IMMIGRANTS AND HEALTH CARE IN CALIFORNIA: ELIGIBILITY ENROLLMENT CHALLENGESCOSTS OF BEING UNINSURED

Gabrielle Lessard

National Immigration Law Center

Who We Are

National Immigration Law Center (NILC) Our mission is to defend & advance the

rights & opportunities of low-income immigrants and their family members.

We provide publications, offer technical assistance and training, and engage in advocacy and strategic litigation.

3 Eligibility

Major Health Coverage Options

Covered California state health insurance marketplace/exchange

Medi-Cal Full-scope Limited-scope

Emergency, pregnancy, etc. Services open to all

Includes emergency Medi-Cal, community health centers, some county programs

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Eligibility for Medi-Cal

Full scope:Qualified immigrantsPRUCOLsLawfully present children

Limited scope (most often emergency or pregnancy):

Others

All must meet income and residency requirements

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Qualified Immigrants

Lawful permanent residents, or LPRs (persons with green cards).

Refugees, persons granted asylum or withholding of deportation/removal, and conditional entrants.

Persons granted parole by the Department of Homeland Security (DHS) for a period of at least one year.

Cuban and Haitian entrants. Certain battered immigrants, their children, and/or

their parents. Certain victims of trafficking.

For the complete list see Overview of Immigrant Eligibility for Federal Programs at: http://www.nilc.org/table_ovrw_fedprogs.html

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PRUCOL

Permanently Residing Under Color of Law - not an immigration status, but a benefit eligibility category (see MC 13 Form – Statement of Citizenship, Alienage, and Immigration Status). May include persons:

with approved immediate relative visa petition

who filed application for adjustment to LPR status

granted deferred action (including DACA)

granted Family Unity status

granted a stay of deportation

who have lived in the US continuously since before Jan. 1, 1972

who are survivors of domestic violence (certain immigrants)

Other persons in the US with the knowledge of DHS whose departure that agency does not contemplate enforcing.

State Residency

Live in CA with intent to reside here, or

Live in CA and entered State with job commitment or to seek employment, whether or not currently employed.

Children generally assume the residence of their parents, with an opportunity to establish state residence independently.

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Eligibility for Covered California

Lawfully Present

Qualified

lawfully present immigrants are eligible to purchase health coverage through state health care marketplaces

exception:People who received deferred action through DACA are specifically excluded

Lawfully Present Noncitizens

• All “qualified” immigrants

• Others authorized to live and/or work in the U.S., e.g. • temporary protected status (TPS)• most with deferred action

• Applicants for: adjustment to LPR and certain other statuses• Asylum applicants with employment authorization• Family immigrants with available visa

• Individuals with valid nonimmigrant status• Students, workers, etc.• May not satisfy the residency requirement

Complete list:

https://www.healthcare.gov/immigration-status-and-the-marketplace/

11 Enrollment Challenges

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Barriers

Confusion about eligibility Problems in application process Language access issues Lack of information/misinformation

Concern that receiving benefits or having medical debt will interfere with ability to naturalize or adjust status (“public charge”)

Fears about jeopardizing family members Belief that benefits will need to be repaid by recipient

or sponsor

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Public Charge

“Public charge”: likely to become primarily dependent on government for

subsistence, as demonstrated by: receipt of public cash assistance for income maintenance or institutionalization for long-term care at government expense

“Totality of circumstances”: age, health/disability, income, education, job/skills,

family situation and affidavit of support

Can result in denial of: Admission to U.S., or adjustment to Lawful permanent resident status But not relevant for citizenship applicants, asylees, survivors of

domestic violence, trafficking, serious crime, etc.

Not relevant in public charge determinations: Medical benefits other than long-term care Non-cash benefits (e.g., SNAP, WIC) “earned benefits” or cash for food, housing, child care, etc.

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Immigration Enforcement

Information provided on applications is confidential Information about immigration status may be used only to determine an applicant’s

eligibility for health care coverage.

U.S. Immigration and Customs Enforcement (ICE) has released a notice stating that

information provided in health insurance application process will not be used for civil

immigration enforcement On October 25, 2013, U.S. Immigration and Customs Enforcement (ICE) issued a

memo titled “

Clarification of Existing Practices Related to Certain Health Care Information,”

confirming that immigrant parents can enroll their U.S. citizen children and other

eligible family members in health insurance programs under the ACA without triggering

immigration enforcement activity.

http://www.ice.gov/doclib/ero-outreach/pdf/ice-aca-memo.pdf

http://www.ice.gov/espanol/factsheets/aca-memoSP.htm

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Information Provided to Covered CA

People submitting application must provide basic information about all members of the tax household. Subsidies are based on tax household income

Only individuals who are applying for coverage are required to provide their immigration/citizenship status.

The Social Security Number (SSN) of a non-applicant may be requested to electronically verify household income. 

A non-applicant can be required to provide an SSN only if that person is: a primary tax filer, who has an SSN, and is applying for tax credits.

Key Issues for Mixed-Status Families

• Undocumented people may apply for coverage on behalf of their dependent family members Applications should distinguish between applicants (e.g., U.S.

citizen child) & non-applicants (e.g., undocumented parent) Non-applicants are not required to provide their immigration

status Non-applicants without SSNs cannot be required to provide one

Never provide an SSN unless officially issued by the Social Security Administration

Individual Taxpayer Identification Numbers (ITINs) should not be used

Information provided on an application may be used ONLY to determine eligibility for health insurance.

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17 Costs of Being Uninsured

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Individuals

Uninsured people live sicker and die younger Diagnosed in later stages of disease

cancer More likely to die from accidents and acute

conditions Heart attack, stroke

Less likely to know they have asymptomatic conditions HIV, diabetes, high blood pressure

More likely to have medical debt More likely to miss work or retire early due to

illness

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Health Care System

Hospitals tend to terminate less profitable services These are generally services used by the uninsured

Emergency, maternity, psychiatric Health and hospital systems invest in areas

with more insured residents Doctors generally prefer newer facilities and

equipment Hospitals with older facilities have more difficulty

recruiting on-call specialists, resulting in longer wait times for everyone

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National Immigration Law Center: Www.Nilc.Org

lessard@nilc.org