Two Important Goals Ensure that we are Ensure that we are - - PDF document

1

New York State Immigrant Eligibility for Medicaid

1 This has been compiled from the following sources: New York State published policies and procedures, Research Foundation of SUNY/BSC/CDHS, CAI

Objectives

• Interpret immigrant eligibility guidelines for

government funded health insurance programs

• Identify the different immigration statuses
• Recognize immigrants’ concerns
• Review acceptable forms of documentation
• Understand WMS coding for each

immigration category

2

Two Important Goals

3

Ensure that we are providing the type of Medicaid coverage that the applicant/recipient is eligible for Ensure that we are claiming Federal Financial Participation when we can

• Rev. 3.28.16

2

4

Is it a Pregnant Woman?

Do they have all of the documentation that we need?

Are they a Non- Immigrant? Do they pass the Residency Review test?

Federal Immigration Agencies

• There are 2 Federal Immigration Agencies

under the Department of Homeland Security:

– USCIS: United States Citizenship and Immigration Services – ICE: Immigration and Customs Enforcement

• Within the Department of Justice there is:

– EOIR: Executive Office of Immigration Review

5

Who is Eligible?

• To be eligible for MA an individual must be

a U.S. Citizen, U.S. National, Native American, an immigrant in “satisfactory immigration status” or a temporary non- immigrant who is lawfully present and a NYS Resident

6

• Rev. 3.28.16

3

Immigrants

• All immigrants in a satisfactory immigration

status or temporary non-immigrants who are lawfully present and NYS Residents may be eligible for Medicaid as long as the applicant meets the other eligibility requirements of the program

7

What is Satisfactory Immigration Status?

• “Satisfactory immigration status” is defined

as an immigration status that does not make the individual ineligible for benefits under the applicable program

8

Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA)

• PRWORA identified certain categories of

immigrants who were not eligible for federally funded public programs if they:

– Entered the U.S. on or after August, 22 1996 and – Have not resided in the U.S. in a qualified alien status for at least five years

• This is known as the “federal five year

ban”

9

• Rev. 3.28.16

4

PRWORA

• Established new immigration categories

– Qualified Aliens were eligible for public programs

• Established five year ban on application for public

programs for some groups

– Non-Qualified Aliens were not eligible for public programs

• Includes PRUCOL

10

Aliessa v. Novello and Adamolekun v. Novello Court Cases

• Restored Medicaid coverage to residents
• f NYS who were:

– Qualified Aliens who entered the U.S. on or after August 22, 1996 who were otherwise subject to the federal five year ban – PRUCOLs regardless of when they entered the U.S.

11

Aliessa v. Novello and Adamolekun v. Novello Court Cases, cont'd.

• Since these groups are outside the federal

legislation, they do not have federal financial funding for their medical costs under Medicaid while in the five year ban

– Medicaid is state funded during the first five years

• All NYS immigrants in satisfactory

immigration status are eligible for Medicaid, if otherwise eligible

12

• Rev. 3.28.16

5 Who has Satisfactory Immigration Status?

• Satisfactory immigration status in NYS

includes:

– Qualified Aliens – PRUCOL

13 14

Documentation Guide

• Category 1: U.S. Citizens
• Category 2: Qualified Aliens
• Category 3: Persons who are

Permanently Residing in the U.S. Under Color of Law (PRUCOL)

• Category 4: Non-Immigrants
• Category 5: Undocumented Aliens

15

• Rev. 3.28.16

6

Citizens (Category 1)

• U.S. Citizens include:

– Individuals born in the United States – Naturalized U.S. citizens – U.S. Nationals

16

Citizens (Category 1), cont’d.

