Complicated benefit eligibility rules. Added complexity for - - PDF document

March 28, 2019 Katie Condon Grace & Vicky Pulos

• Complicated benefit eligibility

rules.

• Added complexity for

immigrant eligibility

• Language access
• Fears of adverse immigration

consequences:

• Removal
• Public Charge
• Changing federal landscape

increasing threats.

• To qualify for comprehensive MassHealth and to qualify to purchase

insurance through the Health Connector, people must satisfy both financial and non-financial eligibility criteria.

• Benefits available to U.S. citizens and eligible Immigrants:
• MassHealth
• Connector Care
• Safety net benefits with no citizenship/immigration requirements:
• Health Safety Net program (HSN)
• Children’s Medical Security Plan (CMSP)
• MassHealth Limited
• MassHealth Standard for Pregnant women.
• 5 Types of MassHealth Coverage:

1) MassHealth Standard:

• The “good” MassHealth

2) MassHealth CommonHealth:

• For certain disabled adults & disabled children with income too high for

Standard 3) MassHealth CarePlus:

• 2014 Medicaid expansion for 21-64 under Affordable Care Act

4) MassHealth Family Assistance:

• Includes CHIP for children in families with income too high for Standard
• Also the benefit for most “PRUCOL” immigrants.

5) MassHealth Limited:

• Emergency care for those not eligible for Standard/CarePlus due to

immigration eligibility rules (the only all-immigrant program)

• Private Insurance through Health

Insurance Connector

• Subsidized for individuals with

income from 0-300% FPL(Plan Types 1-3)& no access to other insurance

• 0-100% FPL (Plan Type 1) is only

for lawfully present immigrants not eligible for MassHealth due to its immigrant eligibility rules

• After being found eligible must

select a plan & pay any premium due by a deadline to be enrolled

• Qualified Aliens
• Not Barred
• Barred
• Lawfully Present Aliens
• Includes all Qualified aliens
• Plus added groups (Non-Qualified Lawfully Present)
• Persons Residing in the US Under Color of Law (PRUCOL)
• Used for immigrants who are not Lawfully Present but who are known to

USCIS and who DHS is not contemplating removing.

• Undocumented
• No status or out of status

Lawfully Present Undocumented PRUCOL Qualified – Not Barred Qualified - Barred More comprehensive health benefits

• For certain Qualified Aliens

(LPR, Paroled, battered), they must:

1. Have their qualifying immigration status for 5 years (“meet the 5-year bar”), or 2. Satisfy additional factors that exempt them from the 5-year bar.

• Until either of these occur,

they will be considered “Qualified – Barred”.

• After either of these occur,

then they will be considered “Qualified – Not Barred”.

• Group A - Some qualified aliens are never barred:
• Asylee;
• Refugee;
• Granted withholding of deportation or withholding of removal under

immigration laws;

• Veteran or active duty military and spouse, widow and dependent child/ren
• Cuban/Haitian entrant, including a Cuban or Haitian;
• Paroled into US after 1980
• Applicant for Asylum, or
• Subject to a non-final order of exclusion;
• American Indian born in Canada or other member of federally recognized

tribe;

• Victim of trafficking and his or her spouse, child, sibling, or parent;
• Conditional entrant granted before 1980;
• Group B – Qualified aliens who were subject to the 5 year bar but who are no longer barred

because they met the 5 years or additional factors exempt them from the 5-year bar:

• Legal permanent resident (LPR/Green Card Holder);
• Paroled into the U.S. for at least1 year; or
• Battered spouse and child/ren, or battered child and parent;
• Battered in US by US Citizen or Legal Permanent Resident spouse or parent, or family member or

spouse or parent,

• No longer living with abuser, and
• With approved or pending petition that will lead to permanent resident status (petition has been

found to establish a “prima facie case”). AND

• Had Permanent Resident/Paroled/Battered Immigrant status for 5 or more years; or
• Had such status for less that 5-years, but exempt from the 5-year bar because:
• Entered US prior to 8/22/96 (regardless of status at time of entry) & continuously present until

becoming Permanent Resident/Parolee/Battered Immigrant

• Veteran on Active Duty military and his/her spouse, widow, or dependent child/ren
• Iraqi or Afghan Special Immigrant
• American Indian born in Canada (or other member of federally recognized tribe)
• Cuban or Haitian who became a Legal Permanent Resident under certain special laws (not through a

family member or employer)

• Amerasian born in Vietnam during Vietnam War era
• Before becoming Legal Permanent Resident (LPR), individual was a:
• Refugee, Asylee, Granted withholding of deportation, Cuban Haitian Entrant, Trafficking Victim.

• Individuals with one of the

following statuses who have had that status for less than 5 years, or do not meet the exceptions on the previous slide, are considered “Qualified – Barred”:

• Lawful Permanent Resident

(LPR/Green Card holder)

• Paroled into the U.S. for at least one

year

• Battered Spouse and child/ren, or

battered child and parent

• Battered in US by US Citizen or Legal

Permanent Resident spouse or parent, or family member or spouse or parent,

• No longer living with abuser, and
• With approved or pending petition that

will lead to permanent resident status (petition has been found to establish a “prima facie case”).

