[Business Communication]

Report
Barriers to Immigrants’ Access to Health
Insurance and Health Care
– Legal barriers - http://nilc.org/access-to-bens.html
– Confusion around eligibility rules -http://nilc.org/immigrantshcr.html;
http://nilc.org/immigrantshcrsp.html; https://www.healthcare.gov/what-do-immigrantfamilies-need-to-know/
Public charge - http://nilc.org/pubcharge.html
–
– Sponsor deeming and liability - http://nilc.org/affidavits.html
– Verification & documentation - http://nilc.org/document.html?id=35;
–
–
–
https://www.healthcare.gov/help/immigration-document-types/;
https://www.healthcare.gov/help/citizenship-and-immigration-status-questions/
Confidentiality and reporting fears - http://www.ice.gov/doclib/erooutreach/pdf/ice-aca-memo.pdf
Linguistic and cultural barriers - https://www.cuidadodesalud.gov/es/;
http://marketplace.cms.gov/getofficialresources/other-languages/other-languagesmaterials.html; http://www.hhs.gov/open/execorders/13166/index.html
Fear of immigration enforcement - http://www.ice.gov/doclib/erooutreach/pdf/ice-aca-memo.pdf
– Residency and other program requirements
Who’s Eligible for Federal Non-emergency
Medicaid and CHIP?
Two categories of immigrants for federal benefits eligibility purposes
under “welfare reform” (PRWORA of 1996):
• ELIGIBLE = “Qualified”: Categories defined by statute –
– LPRs, refugees, asylees, parolees, Cuban/Haitian entrants, certain DV and
trafficking survivors and their derivatives, certain conditional entrants
– Qualified immigrants who entered the U.S. on or after August 22, 1996
must wait at least five years in qualified status (also known as the “fiveyear bar”)
– Some exemptions
• NOT ELIGIBLE = “Not qualified”: Anyone who is not a citizen or
“qualified” immigrant, such as—
– Undocumented immigrants
– PRUCOLs (other lawfully present individuals)
– Temporary visa holders
2
Exceptions in Medicaid and CHIP
• In 2002 HHS granted states the option to provide prenatal services
to pregnant women under the “unborn child” option in CHIP.
– See NILC coverage maps at http://www.nilc.org/healthcoveragemaps.html
• CHIPRA of 2009 granted states the option to provide Medicaid/CHIP
to “lawfully present” children and pregnant women and waive the
5-yr bar - http://nilc.org/facts-chipra.html
• State variation - http://www.nilc.org/document.html?id=159
• Medicaid for treatment of emergencies available if not eligible for
Medicaid based on immigration status
– Emergency Medicaid expands as Medicaid expands, with full FMAP http://www.medicaid.gov/Federal-Policy-Guidance/downloads/FAQ-1227-13-FMAP-Foster-Care-CHIP.pdf (Q #5)
3
Health Coverage for Pregnant Women | January 2014
ME
Alaska
WA
VT
OR
WI
SD
IA
IL
NV
UT
CO
KS
IN
WV
VA
KY
MO
NC
TN
OK
AZ
SC
AR
NM
MS
TX
AL
GA
LA
FL
Hawaii
KEY
Medicaid for lawfully residing pregnant women, regardless of date of entry
CHIP or other medical coverage for pregnant women, regardless of immigration status
RI
CT
NJ
DE
MD DC
OH
NE
CA
MI
PA
WY
MA
NY
MN
ID
CA
NH
MI
ND
MT
Health Coverage for Immigrant Children | January 2014
ME
Alaska
WA
VT
OR
WI
SD
IA
IL
NV
UT
CO
KS
IN
WV
VA
KY
MO
NC
TN
OK
AZ
SC
AR
NM
MS
TX
AL
GA
LA
FL
Hawaii
KEY
Medicaid/CHIP for lawfully residing children, regardless of date of entry
Medical coverage for children, regardless of immigration status
Medical coverage for lawfully residing children (statewide), and for children regardless
of immigration status in some counties
RI
CT
NJ
DE
MD DC
OH
NE
CA
MI
PA
WY
MA
NY
MN
ID
CA
NH
MI
ND
MT
Immigrants and the ACA
“Lawfully Present” Individuals
• On road to citizenship (e.g., Lawful
Permanent Resident (LPR))
• Permission to stay indefinitely in the
U.S. without pathway to citizenship
(e.g., TPS)
• Permission to stay temporarily (e.g.,
visa holders)
• Exception: DACAmented individuals
http://www.nilc.org/acadacafaq.html
• See
https://www.healthcare.gov/immigratio
n-status-and-the-marketplace/
Undocumented
• Individuals who lost permission to
remain in the U.S., or entered the
U.S. without permission
----------------------------• Emergency Medicaid
• No Marketplace/Exchange access
• No ACA subsidies
• Exempt from individual mandate
• Remain eligible for FQHCs and
other programs available
regardless of status
Immigrant Eligibility for Medicaid/CHIP/ACA
Medicaid
Refugees,
Asylees, &
Other
Humanitarian
Immigrants
Lawful Permanent Residents
(Green Card Holders)
Adults 18 &
over

X
Children
under age 18
Pregnant
women
STATE
OPTION
During
first 5 yrs
STATE
OPTION
During
first 5 yrs
Until after
first 5 years
STATE
OPTION
During first 5
years
STATE
OPTION
During
first 5 yrs









Until after
first 5 years
CHIP
ACA: full
price
ACA:
subsidies
ACA:
mandate




X
Other
Lawfully
Present
Individuals
(except
DACA)
Undocumented
Immigrants
&
DACAmented
Immigrants
X
X
STATE
OPTION
If under 21
or pregnant
X
(Except emergency
services)
X
STATE
OPTION
If under 21
or pregnant
STATE OPTION
Prenatal care
services only



X
X
X

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