COVERAGE FOR IMMIGRANTS - PowerPoint Presentation

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COVERAGE FOR IMMIGRANTS underHealth Care reform

October 22, 2013

County Welfare Directors Association of California

Cathy Senderling-McDonald

Los Angeles County

Isabelle Maggio

California Pan-Ethnic Health Network

Ellen WuSlide2

OVERVIEW OF TRAININGGlossary of Terms

Immigrant Categories Undocumented Immigrants

Eligibility and Verification Systems

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GLOSSARY OF TERMSUtilize the glossary (Attachment I) to become familiarized with terms used throughout this presentation.

Make the glossary a part of your individual trainings and provide as a desk reference.

Add additional terms that will assist staff as you implement training in your counties.

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QUICK NOTE

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For the purpose of this presentation, you will hear us use:

The federal term “Lawfully Present”

, when referring to Federal rules and the rules used by Covered California.

Note:

For a complete list of “Lawfully Present” individuals

under the Affordable Care Act (ACA), please refer to

Attachment II.

The state term “Qualified Immigrants”

, when referring to

Medi-Cal.

Note: “Lawfully Present” describes a broader category that includes “Qualified Immigrants”.Slide5

Immigration categoriesLawful Permanent ResidentsPermanent Residence Under Color of Law

Refugee Medical AssistanceUndocumented Immigrants

Immigrants with Temporary Status

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IMMIGRANT POPULATIONS ELIGIBLE TO FULL-SCOPE MEDI-CALLawful Permanent Residents (LPRs)

Permanent Residence Under Color of Law (PRUCOL)Asylees

Refugees

Cuban and Haitian Entrants

Certain Battered Spouses and Children

Victims of Trafficking

Individuals Granted Conditional Entry

Individuals Granted Witholding of Deportation/Removal

Individuals Paroled into the U.S. for at Least One Year

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ELIGIBLE NON-CITIZENS UNDER 5 YEARSCurrent Federal regulations establish a “5 year bar” for lawfully present immigrants in order to be eligible for Federal Medicaid.

However, in California, qualified immigrants who have not satisfied the “5 year bar” are eligible to receive state-only full-scope

Medi-Cal.

The state-only programs have been transparent to county staff, because there have never been separate aid codes to identify this population.

With the implementation of Health Care Reform (HCR), the state has decided to continue with the same methodology, i.e., no separate aid codes for this group.

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PERMANENT RESIDENCE UNDER COLOR OF LAW

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Permanent Residence Under Color of Law (PRUCOL):

Immigrants who are PRUCOL are eligible for full-scope Medi-Cal as long as they are otherwise eligible.

Under PRUCOL category #16 of

question 5 of the MC 13, the immigrant is declaring that federal immigration authorities are aware of the immigrant’s presence, but do not plan to remove him or her from the country.

The Deferred Action for Childhood Arrivals (DACA), is

PRUCOL category#12 found under question 5 of the MC 13.

Medi-Cal benefits for immigrants who are PRUCOL will not change with the implementation of Health Care Reform.Slide9

MEDI-CAL ELIGIBILITYThe following qualified immigrants and PRUCOLs are eligible for full-scope

Medi-Cal benefits:

Individuals up to 21 years of age

Pregnant women with income up to 60% of the Federal Poverty Level (FPL)

Children in families with income up to 266% of the FPL

Parents, seniors, and persons with disabilities

Qualified immigrants who are pregnant with income above 60% and up to 213% of the FPL are eligible for pregnancy-only Medi-Cal.

Depending on reported income, pregnant individuals may also be eligible to full-scope Medi-Cal benefits with a Share-of-Cost (SOC) and/or an Advanced Premium Tax Credit (APTC) through the Exchange, in addition to pregnancy related services.

Medi-Cal expansion covers eligible immigrants who are childless adults with income up to 138% of the FPL.

As with all applicants,

Medi-Cal

expansion eliminates the

linkage, deprivation,

and assets requirements. It

requires that

qualified immigrants

only meet the

income and state residency requirements.

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ELIGIBILITY FOR THE LAWFULLY PRESENT IMMIGRANTAs of January 2014, the following will apply to lawfully present immigrants:

Subject to the individual mandate and related tax penalty.

May enroll in a health plan from the state insurance exchange.

Eligible for premium tax credits and subsidies.

No waiting periods for enrolling in state insurance exchanges or premium tax credits.

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REFUGEE MEDICAL ASSISTANCE

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Refugee Medical Assistance (RMA) Program

The RMA Program will continue as usual until, December 31, 2013:

The RMA Program will sunset.

State Department of Health Care Services (DHCS) to issue instructions.

Immigrants who would have been eligible to benefits under the RMA program will become part of the new Medicaid Expansion population – MAGI Medi-Cal – beginning January 2014.Slide12

UNDOCUMENTED IMMIGRANTS

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Undocumented immigrants include non-citizens without a lawful

immigration status.

