Health Care for ALL - Mass Legal Services

Report
Health care access for
immigrants
March 6, 2013
Vicky Pulos, MLRI
[email protected]; 617-357-0700 Ext. 318
Comprehensive health benefits

Immigrants must have an eligible immigration
status to receive Any
type of MassHealth except Limited
 Commonwealth
Care
Eligible immigration status
Immigrants must satisfy all the eligibility
rules for MassHealth/Commonwealth
Care that apply to US citizens…
and in addition
 Immigrants must have an eligible
immigration status

Qualified in MassHealth

MassHealth defines “qualified” to mean federally
qualified and currently eligible


MassHealth defines “aliens with special status”
(AWSS) to mean



5-year bar exempt or 5-years met
Federally qualified but 5-year barred
Not federally qualified but permanently residing in US
under color of law (PRUCOL)
2009 federal law change applies new term
“lawfully present” to pregnant women & children
Health exercise # 1

Mrs. Pappas is 66. She has had a green
card for 6 years but is only on
MassHealth Limited and the Health
Safety Net.
What should she be eligible for?
 What steps are needed to correct the
situation?

New green cards –May 2010
Does code show status not subject to 5 yr bar?
Is country Cuba, Haiti, Iraq,
Afghanistan, Vietnam, Canada?
Is date 5 or more years ago?
Eligible children & pregnant women
2009 change in Medicaid law
 All “lawfully present” children & pregnant
women federally eligible

No 5-year bar
 Includes other AWSS


Replaces PRWORA rules with
State residence
 Lawful presence

Regulation-free zone for lawfully
present pregnant women & children
Lawfully present pregnant women &
children eligible since 2009
 August 2009 Eligibility Ops memo 09-11
eliminated 5-year bar
 Member booklet recognizes AWSS
children & pregnant women can get MH
Standard (in your materials)
 MassHealth regulations have not yet
been amended

“Lawful presence” –federal definition
Proposed federal Medicaid regulation
defining lawful presence (in your
materials)
 Same definition will be used for new
types of subsidized insurance available
in 2014

Exercise # 2
Mrs. Smyth and her 7 year old child
have been in the U.S. with green cards
for 2 years.
 Does either one have a qualified eligible
status for MassHealth benefits?
 What if Mrs. S tells you she is pregnant?

Eligibility checklist for green card
holders






Child (under 19) or pregnant woman,
Status since date 5+ years ago,
U.S. entry date prior to 8/22/96,
Battered immigrant, trafficking victim, veteran,
Prior status was refugee, asylee, deportation
withheld
Cuban-Haitian Entrant; Iraqi/Afghani Special
Immigrant; Vietnamese Amerasian; American
Indian (born in Canada or Mexico)
Identifying codes

Keys to codes on specified documents





Green cards
Employment authorization cards
I-94 arrival/departure cards
Visas in foreign passports
Resources

masslegalservices.org





MassHealth Advocacy Guide (MLRI)
MassHealth Immigration Advocacy Desk Guide (MLRI)
Office of Medicaid Memos
NILC Tables (in materials)
USCIS website
Tips for helping immigrants get the
best coverage they can






Send in proof of current status AND any prior
qualified status
List U.S. entry date on app. if prior to 8/22/96
Check if domestic violence & veteran
protections apply on application form
Include proof for each family member
Add name, DOB, SSN (if avail) on everything
you send in
Make sure codes & dates on cards and
other immigration papers are legible

Circle & write code/date in margin
New green cards –May 2010
Does code show status not subject to 5 yr bar?
Is country Cuba, Haiti, Iraq,
Afghanistan, Vietnam, Canada?
Is date 5 or more years ago?
“Special status”legal immigrants

“Special status” or “AWSS” are
MassHealth terms forLegal permanent residents & parollees
during 5-year wait
 Persons residing in US under color of law
(PRUCOL) but not “qualified”



Known by Dept. of Homeland Sec. to be living in
U.S. & DHS is not contemplating removal
No federal matching funds (except for
pregnant women & children)
Elderly & disabled AWSS

For elderly & disabled AWSS adults
under 100% fpl

MH Essential plus Limited

No home health or nursing home care
For seniors, assets under $2000/$3000
 Younger disabled must also have been
unemployed for past 12 mos. (or EAEDC
recipients)
 Will change in 2014

