Immigrant Eligibility - Lawfully Present Immigrants

Immigrants and the Affordable Care
September 18, 2013
Kate Laner
Northwest Justice Project
(206) 464-1519
[email protected]
A Little Background: Welfare Reform
and Immigrant Eligibility for Medicaid
 Must have “qualified” status for means-tested public benefits
(including non-emergency medicaid)
 Some (primarily family visa beneficiaries) who entered after
8/22/1996 must be in qualified status for 5 years
 Exemptions for humanitarian entrants, and for active duty
military, veterans and their families
 Sponsor deeming
 Primarily applies to family visa beneficiaries
 Sponsor’s income is counted in determining benefits
 For federal benefits, lasts until immigrant naturalizes or can
be credited with 40 quarters of work history (or dies)
Immigrant Eligibility and the ACA:
3 General Groups
US Citizens and Nationals
“Lawfully Present” immigrants
– Qualified
– Non-Qualified
Immigrants not Lawfully Present
Immigrant Eligibility - US Citizens and
 Eligible for full-scope Medicaid.
 Eligible for state insurance exchanges, premium tax
credits and cost-sharing reductions, individual mandate
 Includes US citizens by birth or naturalization
 Includes US citizen children of undocumented parents
Immigrant Eligibility - Lawfully
Present Immigrants
 Includes “qualified” and “non-qualified”
 “Qualified” include:
• Lawful Permanent Residents
• Refugees, persons granted asylum or withholding of deportation/removal,
conditional entrants
• Granted parole for at least one year
• Cuban and Haitian entrants
• Certain abused immigrants, their children and/or parents
• Certain Victims of Trafficking
 “Non-qualified” include:
• many immigration applicants
• persons in temporary status including non-immigrants, TPS, granted deferred
action (but note: DACA excluded from federal coverage)
• citizens of Micronesia, Palau, Marshall Islands, etc.
Immigrant Eligibility – Lawfully
Present Immigrants
“Lawfully present” definition for federal
benefits can be found at:
ndAlienStatus/CitizenshipImmEligResTanfMed.shtml (see note
3 of clarifying info).
“Lawfully present” definition for state benefits
can be found at:
enStatus/CitizenGenElig.shtml (see note 7 of clarifying info).
Immigrant Eligibility - Lawfully
Present Immigrants
 Maintains current federal immigrant eligibility restrictions for non-emergency
 Must have qualified status
 5 year bar for those who entered after 8/22/1996 (exceptions for humanitarian
entrants, veterans/military and families)
 sponsor deeming, primarily for family-based immigrants (many exemptions)
 Can still get:
 Children’s & pregnant women’s medical (no 5 year bar/sponsor deeming)
 MCS for those ineligible for Medicaid
 Alien Medical Programs (emergency conditions, cancer, dialysis, LTC)
And now can get:
Eligible for state insurance exchanges
premium tax credits and cost-sharing reductions
individual mandate applies
Immigrant Eligibility – Not Lawfully
Not eligible for non-emergency Medicaid
Not allowed to purchase private insurance in state
insurance exchanges, for premium tax credits or costsharing reductions, exempt from individual mandate
Can still get:
 Alien Medical programs (state and federal)
 State-funded pregnant women’s & children’s medical
Immigrant Eligibility -Verification
 Information about immigration status may be used only to
determine eligibility (will not be used for immigration
enforcement or other purposes)
 Immigration status information only required for the person
applying for benefits - not other family members
 Those applying must supply valid SSN with some exceptions
(including emergency Medicaid, Apple Health for Kids and
WAH for pregnant women)
 alternate proof of status may be sufficient for some
coverage options
Immigrant Eligibility – Use HPF Even
if Ineligible for Traditional Medicaid
 Use the HPF System for other WAH programs
Even if an applicant is clearly ineligible for traditional
Medicaid, (s)he can still apply for other programs through
the HPF system
 Don’t forget Exchange-based coverage
Lawfully present immigrants ineligible for WAH can get
coverage through the HPF, including premium and costsharing assistance with low to moderate income
 Numerous articles on immigrant eligibility
under the ACA at
 Community education publications on
immigrant eligibility for benefits in WA state
found at

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