Individuals Within Mixed-Status Families Eligible Under the Affordable Care Act

1. Individuals Within Mixed-Status Families Eligible Under the Affordable Care Act

2. New Options for Immigrants Under the Affordable Care Act of 2010 (ACA) individuals who are “lawfully present” in the United States are now eligible for new affordable coverage options that started January 1, 2014. • US citizens • “Lawfully Present”

3. Immigrant Statuses that Qualify for Marketplace Coverage •Lawful Permanent Resident (LPR/Green Card holder) •Asylee •Refugee •Cuban/Haitian Entrant •Paroled into the U.S. •Conditional Entrant •Battered Spouse, Child and Parent •Trafficking Survivor and his/her Spouse, Child, Sibling or Parent •Granted Withholding of Deportation or Withholding of Removal, under the immigration laws or under the Convention Against Torture (CAT) •Temporary Protected Status (TPS) •Lawful Temporary Resident  

4. Cont. •Individual with Nonimmigrant Status (includes worker visas, student visas, and citizens of Micronesia, the Marshall Islands, and Palau) •Administrative order staying removal issued by the Department of Homeland Security •Member of a federally-recognized Indian tribe or American Indian born in Canada •Deferred Enforced Departure (DED) •Deferred Action Status* *EXCEPTION: Individuals granted deferred action under the Deferred Action for Childhood Arrivals (DACA) program are not eligible to enroll in coverage in the Marketplace.

5. Mixed-Status Families What is a mixed-status family? Mixed-status family refers to a household made up of individuals with different citizenship or immigration statuses, such as a family with an undocumented mom, a “lawfully present” dad, a child who is a US citizen because he or she was born in the United States.

6. Quick Guide to Immigrant Eligibility for ACA

7. Who is eligible for coverage in a mixed-status family? • Each member of a mixed-status family may be eligible for a different health insurance program and some members may not be eligible for any health insurance program. • Eligibility for private health insurance and the subsidies that make insurance more affordable also know as premium tax credits and cost sharing reductions through the ACA’s health insurance marketplace are only available to US citizens and people who are “lawfully present” in the US.

8. Undocumented Immigrants • No federal coverage • Not allowed to purchase private health insurance at full cost in a state insurance exchange • Not eligible for premium tax credits or lower copayments • Exempt from the individual mandate Citizen or lawfully present children of undocumented parents are eligible: • To purchase from state insurance exchange • For premium tax credits and lower copayments • Medicaid or Children's Health Insurance Program (CHIP)

9. Undocumented Immigrants cont. Undocumented Immigrants who do not meet the Medicaid immigration eligibility requirement or are not eligible to purchase through the marketplace can still apply for : • Emergency Medicaid • Immunizations • Community Health Centers/FQHCs • Migrant Centers • Others

10. Can an eligible member of a mixed family apply for Medicaid or a marketplace plan? YES! A person who is not eligible, such as an undocumented parent, may apply on behalf of eligible family members, including when the ineligible person is the head of household and the household’s primary tax return filer. Immigrants in general, and mixed status families in particular, often do no know what they may be eligible for and are worried about applying. They need reassurance from eligibility workers and other experts from whom they seek help.

11. Non applicant A non applicant is someone who is not applying for health insurance but who is in an applicants household. By law, the information required from a non applicant is limited because only information strictly necessary to determine an applicants eligibility may be required. • Should not be asked for their citizenship or immigration status • May say “I’m not applying for myself. I’m only applying for my child.” • Must provide information about their income • Will be asked for SSN, but do not have to provide one if they do not have one.

12. Key Points to remember about mixed-status families • An ineligible family member such as an undocumented parent may complete an application for an eligible member such as a US citizen child. • By law, individuals who are not applying for themselves are not required to provide information about their citizenship or immigration status and are not required to provide a Social Security number if one is not issued to them. • Information about applicants or members of their households obtained in order to determine eligibility will not be used by US Immigration and Customs Enforcement (ICE) for immigration purposes. ICE issued a clarification of this policy on 10/25/13 http://www.ice.gov/doclib/ero-outreach/pdf/ice-aca-memo.pdf

13. Do mixed-status families have to file tax returns because of the ACA? If a member of a mixed-status household is eligible for a premium tax credit to make health insurance more affordable under the ACA and enrolls in a health insurance, the household must file tax returns for the year in which they eligible person has health insurance. A tax return must be filed in order to “reconcile” the amount of the tax credit and so the applicant can be eligible for a premium tax credit when he or she renews his or her coverage for the following year. If the household’s primary tax filer is not eligible for a SSN, the household must file tax returns using an ITIN.

