Welcoming Communities Conference Jeannine Peterson MPA Hamilton Health Center October 26 2015 Identify what types of health care insurance coverage is available Identify who is eligible for health care coverage ID: 578903
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Helping LEP Immigrants & Refugees Access Health/Affordable Care Act"Welcoming Communities Conference
Jeannine Peterson MPA
Hamilton Health Center
October 26, 2015Slide2
Identify what types of health care insurance coverage is availableIdentify who is eligible for health care coverageWhere to go for help in applying for coverage
Where to go to access medical and dental services
ObjectivesSlide3
Types of CoveragePublic and Privately Funded ProgramsSlide4
Provides free health insurance for low income adults and children
Have incomes at or below 138% of the federal poverty level
Are
lawfully present
, or, in an eligible
qualified immigration
status.
Medical Assistance – Medicaid (MA)Slide5
“
Qualified” Immigrant Status
Lawful
Permanent Residents (“LPRs” or “green card holders”)
Refugees
Aslyees
Cuban/Haitian
entrants
Conditional entrants
Individuals paroled into the US for more than one year
Certain domestic violence and trafficking survivors and their children
Persons granted withholding of deportation/removal Slide6
Pregnant women Children under age
21
Refugees
Asylees
Cuban and Haitian Entrants
Plus others
Refer to the Pennsylvania Medical Assistance Handbook for a full listing of those considered to be “Lawfully Present”
“Lawfully Present”Slide7
Provides health coverage for individuals over age 65 or who have been receiving Social Security Disability Income for over 2 years. Only available to
U.S. Citizens and Legal Permanent Residents (LPRs or “Green Card Holders”) who have been in the United States for at least 5 years
.
Individuals without the requisite work credits may have to pay for Medicare, even if eligible based on immigration status.
MedicareSlide8
Provides free or low-cost health insurance to children up to age 19 whose families are
lawfully present
and earn
too much to qualify for
MA
No
family makes too much money to get CHIP. Depending on income some coverage is free others pay premiumComprehensive and includes both physical, behavioral, dental, vision, and hearing services, as well as prescription drugs, emergency
care and in-patient
services
Children’s Health Insurance Program – CHIPSlide9
Marketplace – ObamacareHealth insurance plans that provide comprehensive coverage at an affordable price for many low-income consumers An immigrant must be lawfully present
to enroll in a Marketplace plan and to receive financial help paying for the plan
Undocumented
immigrants
are excluded from enrolling in the marketplace, even from buying a plan at full cost.
Affordable Care Act/ACASlide10
Medical Assistance Medicaid or MASlide11
Must be living in PA and planning to be here indefinitelyNo time requirement, can travel in and out of the state as long as you plan on returning (example: migrant or seasonal workers)
No permanent address required but you must be able to check their mail regularly
Residency
Eligibility RequirementSlide12
Important because income and resource limits vary by category Each category covers a specific population: children, pregnant women, parents, healthy adults, disabled adults, disabled children, the
elderly – and there are more
Now every Pennsylvanian fits into an MA
category as
long as they meet the residency requirements,
are low income,
and have the eligible immigration status MA CategoriesSlide13
Each MA category has its own income and resources limits, which vary based on the applicant’s household size“Income” - the money an individual receives every month, from sources such as employment, pensions, government benefits,
etc
“
Resources”
-
generally the 5 things an individual owns, such as savings and checking accounts, retirement accounts, the cash value of life insurance policies, etc .
Income and Resource LimitsSlide14
“Qualified” ImmigrantsAdultsMust wait five year before being
eligible
for MA unless you meet certain criteria
Immigration StatusSlide15
Pregnant women (through the 60-day post-partum period)
Children under age
21
Refugees
and
asylees
(even if they now have a green card)Cuban/Haitian entrants; Survivors of
trafficking
Immigrants whose deportation is being withheld;
Certain
veterans and their
families
Certain
people who have lived in the U.S. continuously since before 8/22/1996 who are now legal immigrants
Refer to the Pennsylvania Medical Assistance Handbook for a full listing of those
without a waiting period
No waiting period for MASlide16
Lawfully Present (residing) Children under 21& Pregnant Women
State option: PA Chose to expend Medicaid to this group
This group does not need
to meet the more stringent standard of “qualified” immigration status that applies to
adults
No 5 year bar
: can get MA coverage as soon as they enter US as long as they meet other eligibility requirements (residency and income) There are other categories of
Lawfully Present
listed in the MA handbook
Immigration StatusSlide17
Called HealthChoicesState is divided into regions with each region having certain insurance companies under contract to the PA Department of Human ServicesRecipient must select a MA insurance company i.e. UPMC, Gateway, Health Partners, United, etc
Recipient must select a Primary Care Provider (PCP)
If an insurance company or PCP isn’t selected one will be chosen for you
Mental Health and Substance Abuse Services are “carved out”, that is, they are managed separately
PA’s
MA Managed Care ProgramSlide18
Emergency Medical AssistanceFor People with Medical ConditionsSlide19
Health care coverage for any immigrant regardless of their immigrant status as long as they meet EMA requirements. This includes undocumented immigrants and those “qualified” immigrants who fall within the five year bar
Temporary MA coverage to treat a specific medical condition known as an Emergency Medical Condition (EMC); usually an acute problem
After the treatment of the condition, the MA coverage ends
What is Emergency Medical Assistance (EMA)Slide20
