1. Assisting Immigrants with Health Coverage Applications

2. Learning Objectives I.Classify eligible immigration statuses II.Identify options for undocumented or unqualified individuals III.Discuss issues and concerns for mixed-status families and immigrants unsure about applying for health coverage IV.Explain the Marketplace Identification Verification process

3. Who Qualifies for Marketplace Coverage? In order to buy private health insurance through the Marketplace, you must be a U.S. citizen or be lawfully present in the United States Eligible immigration statuses include: –Lawful Permanent Resident (LPR/Green Card holder) Have permission to live and work in U.S.; may apply for naturalization after five years (three years if married to a U.S. citizen, or one year for certain person in the military and veterans). –Asylee Can apply to be LPR after one year –Refugee –Cuban/Haitian Entrant –Paroled into the U.S. –Conditional Entrant Granted before 1980

4. Eligible Immigration Statuses (continued) Granted Withholding of Deportation or Withholding of Removal, under the immigration laws or under the Convention against Torture (CAT) Individual with Non-immigrant Status (includes worker visas, student visas, and citizens of Micronesia, the Marshall Islands, and Palau) Temporary Protected Status (TPS) Deferred Enforced Departure (DED) Deferred Action Status (Deferred Action for Childhood Arrivals (DACA) is not an eligible immigration status for applying for health insurance) Lawful Temporary Resident Administrative order staying removal issued by the DHS Member of a federally-recognized Indian tribe or American Indian born in Canada Resident of American Samoa

5. Eligible Immigration Statuses (continued) –Battered spouse, child and parent –Victim of trafficking and his/her spouse, child, sibling, or parent Applicant for any of these statuses: –Temporary Protected Status with Employment Authorization –Special Immigrant Juvenile Status –Victim of Trafficking Visa –Adjustment to LPR Status –Asylum* –Withholding of Deportation or Withholding of Removal, under the immigration laws or under the Convention against Torture (CAT)*

6. Eligible Immigration Statuses (continued) With Employment Authorization: Registry Applicants Order of Supervision Applicant for Cancellation of Removal or Suspension of Deportation Applicant for Legalization under IRCA Legalization under the LIFE Act

7. Lawfully Present Immigrants and Medicaid Immigrants who entered on or after August 22, 1996 must meet 5-year waiting period  This means they must wait five years after receiving “qualified” immigrant status before being eligible for Medicaid and CHIP People who don’t have eligible immigration status and therefore aren’t eligible for Medicaid may get Medicaid coverage for limited emergency services if they meet all other Medicaid eligibility criteria

8. Undocumented Immigrants The estimated 11 million immigrants living in the U.S. illegally are not eligible for federal public benefits through the Affordable Care Act or Medicaid –Cannot buy coverage through the Marketplace –Premium tax credits are not available for undocumented immigrants May continue to buy coverage on their own outside the Marketplace and get limited services for an emergency medical condition through Medicaid, if they are otherwise eligible for Medicaid in Indiana Are not subject to the individual shared responsibility requirement

9. Undocumented Immigrants May seek nonemergency health services at community health centers or safety-net hospitals Citizens or lawfully present children of undocumented parents ARE eligible –To purchase from the Marketplace –For PTC and CSR –For Medicaid and CHIP

10. Disclosure of Immigration Status The Marketplaces and state Medicaid and CHIP agencies can’t require applicants to provide information about the citizenship or immigration status of any family or household members who are not applying for coverage –Only those applying are required to provide SSN and immigration/citizenship status States can’t deny benefits to an applicant because a family or household member who isn't applying hasn’t disclosed his or her citizenship or immigration status People who aren’t seeking coverage for themselves won’t be asked about their immigration status

11. Disclosure of Immigration Status Social Security number of a nonapplicant may be requested to electronically verify household income. If unavailable, other proof of income can be provided. Information about immigration status may be used only to determine an individual’s eligibility

12. Mixed-status Families Mixed-status families are households made up of individuals with different citizenship or immigration statuses such as an undocumented mom, a “lawfully present” dad, an adolescent granted deferred action through DACA, and a child who is a U.S. citizen because he or she was born in the U.S. According to the National Immigration Law Center, “As of 2010, nearly one in four children younger than eight years old had at least one immigrant parent

13. What are ITINs? ITINs (Individual Taxpayer Identification Numbers) are issued by IRS to people who are ineligible for SSNs but who need to file tax returns Other lawfully present immigrants who are ineligible for or who may not have an SSN include people in “nonimmigrant” categories whose visas do not permit them to work, some children under 14 years old whose application for asylum or withholding of deportation/removal has been pending for 180 days, and some children who have applied for Special Immigrant Juvenile status

14. Does a nonapplicant need to provide SSN or income information? All members of an applicant’s household, including nonapplicants, need to provide information about their income—if the household is applying for help with the costs of insurance for the applicant (including Medicaid, CHIP, and the marketplace subsidies) Nonapplicants will be asked for their SSN, but they do not have to provide one if they do not have one. Since the IRS will verify income only for households that have filed taxes with an SSN, many mixed-status families will need to provide other proof of income.

15. ID Verification on the Marketplace When ID Verification Cannot Be Completed Online –A unique reference ID is provided –Consumers may call Experian Help Desk directly or with the Marketplace on a three way call –If language assistance is needed, consumers can call the call center first, request language assistance to call the Experian Help Desk

16. ID Verification on the Marketplace When ID Verification Cannot Be Completed Over the Phone –Consumers are required to mail or upload documents to their Healthcare.gov account (manual process) to be verified by the Marketplace in order to have access to and use their online account –When mailing documents, be sure to include reference ID number –Mail to: Health Insurance Marketplace, 465 Industrial Blvd., London, KY 40750

17. ID Verification on the Marketplace Consumers can prove identity by mailing or uploading: One of these: Driver’s license School ID card Voter Registration Card U.S. Military Card U.S. Military Draft Record Military Dependent ID Card Tribal Card Authentic Document from a Tribe U.S.C.G Merchant Mariner Card ID card issued by the federal, state, or local government Including immigration document and US passport Alternatively, 2 of these: U.S. Public Birth Record Social Security Card Marriage Certificate Divorce Decree Employee Identification Card High School or College Diploma Property Deed or Title

18. Resources Immigrant Families and the Marketplace Immigration Status and the Marketplace “Lawfully Present” Individuals Eligible under the Affordable Care Act“Lawfully Present” Individuals Eligible under the Affordable Care Act The Affordable Care Act & Mixed-Status Families