WORKING WITH IMMIGRANT PATIENTS: healthcare or insurance hurt me A - PDF document

2/19/2020 Will getting WORKING WITH IMMIGRANT PATIENTS: healthcare or insurance hurt me A POVERTY LAWYER’S PROSPECTIVE when I apply for citizenship? How does the current climate impact Lisa M. Newstrom immigrants’ access to care? Feb. 18, 2020 Managing Attorney Will getting help public programs hurt my immigration case? Public Charge The idea that some immigrants’ • Fact: Doesn’t apply to all immigrants. immigration status can be • Fact: Doesn’t apply to all government programs. negatively affected by getting • FACT: Most immigrants subject to the public charge government benefits or services. rule aren’t eligible for those programs/benefits that count for the public charge test. 1

2/19/2020 Which Immigrants Are NOT Subject to What “Public Charge” Really Is Public Charge? Does not apply to most “humanitarian” categories of immigrants:  A test applied to some immigrants applying to enter  **Refugees or asylees the U.S. or applying for green cards (LPR status)  **Battered spouses/children self-petitioning or removing conditions on residency under VAWA  There is no public charge test at naturalization  **U visa applicants/holders  **Survivors of human trafficking (T visa)  **Special immigrant juveniles (SIJS)  Certain other immigrants paroled into the US (ex. NACARA, HRIFA, Lautenberg)  What’s the test?: Whether the immigrant is likely to  People applying for/renewing TPS**, DACA, and Cuban/Haitian Entrants receive certain public benefits over a certain **These categories are exempt when getting initial status or at application for LPR/green card amount in a 36 month period Also does NOT apply to any LPRs seeking citizenship  BUT…not all benefits count  LPRs unaffected unless they leave U.S, for 6+ months and need to be readmitted For immigrants subject to public charge, Which Programs Are “Safe”? what programs count against them? • Medi ‐ Cal for children up to 21 State ‐ funded CalFresh (CFAP) • • Cash Support for Income PLUS***: Women Infants and Children (WIC) • Pregnancy Medi ‐ Cal (up to 60 days Maintenance* • Non ‐ Emergency Medicaid • post ‐ natal) • Long Term Institutional Care (Federal Medi ‐ Cal) for Non ‐ School Breakfast and Lunch • at Government Expense* Pregnant Adults 21 and over • State ‐ funded Medi ‐ Cal Energy Assistance (LIHEAP) • • Supplemental Nutrition • Ex: immigrant youth 21 ‐ 26, Transportation vouchers or services • Assistance Program (Federal breast & cervical cancer, etc Non ‐ cash CalWORKs benefits like • * Included under pre ‐ 2/24/20 rule CalFresh) • Emergency medical assistance childcare • Public Housing Federal Earned Income Tax Credit • Entirely state, local or tribal • • Section 8 Housing Vouchers and and Child Tax Credit programs (other than cash Project ‐ Based Section 8 assistance) Disaster relief • ***These only count if the immigrant • Ex: Healthy SF Student Loans • received them after 2/24/2020 • S ‐ CHIP BUT, nearly all immigrants subject to the public charge And everything else not explicitly included! rule are ineligible for these programs anyway! Benefits received by family members don’t hurt the immigrant 2

2/19/2020 10 Privacy Fears? Key Issues for Mixed-Status Families  What about putting my personal information “in the  Benefits received by family members (like USC children) do not count system”? against an immigrant who is subject to public charge  ACA: information gathered for administration of federally funded or subsidized healthcare (Medi-Cal, Medicare, Covered California subsidies) can only be used for program  Ineligible individuals may apply for benefits on behalf of family administration members  HIPAA/CMIA  Applications should distinguish between applicants & non-applicants  Welf. And Inst. Code 10850 (all CA benefit programs)  Non-applicants are not required to provide their immigration status  SB 54: limits data disclosure to immigration officials in  Non-applicants without SSN cannot be required to provide one certain sensitive sectors (incl. healthcare)  Immigrants should only provide an SSN if officially issued by Social  Example of this fear: Census question re: citizenship Security  Privacy laws apply. Information provided on an application may be used ONLY to determine eligibility for benefits. CA Programs Available Regardless of Status  Emergency Medi-Cal  Programs in some counties (ex:  Medi-Cal for Children Healthy SF, Alameda HealthPAC)  Prenatal care (Medi-Cal)  Community clinics  Medi-Cal Access Program (MCAP ,  Family PACT formerly AIM)  Long-term care  Minor consent services  Early Breast Cancer Detection &  Mental health services Breast & Cervical Cancer  Regional Center Services Treatment  Women Infants and Children (WIC)  California Children’s Services (CCS)  School lunch and breakfast  Healthy kids programs in some counties Other Barriers to Getting Benefits 3