Undocumented immigrants who meet all other program requirements for Medi-Cal will be eligible to receive restricted/limited scope benefits.

Undocumented immigrant childless adults will be included in the MAGI Medicaid Expansion population for restricted benefits.

Undocumented immigrant children will be eligible for restricted-scope benefits via the coverage groups that exist for children’s coverage under the Affordable Care Act, including but not limited to the general children’s coverage group. Please refer to the aid code chart (Attachment III) to see the programs that will have restricted-scope aid codes associated with them.Slide13

UNDOCUMENTED IMMIGRANTS

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Medi-Cal for undocumented immigrants:

Not eligible for Medicare or full-scope Medi-Cal.

If all eligibility requirements are met, undocumented immigrants will continue to receive:

Emergency-related services.

Pregnancy-related services:

Prenatal

care.

Labor and

delivery.

Up to 60 days of post-partum

care.

Family planning

services.

State funded Long-Term Care (LTC).

May seek non-emergency health services at community health centers or safety-net hospitals.

For aid code information, refer to Attachment III.Slide14

UNDOCUMENTED IMMIGRANTS

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APTC and Health Benefit Exchange coverage for undocumented immigrants:

Exempt from the individual mandate.

Not allowed to purchase private health insurance through the state insurance exchange(s), even if paying full cost.

Not eligible for premium tax credits or subsidies.

Citizen or lawfully present children of undocumented parent may be eligible (see next slide regarding mixed households).Slide15

MIXED IMMIGRATION STATUS HOUSEHOLDS

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Undocumented parents of citizen or lawfully present children are eligible:

To purchase from the state insurance exchange on behalf of their children, but not for themselves.

For premium tax credits and subsidies on behalf of their children, but not for themselves, if they file taxes.

Citizen or lawfully present children of undocumented parents are eligible:

For full-scope Medi-Cal, if otherwise eligible.Slide16

IMMIGRANTS WITH TEMPORARY STATUSIndividuals with temporary visas or those who do not intend to stay permanently in the United States, such as foreign visitors and students, are not typically eligible, unless they can establish that they intend to permanently reside in the state, and meet all other eligibility requirements.

If eligible to Medi-Cal, they receive the same restricted-scope benefits as undocumented individuals.

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Eligibility and verification systemsCalHEERSSystematic Alien Verification for Entitlement (SAVE)

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DETERMINING ELIGIBILITY IN CalHEERS

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CalHEERS is programmed to determine eligibility for each individual regardless of citizenship status.

It is imperative that Eligibility Workers enter accurate information in CalHEERS to assign the correct program and aid code.

The Notice of Action sent to customers will inform them of their approval to MAGI Medi-Cal with either limited-scope or restricted-scope benefits.Slide19

SYSTEMATIC ALIEN VERIFICATION FOR ENTITLEMENT

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Systematic Alien Verification for Entitlement (SAVE) use:

During the Pre-Enrollment period from October to December 2013, cases entered directly into CalHEERS will have citizenship and immigration status information reported by the customer verified against the Federal Data Hub.

The United States Department of Homeland Security will be one of the entities providing information to the Federal Data Hub.

If a discrepancy occurs, staff will need to request verification of the lawfully present status. If secondary verification is required, counties are to use the same process as used today by sending a G-845 to USCIS and following-up accordingly once a response is received.

Benefits are not to be delayed pending this secondary verification process. Per existing Medi-Cal regulations, if acceptable evidence of lawful permanent residence is provided by the applicant,

full-scope benefits are to be issued while the G-845 is pending with USCIS.

Once the SAWS and CalHEERS interface is implemented, counties will process SAVE documents in the same manner they do today in SAWS.

Note: if secondary verification is instituted when the case is processed in CalHEERS, this process does not need to be completed again in SAWS if a new SAVE is generated due to the case migration.Slide20

Additional informationPending Future Guidance

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PENDING FUTURE GUIDANCEWrap Around Program:

A Wrap Around Program is being established by the Department of Health Care Services (DHCS) and Covered California for qualified immigrants who are childless adults (21 years of age and older), under the “5 year bar," earning up to 138% of the FPL.

This program will allow these adults to enroll in coverage in Covered California with APTC applied towards their premium. DHCS will provide payments to reduce the premium and out-of-pocket expenses to zero.

DHCS will also provide these adults benefits that are available in Medi-Cal, but not included in Covered California.

Details of the program policy are still in development.

The program is expected to be implemented no earlier than

April 2014.

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PENDING FUTURE GUIDANCEMC 13 for Medi-Cal:

At this time, counties are to continue using the MC 13 for customers requesting Medi-Cal consistent with current requirements.

Future guidance has been requested for the use of the MC 13 for customers requesting

Medi-Cal later, and all customers after January 01, 2014.

DHCS is currently reviewing the requirement.

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QUESTIONS?

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