Immigrants and the Affordable Care Act September 18, 2013 Kate Laner Northwest Justice Project (206)

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: ndAlienStatus/CitizenshipImmEligResTanfMed.shtmlhttp:// ndAlienStatus/CitizenshipImmEligResTanfMed.shtml (see note 3 of clarifying info).  “Lawfully present” definition for state benefits can be found at: enStatus/CitizenGenElig.shtmlhttp:// 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  Community education publications on immigrant eligibility for benefits in WA state found at