• They have “not met the 5-year

bar” or are not exempt from it.

Using a Legal Permanent Resident Card (Green card) to Determine if Qualified Alien is Barred or Not Barred

If country is Cuba, Haiti, Iraq, Afghanistan, Vietnam, Canada – does exception apply? Does code show status not subject to 5 yr bar? Is date 5 or more years ago?

14

• All Qualified aliens (both Not Barred

and Barred) are Lawfully Present:

• Asylee;
• Refugee;
• Granted withholding of deportation or

withholding of removal under immigration laws (but not including CAT);

• Veteran or active duty military and spouse,

widow and dependent child/ren;

• Cuban/Haitian entrant;
• American Indian born in Canada or other

member of federally recognized tribe;

• Victim of trafficking and his or her spouse,

child, sibling, or parent;

• Conditional entrant granted before 1980;
• Amerasian born in Vietnam during Vietnam

War era, Iraqi or Afghan special immigrant;

• Legal permanent resident (LPR/Green Card

Holder);

• Paroled into the U.S. for at least 1 year, or
• Battered spouse and child/ren, or battered

child and parent;

• Battered in US by US Citizen or Legal

Permanent Resident spouse or parent, or family member or spouse or parent;

• Granted withholding of deportation or

removal under the Convention Against Torture (CAT);

• Individuals with valid non-immigrant

status (including worker visas, student visas, U-visas);

• Temporary Protected Status (TPS);
• Deferred Enforced Departure (DED);
• Deferred Action Status (NOT Deferred

Action for Childhood Arrivals – DACA is PRUCOL for health benefits purposes)

• Applicant for:
• Special Immigrant Juvenile Status;
• Adjustment to LPR status with an approved

visa petition;

• Victim of trafficking visa;
• Asylum who has either been granted

employment authorization, or is under 14 and has had an application for asylum pending for at least 180 days;

• Withholding of Deportation or Withholding of

Removal, under the immigration laws or under the Convention Against Torture (CAT) who has either been granted employment authorization, or is under 14 and has had an application for withholding of deportation or removal under the immigration laws or under CAT pending for at least 180 days;

• Granted administrative stay of

removal by the Department of Homeland Security (DHS);

• Lawful temporary resident;
• Individuals with employment

authorization under 8 CFR 274a.12(c) including:

• Registry applicants;
• Those under an order of supervision;
• Applicants for Cancellation of Removal of

Suspension of Deportation;

• Applicants for Legalization under IRCA;
• Applicants for Temporary Protected Status

(TPS);

• Persons granted legalization under the LIFE

Act.

• Remember : No 5-year bar to be

lawfully present. Category Code Expiration Date Alien Registration Number

• Granted indefinite stay of deportation;
• Granted indefinite voluntary departure;
• Have approved immediate relative petition, entitled to voluntary departure,

and whose departure the U.S. Department of Homeland Security (DHS) does not contemplate enforcing;

• Granted voluntary departure by DHS or an Immigration Judge, and whose

departure DHS does not contemplate enforcing;

• Living under order of supervision who do not have employment authorization

under 8 CFR 274a.12.(c);

• Have entered and continuously lived in the United States since before

January 1, 1972;

• Granted suspension of deportation, and whose departure DHS does not

contemplate enforcing;

• Have a pending application for Asylum under 8 USC 1158, or for

withholding of removal under 8 USC 1231, or under the Convention Against Torture (CAT), who have not been granted employment authorization, or are under the age of 14 and have not had an application pending for 180 days

• r more;
• Granted Deferred Action for Childhood Arrivals (DACA) or who have a

pending application for DACA;

• Have filed an application, petition, or request to obtain a lawfully present

status that has been accepted as properly filed, but who have noy yet

• btained employment authorization and whose departure DHS does not

contemplate enforcing;

• Any noncitizen living in the United States with the knowledge and consent of

DHS, and whose departure DHS does not contemplate enforcing.

• Entry without inspection
• Out of Status
• Visa overstay, etc.
• Not “eligible Immigrants”

for purposes of health benefits.

• For a complete list of

immigrant types & cites to regulations, see:

• Understanding the ACA in

Massachusetts: Immigrants’ Eligibility for MassHealth and other subsidized coverage, 2018.

• Additional materials.

Lawfully Present Undocumented PRUCOL Qualified – Not Barred Qualified - Barred More comprehensive health benefits

• Benefits available to U.S.

citizens and eligible Immigrants:

• MassHealth
• Connector Care
• Safety net benefits with no

citizenship/immigration requirements:

• Health Safety Net program

(HSN)

• Children’s Medical Security Plan

(CMSP)

• MassHealth Limited
• MassHealth Standard for

Pregnant women.