• U.S. Citizens also include:

– Native Americans (Category 2 on Documentation Guide)

• Includes Native Americans born in Canada or

belonging to a federally recognized tribal group

– For a list of federally recognized tribal groups go to: http://www.bia.gov/cs/groups/public/documents /text/idc1-029079.pdf

17

Identifying Immigrant Categories

18

• Rev. 3.28.16

7

Qualified Aliens

Category 2

19

Qualified Aliens

• Qualified aliens are persons who usually

live and work here with the permission of the federal immigration agency

• No five year waiting period for health

benefits

• Some immigrants are not eligible for

Medicaid benefits with Federal Financial Participation

20

Qualified Aliens – Not Subject to the Federal Five Year Ban - FFP

• Refugees
• Asylees
• Persons granted withholding of deportation or

removal

• Cuban/Haitian Entrants
• Amerasians
• Victims of a Severe Form of Human

Trafficking

• Veterans or active U.S. Armed Forces and

their immediate family members

21

• Rev. 3.28.16

8 Qualified Aliens – Subject to Federal Five Year Ban - FNP

• Lawful Permanent Residents (“Green Card”

holders/LPR’s)

• Parolees admitted into the U.S. for at least
• ne year
• Victims of Battery/Abuse and their

dependents

22

Refugee Medical Assistance (RMA)

• Refugee Medical Assistance is a Federal

program available to certain refugees:

– Must be ineligible for “regular” Medicaid – Primarily limited to single individuals or childless couples

• Eligible for ADC-R budgeting under this program
• Allowed to spend down for RMA

– Not full time students – Limited time period (8 months)

23

RMA, cont’d.

• The term “refugee” includes the following

groups:

– Refugees – Asylees – Cuban and Haitian entrants – Amerasians – Federally certified victims of a severe form of human trafficking – Certain family members of certified trafficking victims – Special Immigrant Visa – May include other groups – see 10 OHIP/INF 02

24

• Rev. 3.28.16

9

Eligibility and Funding

• If eligible for “regular” Medicaid

– Costs shared between state, local and federal governments – Authorize Medicaid coverage for 12 months without regard to RMA

• If eligible only through RMA

– 100% federally reimbursable – Authorize up to 8 months of coverage – State/Federal Charge Code 30 or 31 required

25

Redetermination After RMA Coverage

• Using standard Medicaid rules,

redetermine refugee’s eligibility

– Single refugees who are not parent/caretaker relatives no longer have access to ADC budgeting methodology

• If eligible for Medicaid, remove the S/F

Charge code of “30” and enter correct code if applicable

26

Case Examples

27

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10

PRUCOL

Category 3

28

PRUCOL

P= Permanently ► Residing in the U.S. with the intent to remain R= Residing ► Living in New York State (resident) U= Under C= Color O= of ► Some legal basis for L= Law being in the country

29

PRUCOL, cont'd.

• People who are living in the United States

with the federal immigration agencies’ knowledge and permission or acquiescence

• The federal immigration agencies are not

taking steps to deport or remove the immigrant, at least for the time being

30

• Rev. 3.28.16

11

PRUCOL, cont'd.

Two groups:

• “knowledge and permission”
• “knowledge and acquiescence”

– Acquiescence is to agree by default or inaction

31

PRUCOL Aliens

• PRUCOL Aliens are not eligible for federal

funding

– Except pregnant women and children under 21 in certain immigrant categories

• This is true regardless of the amount of

time they have lived in the U.S.

32

PRUCOL Aliens, cont’d.

• Persons paroled into the U.S. for less than

a year

• Persons under an Order of Supervision
• Persons granted an indefinite stay of

deportation

• Persons granted an indefinite voluntary

departure

• Persons “by the petition” of an immediate

relative

33

• Rev. 3.28.16

12

PRUCOL Aliens, cont'd.

• Persons who have applied for an

adjustment of status to lawful permanent resident under section 245

• Persons granted stays of deportation
• Persons granted voluntary departure status

under Section 242(b)

• Persons granted deferred action status
• Persons who entered and continuously

resided in U.S. before 1/1/72

34

PRUCOL Aliens, cont'd.

• Persons granted suspension of deportation

pursuant to Section 244 of INA; USCIS does not contemplate departure

• Others living in U.S. with knowledge and

permission or knowledge and acquiescence of USCIS and whose departure the USCIS does not contemplate enforcing

• Deferred Action for Childhood Arrivals (DACA)
• Special Immigrant Juveniles (SIJ)

35

Others Living in the U.S. with Knowledge and Permission or Acquiescence of USCIS

• This category includes any non-citizen

who can document/verify that the USCIS knows that the immigrant is residing in the U.S., and

• Can document/verify that the USCIS has

either granted them permission to remain in the U.S. or has knowledge of their presence (acquiescence)

36

• Rev. 3.28.16

13

Others Living in the U.S. with Knowledge and Permission or Acquiescence of USCIS, cont’d.