Commonwealth Care
Subsidized insurance for adults through
Connector
 Covers all otherwise eligible AWSS who
are not eligible for MassHealth
 Will be replaced by new forms of
coverage in 2014

PRUCOL

Examples 






Temporary Protected Status (TPS)
Applicants for asylum
Applicants for adjustment of status
Living under orders of supervision
Living in U.S. since Jan. 1, 1972 (Registry)
Certain non-immigrants –K, S, U, V, R, & NEW H1B & H-4
Proof will sometimes be code on Employment
Authorization card or I-94
Employment authorization card
Exercise # 3
Mr. Baptiste is 38 and from Haiti. She is
diabetic & has some health problems.
She shows you her work permit. Under
the word “category” on her card it says
“A-12.”
 Is she qualified? If not, is she eligible for
any health benefits?
 What else do you need to know?

What about federal health reform?
No change in Medicaid eligibility rules
 Starting in 2014 “lawfully present”
immigrants with income under 400% of
poverty will be able to purchase
affordable insurance from Connector
 Undocumented cannot purchase through
Connector or get tax credit

In 2014
Commonwealth Care will end
 “Lawfully present” will be able to

Purchase insurance through the Connector
 Get refundable tax credits to lower premium
costs
 Get cost-sharing subsidies to lower
deductibles, and copays

Legislation in 2013
Expecting a bill to implement federal
health reform
 Administration is proposing additional
state subsidies to make new coverage
as affordable as Commonwealth Care
 Unclear if elderly & disabled AWSS will
remain in MassHealth or move to
Connector

Lawful presence vs. PRUCOL in
2014

Most non-immigrants & most people with work
permits will be considered lawfully present,
includes students & others not now considered
PRUCOL/AWSS
 Some now considered PRUCOL/AWSS will
not be considered “lawfully present” e.g.
applicants who don’t yet have work permits &
DACA

Proposal to retain state-funded coverage for
PRUCOL who can’t use Connector
Safety net programs
Health Safety Net: Acute hospital & CHC
bills
 MassHealth Limited: Emergency care
only
 Healthy Start: Prenatal care only
 CMSP: Primary care for children

Tips for completing application
Never submit a false SSN
 If no pay stubs available to prove income

Can submit letter from employer with wage
& hour info.
 Can submit sworn statement with wage &
hour info & explain no other form of proof is
available
 Can submit tax return filed with ITN number

Info in materials on safety net
programs

“Health benefits available to ALL” –in
English & Spanish
If an immigrant with papers is
denied all but Health Safety Net…
Get help from an experienced advocate
to see if the denial of other benefits was
correct
 Incorrect decisions can be appealed
 Health Care for All Help Line:
800-272-4232
 Legal Aid Referral Line: 800-342-5297
 MIRA Coalition: 617-350-5480

Info in your materials





NILC Guide section on immigration documents
& codes
Immigration section of MassHealth Member
booklet
MassHealth memos on identifying PRUCOL &
Cuban-Haitian entrants & H1B & H4 update
Proposed federal definition of “lawfully
present”
USCIS “fact sheet” on public charge-Mass. ed.
MassHealth Regulations

Immigrant eligibility regulations
 130 CMR § 504.002(B)-(D); § 505.008 (for
under age 65)
 130 CMR § 518.002(B)-(D); § 519.009 (for age
65+)
 Online at www.mass.gov/masshealth

Under “MassHealth regulations and other
publications”

Under “MassHealth regulations”

Under “Eligibility regulations”
Other sources of information
Massachusetts Immigrants & Refugees
Advocacy (MIRA) Coalition:
www.miracoalition.org
 National Immigration Law Center,
www.nilc.org
 Massachusetts Legal Services programs
www.masslegalservices.org

State agencies


Office of Medicaid www.mass.gov/masshealth
Health Insurance Connector
www.mahealthconnector.org
 Division of Health Care Finance & Policy (info
on Health Safety Net)
www.mass.gov/dhcfp
 Dept. of Public Health
www.mass.gov/dph
 Dept. of Elder Affairs
www.mass.gov/elders

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