HMPRG ’ s Chicago Forum for Justice in Health Policy: Ensuring the Health of Non-Citizens Andrea Kovach, Attorney, Sargent Shriver National Center on Poverty Law
The Shriver Center The Sargent Shriver National Center on Poverty Law provides national leadership in advancing laws and policies that secure justice to improve the lives and opportunities of people living in poverty. We specialize in practical solutions. Through our advocacy, communication, and training programs, we advocate for and serve clients directly, while also building the capacity of the nation ’ s legal aid providers to advance justice and opportunity for their clients Like us on Facebook: www.facebook.com/shrivercenter Follow us on Twitter: @shrivercenter www.povertylaw.org
Agenda • Health Coverage in Illinois – Demographics of Illinois uninsured – Eligible but unenrolled vs. ineligible? (focus on immigrants) • New pathway to health coverage benefits immigrant families and Illinois overall – Other states’ initiatives – The Healthy Illinois Campaign
Source: WhiteHouse.gov, March 2016
Number of Uninsured Has Dropped For 3 Reasons 2015 uninsured rate for Illinois adults is10.6%. 1. ACA Medicaid Expansion: 626,248 enrolled in Illinois as of Nov. 2015 (Source: Illinois HFS) 2. Availability of Affordable Insurance in New Marketplaces: 388,179 Illinoisans enrolled in and paid for a Marketplace plan in 2016 • 75% receive financial help through premium tax credits in 2016 (Source: CMS) 3. Young Adults Up to Age 26 Staying on Parents ’ Plan
1,122,000 uninsured nonelderly adults in Illinois Source: http://files.kff.org/attachment/issue-brief-new-estimates-of-eligibility-for-aca-coverage-among-the-uninsured
2015 Uninsured Rate in Most Populous Counties in Illinois Source: Enroll America, October 2015
Illinois Uninsured Rates for 2013 and 2015 African American men ages 18 to 34 (18%) have the highest 2015 uninsured rates, followed by Hispanic men ages 18 to 34 (18%) and Hispanic women ages 18 to 34 (15%). Source: Enroll America, October 2015
Uninsured Illinois Residents: 1,122,000 Data published October 2015 559,000 563,000 have a pathway to health insurance coverage (50%) fall into one of 3 categories 397,000 (35%) are Medicaid eligible 166,000 (15%) are Marketplace eligible including the ACA tax credits 1) 173,000 (15%): Eligible for ACA marketplace coverage but are ineligible for ACA marketplace financial assistance due to being over income 2) 151,000 (13%): They have an offer of employer sponsored coverage that the ACA deems is affordable 3) 235,000 (21%): They are ineligible for the marketplace or for Medicaid due to their immigration status Source: Kaiser, October 2015
Uninsured Illinois Residents: 1,122,000 Data published October 2015 559,000 563,000 have a pathway to health insurance coverage (50%) fall into one of 3 categories 397,000 (35%) are Medicaid eligible 166,000 (15%) are Marketplace eligible including the ACA tax credits 1) 173,000 (15%): Eligible for ACA marketplace coverage but are ineligible for ACA marketplace financial assistance due to being over income 2) 151,000 (13%): They have an offer of employer sponsored coverage that the ACA deems is affordable 3) 235,000 (21%): They are ineligible for the marketplace or for Medicaid due to their immigration status
Reminder: Who Can Enroll in Medicaid? • A U.S. citizen or non-citizen whose status meets Medicaid qualifiers An adult (age 19-64) • Illinois resident can enroll if… • Income below $1,354 [FPL 2015] for one person • A U.S. citizen or non-citizen whose status meets Medicaid qualifiers A person who is • Illinois resident 65+(aged), blind or • Income below $981 (one person) (if over $981 [FPL 2015] then disabled and is covered enrolled in Spend down) by Medicare can enroll • Resources limited to $2,000 (one person) or $3,000 for two people); if… if over enrolled in Spenddown • Illinois resident A pregnant woman or child under one can • Income below $2,828 [FPL 2015] (this is for a household of two and enroll if… includes the unborn child) • Illinois resident A child (age birth- • Income at or below $6,426 [FPL 2015] for a family of four through 18) can enroll • When income is $4,224 [FPL 2015] or more (family of four) the if… child(ren) has to be uninsured for 12 or more months. This is the income level for All Kids Level 2 coverage. 11
