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Health care access for immigrants

Health care access for immigrants. March 6, 2013 Vicky Pulos, MLRI vpulos@mlri.org ; 617-357-0700 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.

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Health care access for immigrants

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  1. Health care access for immigrants March 6, 2013 Vicky Pulos, MLRI vpulos@mlri.org; 617-357-0700 Ext. 318

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

  3. 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

  4. 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

  5. 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?

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

  7. 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

  8. Regulation-free zone for lawfully present pregnant women & children • Lawfully present pregnant women & children eligible since 2009 • August 2009 Eligibility Ops memo 09-11 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

  9. “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

  10. 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?

  11. 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)

  12. 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

  13. 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

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

  15. “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)

  16. 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

  17. 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

  18. 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

  19. Employment authorization card

  20. 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?

  21. 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

  22. 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

  23. 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

  24. 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

  25. 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

  26. 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

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

  28. 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: 800-272-4232 • Legal Aid Referral Line: 800-342-5297 • MIRA Coalition: 617-350-5480

  29. 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.

  30. MassHealth Regulations • Immigrant eligibility regulations • 130 CMR § 504.002(B)-(D); § 505.008 (for under age 65) • 130 CMR § 518.002(B)-(D); § 519.009 (for age 65+) • Online at www.mass.gov/masshealth • Under “MassHealth regulations and other publications” • Under “MassHealth regulations” • Under “Eligibility regulations”

  31. Other sources of information • Massachusetts Immigrants & Refugees Advocacy (MIRA) Coalition: www.miracoalition.org • National Immigration Law Center, www.nilc.org • Massachusetts Legal Services programs www.masslegalservices.org

  32. State agencies • Office of Medicaid www.mass.gov/masshealth • Health Insurance Connector www.mahealthconnector.org • Division of Health Care Finance & Policy (info on Health Safety Net) www.mass.gov/dhcfp • Dept. of Public Health www.mass.gov/dph • Dept. of Elder Affairs www.mass.gov/elders

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