A medical condition with acute symptoms including severe pain, that without immediate attention, could result in: Health being in serious
jeopardy
Serious
impairment to bodily
functions
Serious dysfunction of any body organ or part Does not necessarily require ER visitDoes not include any services related to organ transplants
What is an EMCSlide21
Eligible for EMA if experiencing a high risk pregnancyLabor and Delivery automatically coveredPre natal and post natal covered up to 60 days post delivery
Pregnant Women (undocumented)Slide22
Doctors letter required to accompany applicationUse the standard MA application form (PA-600HC)Apply online using the COMPASS system, or via telephone by calling 866-550-4355 Write on the form “Application for EMA only”
Immigrant does not have to indicate their immigrant status (documented vs undocumented)
How to apply for EMASlide23
Doctor determines if condition meets EMC definition and be willing to write the letterLetter must identify what the EMC isIdentify what specific criteria the condition satisfiesWhat types of medical services will be required for to treat the condition
Identify how long treatment will be required. Recommendation is no longer than 6 months and then condition can be reassessed, unless the doctor knows it will take longer. Longer time frame brings greater scrutiny
Explain what will happen if patient doesn’t get the care that’s needed
Doctors LetterSlide24
ResidencyIncome and ResourceWork with doctor and County Assistance OfficeInclude Medical RecordsOther requirementsSlide25
EMC is usually for short term conditions, but chronic conditions can be covered, but substantiating this will be more difficultWe have resource materials available to you today that may help you with thisEMC – Chronic Conditions Slide26
Children’sHealth Insurance CoverageCHIPSlide27
Provides free or low-cost health insurance to uninsured children up to age 19 whose families earn too much to qualify for MAIncludes both physical and behavioral services, including prescription drugs, vision, hearing and dental services as well as emergency care and in-patient services
Uses
the same “lawful presence” immigration status
utilized
for pregnant women and children applying for MA
No income too high for CHIP but may have to pay premium for coverage
CHIPSlide28
Use online system – COMPASS same as for MAIf unsure if child is MA or CHIP eligible, apply for MA. The county assistance office will transfer the application to CHIP if family income is too high for CHIPApply directly to CHIP if you know the income is too high for MA and child doesn’t have a disabilityHow to apply Slide29
Marketplace InsuranceObamacare CoverageSlide30
Must be “lawfully present” to enroll in a plan and receive financial help paying for the plan Lawful presence
includes:
Lawful
Permanent
Residents
(LPRs or “green-card holders
”)Humanitarian statuses like asylumNon-immigrant visa holders, including those on work or student visas “Qualified” immigrants who do not meet the Five Year Bar should also consider the
Marketplace
U
ndocumented
immigrants
are excluded from enrolling in the marketplace, even from buying a plan at full cost
Marketplace
Plan
EligiblitySlide31
Premium Tax Credits (PTC) help lower an individual’s monthly health insurance premium (money paid each month to be enrolled in the plan) Cost Sharing Reductions (CSR) help with out-of-pocket costs (money spent on things like doctor’s visits, lab tests, and prescription drugs.) CSRs are only available to people enrolled in “Silver” level Marketplace plans
Financial AssistanceSlide32
Only people with household incomes between 138% FPL and 400% FPL can get help paying for Marketplace coverage using PTCs and CSRs exceptionImmigrants who are ineligible for MA because of their immigration status can get PTCs and CSRs
even if
their income is below the traditional 138% FPL floor
. This includes immigrants who are ineligible for MA because of the Five Year Bar
Who’s EligibleSlide33
Apply online at Healthcare.gov or by calling 800-318-2596 Only during open enrollment periods: Open Enrollment for 2016 coverage will be October 15, 2015 through December 15, 2016
Can only enroll outside this period if you have a major life event, such as marriage, divorce or child birth
Must document citizenship or immigrant status
Applying for coverageSlide34
Certified Application Organizations have received designation by the Federal Government Individuals called Certified Application Counselors are able to assist with enrollment into Medicaid, CHIP and the MarketplaceWho are designated: Federally Qualified Health Centers, hospitals, and social service agencies
Getting Assistance to ApplySlide35
Identify health care providers that accept your insuranceIf uninsured, i.e. do not qualify for Medicaid, CHIP, EMA, or the Marketplace, seek out free clinics or Federally Qualified Health Centers who have sliding fee scale and other types of free services
Do not use the Emergency Room for non-emergency care
You will need to find a doctor within the health care network willing to assist with EMA paperwork
Where to go for health care servic
esSlide36
Need routine primary care for children and adults (well child check ups, immunizations, sick care for adults and children)Need work physical exams, driver physical exams Women’s annual exams, prenatal care, birth control
Importance of Selecting a DoctorSlide37
Dental careMental healthSubstance AbuseOther servicesSlide38
LanguageMust comply with Title VI of 1964 Civil Rights ActAny organization that receives federal funding - health care provider, insurance company, the County Assistance Office, must provide interpreting services free of charge
Can be live interpreters or telephone service
Social Security Number
Should not be required to receive services at publically funded clinics, for EMA or for CHIP; Do not use false number, just indicate no number
It is required for MA and the CAO can help with this
Immigration Status
“Qualified Immigrants must prove their status
Health clinics do not require proof
Barriers to CareSlide39
PA Health Law Project’s 2015 MA Eligibility Manual
Health Care for Immigrants: A Manual for Advocates in
Pennsylvania
PA Department of Human Services
MA Manual
References Slide40
QUESTIONS