14. Example: Mom, who is undocumented, applies for health insurance for her US citizen son. The marketplace determines that they boy is eligible for a premium tax credit and he is enrolled in health insurance for 2014. Since they boy is eligible for a premium tax credit, mom must use an ITIN to file an income tax return for the 2014 tax year by April 15, 2015, tax filing deadline

15. Individual Mandate - Penalty 2014 • 1% of your yearly household income • $95 per person for the year ($47.50 per child under 18) 2015 • 2% of your yearly household income • $325 per person 2016 • 2.5% of your yearly household income • $695 per person

16. Public Charge Public Charge is a term used in immigration law that describes a person who cannot support themselves and who depends on benefits that provide cash for their income. Depending on your immigration status, the Department of Homeland Security can refuse to let you enter the US, reenter the US, or become a lawful permanent resident if they think you will not be able to support yourself without these benefits in the future.

17. Highlights of Public Charge • Use of Medicaid, CHIP, or other health programs by you or your family members will NOT affect the public charge decision. • Use of food stamps, WIC, public housing or other noncash programs by you or your family will NOT affect the public charge decision • Buying health insurance through the new health insurance marketplace and obtaining premium tax credits or cost sharing reductions that make coverage more affordable will not be considered in the public charge decision.

18. Important dates and Resources Open Enrollment for 2015 • November 15, 2014 – February 15, 2015 • Arizona Alliance for Community Health Centers – www.aachc.org • National Immigration Law Center – www.nilc.org • Health Insurance Marketplace - www.healthcare.gov • AZ Medicaid, Nutrition Assistance + more - www.healthearizona.org • Cover Arizona – www.coveraz.org

19. Thank You! David Aguirre, Arizona Alliance of Community Health Centers

20. Assisting Special Populations: People with Disabilities

21. How do Disability Rights Laws Affect the Operation of the Marketplace? • The 1990 Americans with Disabilities Act and the 2010 ADA Amendments Act along with Section 504 of the 1973 Rehabilitation Act prohibit discrimination against people with disabilities. • These laws apply to the programs delivered through the Marketplace, the federally conducted Marketplace infrastructure, andto the organizations that will assist consumers to learn about their healthcare insurance options.

22. How do Disability Rights Laws Affect the Operation of the Marketplace? Cont… Consumer education materials, websites, or other tools utilized for consumer assistance purposes must be accessible to people with disabilities including those with sensory impairments, such as visual or hearing impairments, and those with mental illness, addiction, and physical, intellectual, and developmental disabilities

23. What do Navigators Need to Know about Disability? As a CAC or NAV, your role is to help consumers obtain health insurance coverage, and you might also need to assist some people with Disabilities identify additional healthcare programs or services for which they might be eligible. Some local disability and affinity organizations are excellent resources That can assist or advise about programs such as Supplemental Security Income SSI), Social Security Disability Insurance SSDI), Medicare, Pharmaceutical assistance programs,and Medicaid home and community-based services (HCBS).

24. Plan Ahead • It is best to build relationships with support groups in advance. Make contact with organizations when you are in the early stages of planning for an outreach event or developing written materials, so when the need arises you will have ready access to referral services.

25. What is disability Etiquette? • While some disabilities are visible, others are hidden. • People with functional impairments may not see themselves as someone with a disability. • Always be respectful and avoid referring to someone by his/her disability. • Use “people first” language – person with a disability. • Be willing to spend extra time, if necessary.

26. Consumers with Disabilities: Who Are They? Workers with Disabilities • Includes some previously excluded from individual or small business insurance due to preexisting condition discrimination or lifetime limits • Individuals on SSDI in the two year Medicare Waiting Period. • Families with dependents under age 26 with • disabilities

27. Visual Impairment People with visual impairments or who are blind might require print materials in accessible formats such as Braille, audio, digital, or large print formats. Or people who are deaf or hard of hearing might require Sign Language interpreters in order to ensure effective communication.

