
13 State Residency In general, for QHP enrollment and • Medicaid/CHIP, residency is the state in which an individual lives and: Intends to reside, including without a • fixed address; or Has entered with a job commitment or is • seeking employment (whether or not currently employed) To verify residency, Marketplaces: • Can accept self-attestation • Can use HHS approved electronic • sources to the extent that they exist Evidence of immigration status can’t be • used
14 Premium Tax Credit Eligibility for Lawfully Present Adults Coverage Landscape for Families that Include Immigrants In States Expanding Medicaid In States Not Expanding Medicaid
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