• Applicants for adjustment of status to LPR,

asylum, suspension of deportation, cancellation of removal, or requesting deferred action

• Persons granted Deferred Enforced Departure

due to conditions in their home country

• Permanent non-immigrants pursuant to PL 99-

239 that applies to citizens of Micronesia and the Marshall Islands

37

Others Living in the U.S. with Knowledge and Permission or Acquiescence of USCIS, cont’d.

• Persons granted or who have applied for

Temporary Protected Status

– Granted to citizens of countries where:

• There is an ongoing armed conflict where return of

nationals to that state would pose a serious threat to their personal safety;

• An environmental disaster has occurred resulting in a

substantial, temporary disruption of living conditions, and the state has requested TPS designation;

• Extraordinary and temporary conditions exist that

prevent nationals from returning safely

38

Others Living in the U.S. with Knowledge and Permission or Acquiescence of USCIS, cont’d.

• Visas for Special Non-Immigrants

(Category 4 in Desk Aid)

– K – Spouses, fiancées, and children of U.S. citizens – N – Parents or children of Special immigrants – R – Religious Workers and their children – S – For informants and their children providing critical information about a criminal organization or terrorism

39

• Rev. 3.28.16

14

Others Living in the U.S. with Knowledge and Permission or Acquiescence of USCIS, cont’d.

• Visas for Special Non-Immigrants, cont'd.

– T – Victims of Severe Form of Human Trafficking – U – Victims of certain criminal activities and their family including parents – V – Spouses and children of Lawful Permanent Residents – There are other groups of immigrants that may fall into this category

40

Deferred Action for Childhood Arrivals (DACA)

• Certain immigrants who came to the U.S.

as children (through no fault of their own) may request consideration of deferred action for a period of two years

– Subject to renewal

• Does not provide lawful status
• Eligible for state-funded MA as PRUCOL

41

Special Immigrant Juveniles (SIJ) Status

• Status intended for foreign children who are

in the U.S. that have been abused, abandoned or neglected and the court has decided they cannot return to their home country or their parent

– Unmarried child under 21 – Will have a state court order in effect when filing Form I-360 (Petition for Amerasian, Widow(er), or Special Immigrant) – Considered PRUCOL while I-360 is pending

42

• Rev. 3.28.16

15 Special Immigrant Juveniles (SIJ) Status, cont’d.

• Once the individual is granted an I-551

(Green Card) they are considered a Lawful Permanent Resident

– Refer to Qualified Alien (Category 2)

43

Essential Health Plan

16 OHIP/ADM-01

44

ACA and The Essential Plan

• Essential Plan in NYS offers health

coverage for:

– Individuals with MAGI income >138% ≤ 200% FPL; or – Individuals with MAGI income 0% ≤ 200% who are lawfully present in the U.S. but do not qualify for FFP MA due to immigration status

• NYS receives federal funding

45

• Rev. 3.28.16

16 Essential Plan for Lawfully Present Immigrants

• Lawfully present immigrants who are

eligible for EP include:

– Qualified aliens in the five-year ban; – PRUCOL; and – Temporary non-immigrants meeting residency requirements

46

Essential Plan for Lawfully Present Immigrants, cont’d.

• For lawfully present immigrants in the

MAGI category who:

– Have MAGI income at or below 138% FPL; – Were not otherwise eligible for FFP due to immigration status (“Aliessa” immigrants); – Are between the ages of 21-64; and – Are not pregnant

47

Essential Plan for Lawfully Present Immigrants, cont’d.

