Health care access for immigrants March 6, 2013 Vicky Pulos, MLRI Ext. 318

Comprehensive health benefits Immigrants must have an eligible immigration status to receive- Any type of MassHealth except Limited Commonwealth Care

Eligible immigration status Immigrants must satisfy all the eligibility rules for MassHealth/Commonwealth Care that apply to US citizens… and in addition Immigrants must have an eligible immigration status

Qualified in MassHealth MassHealth defines “qualified” to mean federally qualified and currently eligible 5-year bar exempt or 5-years met MassHealth defines “aliens with special status” (AWSS) to mean Federally qualified but 5-year barred Not federally qualified but permanently residing in US under color of law (PRUCOL) 2009 federal law change applies new term “lawfully present” to pregnant women & children

Health exercise # 1 Mrs. Pappas is 66. She has had a green card for 6 years but is only on MassHealth Limited and the Health Safety Net. What should she be eligible for? What steps are needed to correct the situation?

New green cards –May 2010 Is country Cuba, Haiti, Iraq, Afghanistan, Vietnam, Canada? Does code show status not subject to 5 yr bar? Is date 5 or more years ago?

Eligible children & pregnant women 2009 change in Medicaid law All “lawfully present” children & pregnant women federally eligible No 5-year bar Includes other AWSS Replaces PRWORA rules with State residence Lawful presence

Regulation-free zone for lawfully present pregnant women & children Lawfully present pregnant women & children eligible since 2009 August 2009 Eligibility Ops memo eliminated 5-year bar Member booklet recognizes AWSS children & pregnant women can get MH Standard (in your materials) MassHealth regulations have not yet been amended

“Lawful presence” –federal definition Proposed federal Medicaid regulation defining lawful presence (in your materials) Same definition will be used for new types of subsidized insurance available in 2014

Exercise # 2 Mrs. Smyth and her 7 year old child have been in the U.S. with green cards for 2 years. Does either one have a qualified eligible status for MassHealth benefits? What if Mrs. S tells you she is pregnant?

Eligibility checklist for green card holders Child (under 19) or pregnant woman, Status since date 5+ years ago, U.S. entry date prior to 8/22/96, Battered immigrant, trafficking victim, veteran, Prior status was refugee, asylee, deportation withheld Cuban-Haitian Entrant; Iraqi/Afghani Special Immigrant; Vietnamese Amerasian; American Indian (born in Canada or Mexico)

Identifying codes Keys to codes on specified documents Green cards Employment authorization cards I-94 arrival/departure cards Visas in foreign passports Resources masslegalservices.org MassHealth Advocacy Guide (MLRI) MassHealth Immigration Advocacy Desk Guide (MLRI) Office of Medicaid Memos NILC Tables (in materials) USCIS website

Tips for helping immigrants get the best coverage they can Send in proof of current status AND any prior qualified status List U.S. entry date on app. if prior to 8/22/96 Check if domestic violence & veteran protections apply on application form Include proof for each family member Add name, DOB, SSN (if avail) on everything you send in Make sure codes & dates on cards and other immigration papers are legible Circle & write code/date in margin

New green cards –May 2010 Is country Cuba, Haiti, Iraq, Afghanistan, Vietnam, Canada? Does code show status not subject to 5 yr bar? Is date 5 or more years ago?

“Special status”legal immigrants “Special status” or “AWSS” are MassHealth terms for- Legal permanent residents & parollees during 5-year wait Persons residing in US under color of law (PRUCOL) but not “qualified” Known by Dept. of Homeland Sec. to be living in U.S. & DHS is not contemplating removal No federal matching funds (except for pregnant women & children)

Elderly & disabled AWSS For elderly & disabled AWSS adults under 100% fpl MH Essential plus Limited No home health or nursing home care For seniors, assets under $2000/$3000 Younger disabled must also have been unemployed for past 12 mos. (or EAEDC recipients) Will change in 2014

Commonwealth Care Subsidized insurance for adults through Connector Covers all otherwise eligible AWSS who are not eligible for MassHealth Will be replaced by new forms of coverage in 2014

PRUCOL Examples - Temporary Protected Status (TPS) Applicants for asylum Applicants for adjustment of status Living under orders of supervision Living in U.S. since Jan. 1, 1972 (Registry) Certain non-immigrants –K, S, U, V, R, & NEW H- 1B & H-4 Proof will sometimes be code on Employment Authorization card or I-94

Employment authorization card

Exercise # 3 Mr. Baptiste is 38 and from Haiti. She is diabetic & has some health problems. She shows you her work permit. Under the word “category” on her card it says “A-12.” Is she qualified? If not, is she eligible for any health benefits? What else do you need to know?

What about federal health reform? No change in Medicaid eligibility rules Starting in 2014 “lawfully present” immigrants with income under 400% of poverty will be able to purchase affordable insurance from Connector Undocumented cannot purchase through Connector or get tax credit

In 2014 Commonwealth Care will end “Lawfully present” will be able to Purchase insurance through the Connector Get refundable tax credits to lower premium costs Get cost-sharing subsidies to lower deductibles, and copays

Legislation in 2013 Expecting a bill to implement federal health reform Administration is proposing additional state subsidies to make new coverage as affordable as Commonwealth Care Unclear if elderly & disabled AWSS will remain in MassHealth or move to Connector

Lawful presence vs. PRUCOL in 2014 Most non-immigrants & most people with work permits will be considered lawfully present, includes students & others not now considered PRUCOL/AWSS Some now considered PRUCOL/AWSS will not be considered “lawfully present” e.g. applicants who don’t yet have work permits & DACA Proposal to retain state-funded coverage for PRUCOL who can’t use Connector

Safety net programs Health Safety Net: Acute hospital & CHC bills MassHealth Limited: Emergency care only Healthy Start: Prenatal care only CMSP: Primary care for children

Tips for completing application Never submit a false SSN If no pay stubs available to prove income Can submit letter from employer with wage & hour info. Can submit sworn statement with wage & hour info & explain no other form of proof is available Can submit tax return filed with ITN number

Info in materials on safety net programs “Health benefits available to ALL” –in English & Spanish

If an immigrant with papers is denied all but Health Safety Net… Get help from an experienced advocate to see if the denial of other benefits was correct Incorrect decisions can be appealed Health Care for All Help Line: Legal Aid Referral Line: MIRA Coalition:

Info in your materials NILC Guide section on immigration documents & codes Immigration section of MassHealth Member booklet MassHealth memos on identifying PRUCOL & Cuban-Haitian entrants & H1B & H4 update Proposed federal definition of “lawfully present” USCIS “fact sheet” on public charge-Mass. ed.

MassHealth Regulations Immigrant eligibility regulations 130 CMR § (B)-(D); § (for under age 65) 130 CMR § (B)-(D); § (for age 65+) Online at Under “MassHealth regulations and other publications” Under “MassHealth regulations” Under “Eligibility regulations”

Other sources of information Massachusetts Immigrants & Refugees Advocacy (MIRA) Coalition: National Immigration Law Center, Massachusetts Legal Services programs

State agencies Office of Medicaid Health Insurance Connector Division of Health Care Finance & Policy (info on Health Safety Net) Dept. of Public Health Dept. of Elder Affairs