Two Important Goals Ensure that we are Ensure that we are - PDF document

New York State Immigrant Eligibility for Medicaid This has been compiled from the following sources: New York State published policies and procedures, Research Foundation of SUNY/BSC/CDHS, CAI 1 Objectives • Interpret immigrant eligibility guidelines for government funded health insurance programs • Identify the different immigration statuses • Recognize immigrants’ concerns • Review acceptable forms of documentation • Understand WMS coding for each immigration category 2 Two Important Goals Ensure that we are Ensure that we are providing the type of claiming Federal Medicaid coverage that Financial Participation the applicant/recipient when we can is eligible for 3 Rev. 3.28.16 1

Do they have all of the documentation that we need? Is it a Are they a Pregnant Non- Immigrant? Woman? Do they pass the Residency Review test? 4 Federal Immigration Agencies • There are 2 Federal Immigration Agencies under the Department of Homeland Security: – USCIS: United States Citizenship and Immigration Services – ICE : Immigration and Customs Enforcement • Within the Department of Justice there is: – EOIR: Executive Office of Immigration Review 5 Who is Eligible? • To be eligible for MA an individual must be a U.S. Citizen, U.S. National, Native American, an immigrant in “satisfactory immigration status ” or a temporary non - immigrant who is lawfully present and a NYS Resident 6 Rev. 3.28.16 2

Immigrants • All immigrants in a satisfactory immigration status or temporary non-immigrants who are lawfully present and NYS Residents may be eligible for Medicaid as long as the applicant meets the other eligibility requirements of the program 7 What is Satisfactory Immigration Status? • “Satisfactory immigration status” is defined as an immigration status that does not make the individual ineligible for benefits under the applicable program 8 Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) • PRWORA identified certain categories of immigrants who were not eligible for federally funded public programs if they: – Entered the U.S. on or after August, 22 1996 and – Have not resided in the U.S. in a qualified alien status for at least five years • This is known as the “federal five year ban” 9 Rev. 3.28.16 3

PRWORA • Established new immigration categories – Qualified Aliens were eligible for public programs • Established five year ban on application for public programs for some groups – Non-Qualified Aliens were not eligible for public programs • Includes PRUCOL 10 Aliessa v. Novello and Adamolekun v. Novello Court Cases • Restored Medicaid coverage to residents of NYS who were: – Qualified Aliens who entered the U.S. on or after August 22, 1996 who were otherwise subject to the federal five year ban – PRUCOLs regardless of when they entered the U.S. 11 Aliessa v. Novello and Adamolekun v. Novello Court Cases, cont'd. • Since these groups are outside the federal legislation, they do not have federal financial funding for their medical costs under Medicaid while in the five year ban – Medicaid is state funded during the first five years • All NYS immigrants in satisfactory immigration status are eligible for Medicaid, if otherwise eligible 12 Rev. 3.28.16 4

Who has Satisfactory Immigration Status? • Satisfactory immigration status in NYS includes: – Qualified Aliens – PRUCOL 13 14 Documentation Guide • Category 1: U.S. Citizens • Category 2: Qualified Aliens • Category 3: Persons who are Permanently Residing in the U.S. Under Color of Law (PRUCOL) • Category 4: Non-Immigrants • Category 5: Undocumented Aliens 15 Rev. 3.28.16 5

Citizens (Category 1) • U.S. Citizens include: – Individuals born in the United States – Naturalized U.S. citizens – U.S. Nationals 16 Citizens (Category 1), cont’d. • U.S. Citizens also include: – Native Americans (Category 2 on Documentation Guide) • Includes Native Americans born in Canada or belonging to a federally recognized tribal group – For a list of federally recognized tribal groups go to: http://www.bia.gov/cs/groups/public/documents /text/idc1-029079.pdf 17 Identifying Immigrant Categories 18 Rev. 3.28.16 6