• Immigrants who are pregnant or are under

21 years of age, and are in the first five years of their qualified status or are PRUCOL, are eligible for FFP and, therefore, are not eligible for EP and will remain in Medicaid

48

• Rev. 3.28.16

17 Essential Plan for Lawfully Present Immigrants, cont’d.

• To be eligible for the Essential Plan (EP)

an individual must also:

– Be a NYS resident – Not be receiving long term care services – Not be eligible for Medicare, employer sponsored health insurance or other TPHI

49

Non-Immigrants

Category 4

50

Non-Immigrants

• Temporary Non-Immigrants
• Special Non-Immigrants

51

• Rev. 3.28.16

18

Temporary Non-Immigrants

• Lawfully admitted to U.S.
• Will stay in U.S. temporarily or for a

specific time period

• Issued a visa by U.S.

52

Medicaid for Temporary Non-Immigrants

• May be eligible for Medicaid if lawfully

residing in NYS (GIS 16 MA/02)

– Applies to all temporary non-immigrants who are “lawfully present”

• Must be in a valid non-immigrant category
• Must not have violated the terms of the status

under which s/he was admitted to the U.S.

– NYS residency based on results of the Residency Review Worksheet

53

Medicaid for Temporary Non-Immigrants, cont’d.

• Residency Review Worksheet is used to

determine if the temporary non-immigrant is a resident of NYS

– Completion of this form is a condition of eligibility – Documentation required for any “yes” response

• Allow 15 days to provide proof of residency

54

• Rev. 3.28.16

19 Medicaid for Temporary Non-Immigrants, cont’d.

• If the individual passes the residency

review, provides documentation and is

• therwise eligible they will be eligible for

Medicaid

– Authorize coverage using PRUCOL codes – Refer to OHIP-0046 and WMS System Entries guide to determine appropriate codes

55

Emergency Medicaid for Temporary Non-Immigrants

• Many temporary non-immigrants do not qualify

for Medicaid because they have not established residency in New York State

– Did not pass the residency review

• These temporary non-immigrants are only

eligible for Medicaid for the treatment of an emergency medical condition

– Federal funding is available for these cases

• This policy also applies to pregnant women

who are known to be temporary non- immigrants and fail the residency review test

56

Exceptions for Non-Immigrants

• Special Non-Immigrants:

– Non-immigrant visa statuses allow a visa holder to work in the United States and eventually adjust to lawful permanent resident status

• Visas K, N, R, S, T, U, V

– These individuals would be considered PRUCOL

57

• Rev. 3.28.16

20 Victims of Trafficking (T visas)

• Per 04 OMM/ADM-7 these special non-

immigrants may receive Medicaid benefits to the same extent as refugees

– Including eligibility for Refugee Medical Assistance (RMA)

• Refer to Category 2: Qualified Aliens -

Victims of a Severe Form of Human Trafficking

58

Undocumented Aliens

Category 5

59

Undocumented Aliens

• Immigrants who:

– Are unable to provide documentation because they have entered the U.S. without inspection/paperwork OR – Lawfully entered the United States, but have violated the terms of their status

• Only eligible for Medicaid for treatment of

an emergency medical condition

60

• Rev. 3.28.16

21 Undocumented and/or Non-Immigrant Children

• May be eligible for Child Health Plus, if

they meet certain requirements

61

Medicaid Coverage for the Treatment

• f an Emergency Medical Condition
• Physician no longer required to complete

the DOH-4471 “Certification of an Emergency Medical Condition”;

• Individuals may apply without an existing

emergency medical condition

• 12-Month Authorization

62

Medicaid Coverage for the Treatment

• f an Emergency Medical Condition,

cont’d.

• A medical condition (including emergency labor

and delivery) manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in:

– Placing the patient’s health in serious jeopardy; – Serious impairment to bodily functions; or – Serious dysfunction of any bodily organ or part

63

• Rev. 3.28.16

22

• This definition must be met at the time

medical service is provided, or it is not considered to be an emergency medical condition

• Not all services that are medically

necessary meet the federal definition of emergency medical condition

64

Medicaid Coverage for the Treatment

• f an Emergency Medical Condition,

cont’d.

• Emergency medical conditions do not

include debilitating conditions (e.g., heart disease, or other medical conditions requiring rehabilitation) resulting from the initial event which later requires ongoing regimented care

65

Medicaid Coverage for the Treatment

• f an Emergency Medical Condition,

cont’d.