• MassHealth Limited:
• Emergency services only
• i.e. ambulance, ER, labor & delivery, dialysis
• Children’s Medical Security Plan (CMSP):
• Primary and preventative care only
• Health Safety Net program (HSN)
• Health Safety Net (HSN):
• Only acute hospitals and community health centers
• No defined benefits; debt relief
• 0-150% FPL full HSN; 150-300% FPL partial HSN (deductible)
• **Exception: MassHealth Standard for Pregnant women – during pregnancy

and 60 days post-partum**

• Same application for MassHealth, Connector & safety net

programs

• From page 8 of Member Booklet (Mar 2019):

What non U.S. citizens need to know about applying for MassHealth Limited, MassHealth coverage for pregnant women, CMSP, and the Health Safety Net Applications and the information on them will be kept confidential. This means that: Names and addresses will not be sent to immigration enforcement

• fficials

• Immigrants with an eligible

immigration status are eligible for MassHealth (depending on income).

• Type of MassHealth depends on

what “type” of immigrant a person is and their income.

• Only immigrants with an eligible

immigrant status who are lawfully present can apply for coverage through the Health Connector

• PRUCOL, even though “eligible

immigrant”, cannot apply for benefits through the Health Connector.

• Only lawfully present eligible

immigrants are eligible to obtain insurance through the Health Connector

• No PRUCOL
• No Undocumented
• Doesn’t distinguish between Qualified,

Qualified- Barred, Qualified- Not Barred

• ConnectorCare: Subsidized plans for

individuals with income from 0-300% FPL(Plan Types 1-3)& no access to

• ther insurance
• 0-100% FPL (Plan Type 1) is only for

lawfully present immigrants not eligible for MassHealth due to its immigrant eligibility rules

• All “eligible immigrants”

are potentially eligible for comprehensive MassHealth (depends on income).

• Unlike Health Connector,

includes PRUCOL.

• 5 Types of MassHealth Coverage:

1) MassHealth Standard:

• The “good” MassHealth

2) MassHealth CommonHealth:

• For certain disabled adults & disabled children with income too high for

Standard 3) MassHealth CarePlus:

• 2014 Medicaid expansion for 21-64 under Affordable Care Act

4) MassHealth Family Assistance:

• Includes CHIP for children in families with income too high for Standard
• Also the benefit for most “PRUCOL” immigrants.

5) MassHealth Limited:

• Emergency care for those not eligible for Standard/CarePlus due to

immigration eligibility rules (the only all-immigrant program)

• Mrs. Gutierrez came from El

Salvador 6 years ago with a green

• card. Her income is 125% FPL
• Is she eligible for MassHealth

Standard?

• What if she has lived in US for 6

years but only got her green card 3 years ago?

• What MassHealth would she be

eligible for?

• What if you learn she does not

have green card but has had a work permit with TPS for 6 years?

• What MassHealth would she be

eligible for?

• Ms. O’Neil was battered

by her LPR Spouse. She and her 7 year-old son moved out of the house and live together in an

• apartment. Ms. O’Neil has

a VAWA petition that has been pending for 6

• months. They have no

income.

• For what health benefits is
• Ms. O’Neil eligible?
• For what health benefits is

her son eligible?

• Susan is 26 & applied for

asylum 8 months ago, but has not yet gotten a work permit. She lives with relatives & has no income.

• For what health benefits is Susan

eligible?

• Susan gets her work permit, but

still has no job.

• Does this change the health

benefits for which she is eligible?

• Susan is granted asylum & is

working part-time .

• Does this change the health

benefits for which she is eligible?

• Joao is 15 years-old and he

entered the United States without inspection 8 years ago.

• What health benefits it Joao

eligible for?

• Joao applies for Special

Immigrant Juvenile Status and his case is pending.

• Does this change is health benefit

eligibility?

• Joao receives special immigrant

juvenile status and then adjusts to an LPR.

• Does this change is benefit

eligibility?

• Bill introduced in 2019 session of legislature to provide

comprehensive coverage to all children without regard to immigration status

• Bill No. HB 162 & SB 677, An Act To Ensure Equitable Health

Coverage for Children

• Lead sponsors: Rep. Dave Rogers & Sen Sal DiDomenico
• For more information contact

Natalie Litton Policy & Project Coordinator, Health Care for All (617) 275-2897 nalitton@hcfama.org

 Get copy of client’s immigration docs  Use tools in materials to figure out eligible status  Ask MassHealth/Connector what computer shows is client’s immigration status  Find out what info was submitted to MassHealth/Connector & how it was verified  Get info corrected informally or appeal

• MLRI fact sheet on safety

net benefits in English & Spanish

• Understanding the ACA

in MA: Immigrant Eligibility (2018)

• Enrollment assister info
• n maheathconnector.org

under “Help Center” & “Find Local Help”

• Refer to CAC or Navigator

if possible

• Health Care for All Help Line
• Mayor’s Health Line
• Local hospitals & community

health centers

• Other community-based
• rganizations

 Massachusetts Immigrants & Refugees Advocacy (MIRA) Coalition: www.miracoalition.org  National Immigration Law Center, www.nilc.org  Massachusetts Legal Services programs www.masslegalservices.org  MassHealth: www.mass.gov/masshealth  Connector: www.mahealthconnector.org

• Katie Condon Grace MetroWest Legal Services

kcondon@mwlegal.org · 508-620-1830 ext. 238

• Vicky Pulos Massachusetts Law Reform Institute

vpulos@mlri.org 617-357-0700 Ext 318