2/19/2020 13 14 Incorrect Denials of Benefits How About That Paperwork?  Programs make mistakes.  Literacy barriers. (SAWS 2 reading level vs average reading skill)  Noncitizen eligibility is complicated! Especially for non- LPR immigrants.  Language barriers.  NILC  Lingo  Getting verifications can be hard  Poverty doesn’t always come with paperwork, but government  All. Those. Rules. benefits do!  Informal living arrangements, jobs, etc. 15 Overpayments and Fraud  Too much money? Maybe, maybe not.  Most are caused by miscommunication, administrative errors, or household mistakes  Fraud allegations  Super scary, but doesn’t mean you did anything wrong  Refer to legal help  Civil (legal aid) or Criminal (public defender) What Role Can Lawyers Play? 4

2/19/2020 17 18 Know Your Practitioners What Do Benefits Attorneys Do?  Advice on affirmative questions  Public charge, reporting obligations, etc.  Legal Aid? Private Attorney? Public Defender?  Eligibility questions (programs or program services), but typically don’t file applications  Appeals  Immigration attorney vs. public benefits attorney  Application denied  Noncitizen eligibility or other reasons  Benefits reduced/cut off  Services denied  Overpayments/fraud allegations  Fight barriers  Civil rights issues: discrimination, language access  Disability access: Reasonable accommodations  Protections for domestic violence survivors and other crime victims  Policy advocacy and impact litigation 19 20 What Do Immigration Attorneys Do? What Don’t Attorneys Do?  Advice on affirmative or defensive immigration options  Affirmative = ex: applying for family-based status  Defensive = ex: relief from deportation  Process or approve applications  File applications  Advise on how to fill out application, which type of relief is best  Provide aid directly  “Lucky” and “unlucky” types of immigrants  Appeals  Write the rules   Fight removal/deportation  Policy advocacy and impact litigation 5

2/19/2020 Public Charge: Responding to FAQ I was just granted asylum The public charge test does not apply to status a few months ago, asylees. Asylees can get Medi ‐ Cal and other now I’m worried that using benefits without fear ‐ it will not impact an Medi ‐ Cal is going to stop asylee’s green card application. me from getting my green card. The public charge test will not consider I’m pregnant and need non ‐ emergency Medi ‐ Cal used by pregnant help. I’m currently enrolled women up until 60 days after they give in Medi ‐ Cal but I’m afraid birth. It is important to get the health care it will be used against me. that you and your baby need. Everyone’s situation is different. What may My friend says public be good advice for one person could be bad charge will apply to her advice for another. We encourage you to and so she disenrolled learn more about your situation and speak Answering Questions and Connecting from SSI. She said I should to an attorney who knows about too. immigration and public benefits. Patients to Help Public Charge: The Big Message How can I help my patients find help?  The public charge test does NOT apply to all immigrants.  Bay Area Legal Aid  In reality, VERY FEW immigrants who can get public benefits are  Legal Advice Line: 1-800-551-5554, M-Th, 9:30am- affected by public charge  The public charge test does NOT apply to many public benefits. 12:30pm  The public charge test only looks at benefits you get for yourself.  For concerns about getting cash, food, or housing benefits  It does not look at the public benefits other family members get.  Health Consumer Center: 1-855-693-7285, M-F, 9-5 The new public charge test only applies to immigration   For concerns about getting Medi-Cal, IHSS, other health programs applications filed on or after February 24, 2020.  Immigrants who applied before that date will be considered under the  Other Legal Aid Resources: old rules. LawHelpCA.org  Speak to an attorney before cancelling benefits you or your children need to stay healthy.  Other Immigration Resources:  For best advice, talk with an attorney familiar with BOTH immigration and public benefits law. ImmigrationLawHelp.org 6

2/19/2020 Other Resources  Promoting Safe and Secure Healthcare Access for All , CA Office of Attorney General (Privacy guidance and model policies re immigration)  Major Benefits Programs Available to Immigrants in California, National Immigration Law Center  Keepyourbenefitsca.org 7