• The potentially fatal consequence of

discontinuing Medicaid coverage of

• ngoing care, even if such care is

medically necessary, does not transform the condition into an emergency medical condition

66

Medicaid Coverage for the Treatment

• f an Emergency Medical Condition,

cont’d.

• Rev. 3.28.16

23 Emergency Medicaid and Incarcerated Individuals

• Per GIS 16 MA/03, Emergency Services

Only coverage (Cov. Code 07) will be suspended for incarcerated individuals and reinstated upon their release

• While incarcerated, Emergency Services

Only coverage will pay for the treatment of an inpatient medical emergency condition provided off the grounds of the correctional facility

67

Immigrant Concerns

Public Charge Sponsorship Reporting

68

Public Charge

• What is a Public Charge?

– Public Charge is the term used by USCIS to describe immigrants who become dependent

• n public benefits while living in this country

69

• Rev. 3.28.16

24 Public Charge & Health Benefits

• USCIS can try to exclude or refuse to

admit or adjust the status of an immigrant it finds to be a public charge

• Use of government funded health benefits

should NOT make an immigrant a public charge

– Exception: Medicaid for long-term institutionalization

70

Does Public Charge Apply to all Immigrant Categories?

• Public Charge never applies to an

immigrant who is a:

– Refugee – Asylee – Amerasian immigrant at initial admission – An Entrant under the Cuban Adjustment Act, Nicaraguan Adjustment and Central American Relief Act; or Haitian Refugee Immigration Fairness Act

71

Does Public Charge Apply to all Immigrant Categories?, cont’d.

• USCIS does not make a public charge

determination when a Lawful Permanent Resident (LPR) applies for citizenship or naturalizes

72

• Rev. 3.28.16

25

Affidavits of Support (AOS) I-864

• An AOS is an USCIS form signed by an

immigrant’s sponsor. The sponsor promises to financially support the immigrant if USCIS allows the immigrant into the country

73

Sponsor Deeming and Liability

• Sponsor Deeming means that a sponsor’s

income and resources are included when determining the immigrant’s income and resources

• Sponsor Liability means that the sponsor

is financially responsible for the immigrant and may be required to repay costs for the immigrant’s health care services provided through Medicaid

74

Sponsor Deeming and Liability

• At the present time:

– Neither Sponsor Deeming nor Sponsor Liability are currently being used by New York State right now for health programs

• In the future:

– NYS may try to make the immigrant’s sponsor liable to repay the immigrant’s Medicaid costs

75

• Rev. 3.28.16

26

Reporting

• It is New York State’s policy NOT to report

information from applications for Medicaid, CHPlus or prenatal care to the federal immigration agency

• State has told districts that there is NO

duty to report an immigrant’s status to the federal immigration agency

76

Can the Receipt of Government Health Benefits Harm an Immigrant’s Status?

• Most immigrants will be unaffected if they

receive government-funded health care benefits for:

– Medicaid – CHPlus, or – prenatal care services

77

Verification and Documentation

Of Immigrant Status

78

• Rev. 3.28.16

27

Verification of Status

• Verification of status is the process used by

the government to determine an immigrant’s status

• All immigrants in a satisfactory immigration

status must be asked to verify their status when applying for Medicaid or CHPlus

– Only exception: Pregnant women do NOT have to verify their immigration status while pregnant

• r throughout the 60 day post partum period

79

Verification of Status, cont’d.

• An undocumented applicant seeking

coverage for treatment of an emergency medical condition does not have to verify his or her status (i.e., there are no documents to provide)

80

Verification of Identity

• ALL applicants for public health insurance

MUST verify identity

81

• Rev. 3.28.16

28 Social Security Numbers (SSN) and Immigrants

• Immigrants who do NOT have to apply for

SSNs:

– Pregnant Women – Immigrants who are applying for Medicaid for treatment of emergency medical conditions

• Undocumented immigrants
• Temporary Non-immigrants (visitors, students, etc.)

who are not NYS residents

82

SSNs and Immigrants

• All other immigrants must have an SSN or

apply for one

– SSA assigns SSNs to immigrants lawfully residing in the U.S. with a USCIS work authorization – SSA will issue an SSN to individuals who have a valid non-work reason

• If the immigrant is required by law to have an SSN

to receive a federally-funded benefit, such as Medicaid

83

SSNs and Immigrants, cont’d.

