Immigrant eligibility for care and coverage in the ACA era - PowerPoint Presentation

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Immigrant eligibility for care and coverage in the ACA era

Joel Diringer, JD, MPHFebruary 2016

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Definitions“Lawfully present” immigrantsOn road to citizenship – e.g. Legal Permanent Resident (LPR)Permission to stay indefinitely in US without pathway to citizenshipTemporary Protected Status including PRUCOL and DACA “Dreamers”. (Note: DACA not eligible for ACA purposes)Permission to stay temporarily (e.g. visa holders)Undocumented immigrants

Persons who lost permission to remain in US or entered without inspection2Slide3

“Lawfully present” immigrants under the Affordable Care ActCan buy health insurance in Covered CA with own fundsMay qualify for premium and co-pay subsidies in Exchange (up to 400% if <5 years; 100-400% if >5 years)May qualify for full-scope Medicaid (Medi-Cal)Are subject to the individual mandate

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Lawfully present immigrants -- Medi-Cal – California rulesAll legal immigrants are eligible“Permanently Residing Under Color of Law (PRUCOLs)” – are eligible

15 categories plus catch-all: Immigration authorities are aware of presence and has no intention of deportingSelf certification of PRUCOL status (MC-13)

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Deferred Action for Childhood Arrivals (DACA)DACA eligibles are not eligible for Covered California Health Plans, but they are eligible for Medi-Cal in California. However, a DACA-eligible individual may still apply

through Covered California as they may be eligible to receive low or no-cost health coverage through Medi-Cal.DACA/DAPA expansion on hold by federal court

. Supreme Court decision expected in June 2016.

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Undocumented ImmigrantsCannot buy insurance in individual market of Covered California, even at full costCannot receive subsidies through Covered CAExcluded from individual mandate for selves, but not for eligible family membersCan be covered by employer (including in SHOP), or purchase individual policy outside ExchangeEligible for some Medi-Cal services;

also Breast Cancer and Cervical Cancer Treatment, Family PACT, CHDP, WIC, Medi-Cal Access Program (AIM)Can obtain services from FQHCs, emergency rooms and other

clinics and some county programs

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Undocumented immigrantsMedi-Cal coverageRestricted/Emergency Medi-Cal for emergency services and pregnancyFull-scope coverage for all children regardless of immigration status starting May

2016Sign up now!Hospital Presumptive Eligibility

Apply through hospital for full-scope Medi-Cal benefits – up to 2 months eligibility – once a year for adults, twice a year for children. No immigration screen.

CHDP GatewayApply through CHDP provider for up to 2 months eligibility; now twice a year for children. No immigration screen.

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Undocumented immigrantsEmployer-based coverageEmployers with 50 or more full-time equivalent workers are required to offer affordable, comprehensive coverage to full-time workers and dependent children, or pay penalties to the federal government.Employee cost cannot exceed 9.66% of their income.Coverage must pay for at least 60% of average health costs (minimum value).No responsibility to pay for children’s coverage.

Seasonal workers expected to work fewer than 6 months are excluded from the mandate.8Slide9

Mixed-status immigrant familiesUS Citizen or LPR children/spouses – have same rights as other citizensUndocumented adults can apply for Exchange subsidies for eligible family members, but must be tax-filer (with ITIN)Individuals who are not “lawfully present” will not be counted in the household/family size and the household income will be proportionally adjusted (reduced).

While undocumented persons are exempt from the individual mandate, they are subject to the tax penalty for not covering those subject to individual mandate

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Immigration Public ChargeIn general, applying for insurance through Covered California, receiving tax credits for a Covered California Health Plan or receiving low or no-cost coverage through Medi-Cal, will not make an individual a “public charge” – it will not affect a person’s immigration status, chances of becoming a lawful permanent resident, or becoming a

naturalized citizen. The exception is if the individual receives long term care in a nursing home or other facility paid

for by the government, or does not tell the truth on the application.

www.uscis.gov/green-card/green-card-processes-and-procedures/public-charge

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Overcoming barriersClear, concise and accurate information that is linguistically and culturally appropriateBe creative – DACA eligibility? Hospital presumptive eligibility? PRUCOL?Information provided by persons trusted in the communityHands-on assistance by experienced counselors in applicant’s languageBe sensitive to fears and reticence of accepting government assistanceContinued assistance in paying premiums, finding providers, making appointments, understanding health plan (e.g. co-pays, deductibles, in-network providers) and renewal.

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Additional resourceshttp://undocumentedanduninsured.org/http://www.caimmigrant.org/what-we-do/healthcare/

QUESTIONS?

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Joel Diringer, JD, MPHDiringer and Associates

2475 Johnson Avenue

San Luis Obispo, CA 93401

805-546-0950

joel@diringerassociates.com

www.diringerassociates.com