Immigrants and the Affordable Care Act

1. Immigrants and the Affordable Care Act September 18, 2013 Kate Laner Northwest Justice Project (206) 464-1519 katel@nwjustice.org

3. 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)

4. Immigrant Eligibility and the ACA:3 General Groups • US Citizens and Nationals • “Lawfully Present” immigrants • Qualified • Non-Qualified • Immigrants not Lawfully Present

5. 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

6. 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.

7. Immigrant Eligibility – Lawfully Present Immigrants • “Lawfully present” definition for federal benefits can be found at: http://www.dshs.wa.gov/manuals/eaz/sections/CitizenshipAndAlienStatus/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/CitizenshipAndAlienStatus/CitizenGenElig.shtml (see note 7 of clarifying info).

8. 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

9. 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

10. 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

11. 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

12. Resources • Numerous articles on immigrant eligibility under the ACA at www.nilc.org • Community education publications on immigrant eligibility for benefits in WA state found atwww.washingtonlawhelp.org