28. How can local disability and affinity org’s help you? For example, local disability and affinity organizations can help you learn how to arrange and pay for appropriate accommodations that some people might need to understand their health insurance options.

29. Hearing Impairment • Who can help me if my organization needs to hire a Sign Language interpreter or a transcription service? • Many local groups are good resources on specific topics and issues. For example, deaf service organizations, such as associations of the deaf, can help identify qualified Sign Language interpreters for hire and other communications services such as Communications Access Real time Translation (CART), the instant translation of the spoken word into English text.

30. What types of organizations should I know about? Disability organizations can be local, regional or national in scope and vary in mission and purpose from locale to locale. Here are some examples of: • national organizations that have chapters or affiliates in many locations, • local organizations that belong to a national membership group:

31. Disability Organizations Centers for Independent Living are community-based, cross-disability, non-profit organizations that are designed and operated by people with disabilities. • All Centers for Independent Living provide the same core services: peer support, information and referral, and individual and systems advocacy. Centers generally also have expertise in helping people with disabilities apply for federal programs such as SSI and SSDI, and home and community-based services.

32. Who to contact in my area New Horizons ILC 8085 East Manley Prescott Valley, AZ 86314 http://www.newhorizonsilc.org/ Phone Numbers: Local: (928) 772-1266 Toll-free: (800) 406-2377 Accessible: (928) 772-1266 Accessible Phone Type: TTY Counties Served: Mohave, Yavapai, Coconino, Navajo, Apache Arizona Bridge to Independent Living (ABIL) 5025 East Washington Phoenix, AZ 85034 www.abil.org Phone Numbers: Local: (602) 296-0513 Accessible: (602) 296-0591 Accessible Phone Type: TTY Counties Served: Maricopa and parts of Pinal, Gila, Mojave SMILE Independent Living Center 1935 South Arizona Avenue Suite 4 Yuma, AZ 85364 http://www.smile-az.org Phone Numbers: Local: (928) 329-6681 Toll-free: (866) 239-7645 Accessible: (928) 782-7458 Accessible Phone Type: TTY Counties Served: Yuma, La Paz DIRECT Center for Independence, Inc. 1023 North Tyndall Avenue Tucson, AZ 85719 http://directilc.org/ Phone Numbers: Local: (520) 624-6452 Toll-free: (800) 342-1853 Accessible: (520) 624-6452 Accessible Phone Type: TTY Counties Served: Pima, Graham, Greenlee, Santa Cruz, Cochise

33. Support for specific disabilities • The Arc is the largest national community-base advocating for and serving people with intellectual and developmental disabilities and their families. • The National Alliance on Mental Illness (NAMI) is the nation’s largest grassroots mental health organization with 1000 affiliates across the country. • The National Multiple Sclerosis Society (NMSS)conducts research and advocacy, and operates programs and services for people living with MS. • United Spinal Association’s works to improve the quality of life of all people living with a spinal cord injury or disease. United Spinal provides active-lifestyle information, peer support and advocacy, which empower individuals to achieve their highest potential in all facets of life. • The Lighthouse provides resources and information for people with vision loss. • The American Council of the Blind shapes policies that affect people who are blind. • The National Association of the Deaf (NAD) is a leading civil rights organization for people who are deaf and hard of hearing.

34. Resource Page Register & Create an account • http://www.ilru.org/projects/cil-net/cil-center-and-association-directory • http://www.adrc-tae.acl.gov/tiki-index.php?page=HomePage • http://www.thearc.org/Page.aspx?&pid=292 • http://www.nationalmssociety.org/Chapters • http://www.spinalcord.org/nscia-support-groups/location/arizona/ • http://www.lighthouse.org/resources/help-near-you/ • http://acb.org/node/72 • http://hab.hrsa.gov/gethelp/index.html • http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and-SupportS/Home-and-Community-Based-Services/Home-and-Community-Based-Services.html

35. Thank You! Marco Mendoza Program Manager – Keogh Health Connection mmendoza@keoghhealth.org