Qualified Aliens Category 2 19 Qualified Aliens • Qualified aliens are persons who usually live and work here with the permission of the federal immigration agency • No five year waiting period for health benefits • Some immigrants are not eligible for Medicaid benefits with Federal Financial Participation 20 Qualified Aliens – Not Subject to the Federal Five Year Ban - FFP • Refugees • Asylees • Persons granted withholding of deportation or removal • Cuban/Haitian Entrants • Amerasians • Victims of a Severe Form of Human Trafficking • Veterans or active U.S. Armed Forces and their immediate family members 21 Rev. 3.28.16 7

Qualified Aliens – Subject to Federal Five Year Ban - FNP • Lawful Permanent Residents (“Green Card” holders/LPR’s ) • Parolees admitted into the U.S. for at least one year • Victims of Battery/Abuse and their dependents 22 Refugee Medical Assistance (RMA) • Refugee Medical Assistance is a Federal program available to certain refugees: – Must be ineligible for “regular” Medicaid – Primarily limited to single individuals or childless couples • Eligible for ADC-R budgeting under this program • Allowed to spend down for RMA – Not full time students – Limited time period (8 months) 23 RMA , cont’d. • The term “refugee” includes the following groups: – Refugees – Asylees – Cuban and Haitian entrants – Amerasians – Federally certified victims of a severe form of human trafficking – Certain family members of certified trafficking victims – Special Immigrant Visa – May include other groups – see 10 OHIP/INF 02 24 Rev. 3.28.16 8

Eligibility and Funding • If eligible for “regular” Medicaid – Costs shared between state, local and federal governments – Authorize Medicaid coverage for 12 months without regard to RMA • If eligible only through RMA – 100% federally reimbursable – Authorize up to 8 months of coverage – State/Federal Charge Code 30 or 31 required 25 Redetermination After RMA Coverage • Using standard Medicaid rules, redetermine refugee’s eligibility – Single refugees who are not parent/caretaker relatives no longer have access to ADC budgeting methodology • If eligible for Medicaid, remove the S/F Charge code of “30” and enter correct code if applicable 26 Case Examples 27 Rev. 3.28.16 9

PRUCOL Category 3 28 PRUCOL P= Permanently ► Residing in the U.S. with the intent to remain ► Living in New York State R= Residing (resident) U= Under C= Color ► Some legal basis for O= of L= Law being in the country 29 PRUCOL, cont'd. • People who are living in the United States with the federal immigration agencies’ knowledge and permission or acquiescence • The federal immigration agencies are not taking steps to deport or remove the immigrant, at least for the time being 30 Rev. 3.28.16 10

PRUCOL, cont'd. Two groups: • “knowledge and permission” • “knowledge and acquiescence” – Acquiescence is to agree by default or inaction 31 PRUCOL Aliens • PRUCOL Aliens are not eligible for federal funding – Except pregnant women and children under 21 in certain immigrant categories • This is true regardless of the amount of time they have lived in the U.S. 32 PRUCOL Aliens, cont’d. • Persons paroled into the U.S. for less than a year • Persons under an Order of Supervision • Persons granted an indefinite stay of deportation • Persons granted an indefinite voluntary departure • Persons “by the petition” of an immediate relative 33 Rev. 3.28.16 11

PRUCOL Aliens, cont'd. • Persons who have applied for an adjustment of status to lawful permanent resident under section 245 • Persons granted stays of deportation • Persons granted voluntary departure status under Section 242(b) • Persons granted deferred action status • Persons who entered and continuously resided in U.S. before 1/1/72 34 PRUCOL Aliens, cont'd. • Persons granted suspension of deportation pursuant to Section 244 of INA; USCIS does not contemplate departure • Others living in U.S. with knowledge and permission or knowledge and acquiescence of USCIS and whose departure the USCIS does not contemplate enforcing • Deferred Action for Childhood Arrivals (DACA) • Special Immigrant Juveniles (SIJ) 35 Others Living in the U.S. with Knowledge and Permission or Acquiescence of USCIS • This category includes any non-citizen who can document/verify that the USCIS knows that the immigrant is residing in the U.S., and • Can document/verify that the USCIS has either granted them permission to remain in the U.S. or has knowledge of their presence (acquiescence) 36 Rev. 3.28.16 12