Reminder: General Adult Immigrant Eligibility Rules for Medicaid Under the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996, the following groups may be eligible for Medicaid and CHIP: “ Qualified" immigrants "Qualified" immigrants "Qualified" immigrants who entered the U.S. who entered on or after exempt from the 5-year before 8/22/96 8/22/96 who reach the end waiting period of a 5-year waiting period For example: • refugees For example: • asylees • lawful permanent residents • Cuban/Haitian entrants (LPRs or “ green card ” holders) • trafficking survivors • 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 12 Source: Georgetown CCF
Uninsured Illinois Residents: 1,122,000 Data published October 2015 559,000 563,000 have a pathway to health insurance coverage (50%) fall into one of 3 categories 397,000 (35%) are Medicaid eligible 166,000 (15%) are Marketplace eligible including the ACA tax credits 1) 173,000 (15%): Eligible for ACA marketplace coverage but are ineligible for ACA marketplace financial assistance due to being over income 2) 151,000 (13%): They have an offer of employer sponsored coverage that the ACA deems is affordable 3) 235,000 (21%): They are ineligible for the marketplace or for Medicaid due to their immigration status
Reminder: Who is eligible for the Marketplace? Anyone who: • Is a citizen, or non-citizen who is “lawfully present” in the United States • Meets Illinois state residency standards • Can not be currently incarcerated 14
Immigration Categories Eligible for Marketplace Coverage “ Qualified ” Immigrants: Other “ Lawfully Present ” Immigrants: • • Lawful Permanent Resident (LPR/green card Granted relief under the Convention Against holder) 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 Individual with Nonimmigrant Status (includes worker visas; student visas; U • Granted Withholding of Deportation or visas; citizens of Micronesia, the Marshall Withholding of Removal Islands, and Palau; and many others) • Battered Spouse, Child and Parent • Administrative order staying removal issued • Trafficking Survivor and his/her Spouse, by the Department of Homeland Security Child, Sibling or Parent • Lawful Temporary Resident Others: • Family Unity • Member of a federally-recognized Indian tribe or 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. 15
Reminder: Who is eligible for premium tax credits? Ineligible for government Not offered affordable or insurance (eg: Medicaid, minimum value employer- sponsored coverage Medicare, CHIP) Get coverage through Household income Marketplace between 100% - 400% FPL, with exceptions Lawfully residing immigrants Agree to file taxes and with income under 100% FPL have an eligible tax filing & ineligible for Medicaid status 16
Uninsured Are Unaware of Tax Credits Source: Understanding the Uninsured Now, June 2015. Robert Wood Johnson Foundation & PerryUndem Research/Communication
Steps Needed to Cover Eligible But Unenrolled Immigrants • Provide more language enrollment assistance resources • Smooth out system glitches that make enrolling much harder for naturalized citizens and lawful residents • Provide high quality language translations of all important documents • Have Outreach and Enrollment where people are, especially community based orgs, schools, clinics, and faith based institutions
Uninsured Illinois Residents: 1,122,000 Data published October 2015 559,000 563,000 have a pathway to health insurance coverage (50%) fall into one of 3 categories 397,000 (35%) are Medicaid eligible 166,000 (15%) are Marketplace eligible including the ACA tax credits 1) 173,000 (15%): Eligible for ACA marketplace coverage but are ineligible for ACA marketplace financial assistance due to being over income 2) 151,000 (13%): They have an offer of employer sponsored coverage that the ACA deems is affordable 3) 235,000 (21%): They are ineligible for the marketplace or for Medicaid due to their immigration status
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