Barriers to Immigrants’ Access to Health Insurance and Health Care

1. Barriers to Immigrants’ Access to Health Insurance and Health Care • Legal barriers - http://nilc.org/access-to-bens.html • Confusion around eligibility rules -http://nilc.org/immigrantshcr.html; http://nilc.org/immigrantshcrsp.html; https://www.healthcare.gov/what-do-immigrant-families-need-to-know/ • Public charge - http://nilc.org/pubcharge.html • Sponsor deeming and liability - http://nilc.org/affidavits.html • Verification & documentation - http://nilc.org/document.html?id=35; https://www.healthcare.gov/help/immigration-document-types/; https://www.healthcare.gov/help/citizenship-and-immigration-status-questions/ • Confidentiality and reporting fears - http://www.ice.gov/doclib/ero-outreach/pdf/ice-aca-memo.pdf • Linguistic and cultural barriers - https://www.cuidadodesalud.gov/es/; http://marketplace.cms.gov/getofficialresources/other-languages/other-languages-materials.html; http://www.hhs.gov/open/execorders/13166/index.html • Fear of immigration enforcement - http://www.ice.gov/doclib/ero-outreach/pdf/ice-aca-memo.pdf • Residency and other program requirements

2. Who’s Eligible for Federal Non-emergency Medicaid and CHIP? Two categories of immigrants for federal benefits eligibility purposes under “welfare reform” (PRWORA of 1996): • ELIGIBLE = “Qualified”: Categories defined by statute – • LPRs, refugees, asylees, parolees, Cuban/Haitian entrants, certain DV and trafficking survivors and their derivatives, certain conditional entrants • Qualified immigrants who entered the U.S. on or after August 22, 1996 must wait at least five years in qualified status (also known as the “five-year bar”) • Some exemptions • NOT ELIGIBLE = “Not qualified”: Anyone who is not a citizen or “qualified” immigrant, such as— • Undocumented immigrants • PRUCOLs (other lawfully present individuals) • Temporary visa holders

3. Exceptions in Medicaid and CHIP • In 2002 HHS granted states the option to provide prenatal services to pregnant women under the “unborn child” option in CHIP. • See NILC coverage maps at http://www.nilc.org/healthcoveragemaps.html • CHIPRA of 2009 granted states the option to provide Medicaid/CHIP to “lawfully present” children and pregnant women and waive the 5-yr bar -http://nilc.org/facts-chipra.html • State variation - http://www.nilc.org/document.html?id=159 • Medicaid for treatment of emergencies available if not eligible for Medicaid based on immigration status • Emergency Medicaid expands as Medicaid expands, with full FMAP - http://www.medicaid.gov/Federal-Policy-Guidance/downloads/FAQ-12-27-13-FMAP-Foster-Care-CHIP.pdf (Q #5)

4. Health Coverage for Pregnant Women | January 2014 ME WA VT ND MT NH MI MA NY OR MN RI WI CT MI SD ID NJ PA WY OH IA DE WV VA NE MD DC IL IN NV UT CO KY CA CA KS MO NC TN SC OK AR AZ NM GA AL MS TX LA Alaska FL Hawaii

5. Health Coverage for Immigrant Children | January 2014 ME WA VT ND MT NH MI MA NY OR MN RI WI CT MI SD ID NJ PA WY OH IA DE WV VA NE MD DC IL IN NV UT CO KY CA CA KS MO NC TN SC OK AR AZ NM GA AL MS TX LA Alaska FL Hawaii

6. Immigrants and the ACA “Lawfully Present” Individuals • On road to citizenship (e.g., Lawful Permanent Resident (LPR)) • Permission to stay indefinitely in the U.S. without pathway to citizenship (e.g., TPS) • Permission to stay temporarily (e.g., visa holders) • Exception: DACAmented individuals http://www.nilc.org/acadacafaq.html • See https://www.healthcare.gov/immigration-status-and-the-marketplace/ Undocumented • Individuals who lost permission to remain in the U.S., or entered the U.S. without permission ----------------------------- • Emergency Medicaid • No Marketplace/Exchange access • No ACA subsidies • Exempt from individual mandate • Remain eligible for FQHCs and other programs available regardless of status

7. Immigrant Eligibility for Medicaid/CHIP/ACA