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 eligibility. 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 Nationals Eligible for full-scope Medicaid. Eligible for state insurance exchanges, premium tax credits and cost-sharing reductions, individual mandate applies 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: http://www.dshs.wa.gov/manuals/eaz/sections/CitizenshipA ndAlienStatus/CitizenshipImmEligResTanfMed.shtmlhttp://www.dshs.wa.gov/manuals/eaz/sections/CitizenshipA ndAlienStatus/CitizenshipImmEligResTanfMed.shtml (see note 3 of clarifying info). “Lawfully present” definition for state benefits can be found at: http://www.dshs.wa.gov/manuals/eaz/sections/CitizenshipAndAli enStatus/CitizenGenElig.shtmlhttp://www.dshs.wa.gov/manuals/eaz/sections/CitizenshipAndAli enStatus/CitizenGenElig.shtml (see note 7 of clarifying info).
Immigrant Eligibility - Lawfully Present Immigrants Maintains current federal immigrant eligibility restrictions for non-emergency Medicaid 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 Present Not eligible for non-emergency Medicaid Not allowed to purchase private insurance in state insurance exchanges, for premium tax credits or cost- sharing 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 cost- sharing assistance with low to moderate income
Resources Numerous articles on immigrant eligibility under the ACA at www.nilc.orgwww.nilc.org Community education publications on immigrant eligibility for benefits in WA state found at www.washingtonlawhelp.orgwww.washingtonlawhelp.org