• Immigrants with work authorization who do

NOT have an SSN must apply for one

– Must also provide LDSS with documentation

• f their SSN application

84

• Rev. 3.28.16

29

SSNs and Immigrants, cont’d.

• Immigrants without work authorization

must also apply for an SSN

– LDSS must provide a letter that verifies that the immigrant is applying for a federal or state funded program

• Letter must be issued for each applicant
• Copies of these letters are Attachment I and II of

08 OHIP/INF 02

85

SSNs and Immigrants, cont’d.

• PRUCOL immigrants may be denied an

SSN because of their immigration status

– Immigrant must provide documentation of this denial – These individuals do not have to reapply for an SSN unless their immigration status changes

86

Check for Understanding

Part 1

87

• Rev. 3.28.16

30 Asking Immigrants for Documentation

• Immigrants are often unsure of their

specific immigration status

– May not realize which document is important for public health insurance programs

• Ask

– What documents do you have? – What additional documents do you have?

88

Immigrant Documentation

• I-551 or Legal Permanent Resident card

– Often called a “Green Card”

• I-94 – Arrival/Departure Record
• I-766 or I-688B – the Employment

Authorization Document

• Other immigration documents

89

Permanent Resident Card I-551 (Green Card)

90

• Rev. 3.28.16

31

I-94 Arrival/Departure Record

91

Check for Understanding

Part 2

92

Employment Authorization Document (EAD card) I-766

93

• Rev. 3.28.16

32

U.S. Travel Document

94

Non-Immigrant Visas

95

Border Crossing Card

96

• Rev. 3.28.16

33

I-94W – Visa Waiver

97

I-797A – Notice of Action

98

Check for Understanding

Part 3

99

• Rev. 3.28.16

34 Other Immigrant Documents PRUCOL

• The federal immigration agency will not

give an immigrant a piece of paper saying “PRUCOL”

• You will need to review all paperwork to

and from the federal immigration agency to determine if someone is PRUCOL

NYS Department of Health 100

PRUCOL

Knowledge and Permission

• r

Knowledge and Acquiescence

These elements must be established for the immigrant to be PRUCOL

Refer to 08 OHIP/INF-4

NYS Department of Health 101

PRUCOL, cont’d.

Knowledge and Permission:

• Aliens will have a form of documentation

issued by the federal immigration agency that shows that the agency has granted the alien a particular status or relief

– I-94 Arrival/Departure Record – I-766 Employment Authorization – “Notice of Action” (Form I-797) issued by USCIS – Other correspondence from the federal immigration agency

NYS Department of Health 102

• Rev. 3.28.16

35

PRUCOL, cont’d.

Knowledge and Acquiescence:

• Two ways…

– First, immigrants may have a document from the federal immigration agency that demonstrates acquiescence;

• r

– The federal immigration agency has failed to respond to the immigrant’s application, petition or letter within a “reasonable period of time”

NYS Department of Health 103

PRUCOL, cont’d.

Reasonable Period Of Time

• Local departments of social services

should consider that a “reasonable period

• f time” is six months
• The six-month period is measured from

the date that the alien, or the alien’s representative, mailed to the federal immigration agency the initial letter requesting relief

NYS Department of Health 104

PRUCOL, cont’d.

Additional Guidelines

• Requests must clearly state the type of

relief sought

• Must show that the request was mailed to

and received by the federal immigration agency

• Follow-up with the federal immigration

agency on the status of the request during the six month “reasonable time” period

NYS Department of Health 105

• Rev. 3.28.16

36

Case Examples

106

PRUCOL, cont’d.

• What can you do if USCIS fails to respond?

– By completing Form G-845 with USCIS, you may be able to obtain verification of an immigrant’s status – (See page 30 and Attachment B-1 of 04 OMM/ADM-7 for further details)

• If the USCIS verifies the status in response

to the G-845 then the immigrant might be considered PRUCOL

NYS Department of Health 107

Other Documents

• Immigrants may have

correspondence from immigration agencies or less common immigration forms

108

• Ask again if they have any other documents

that might identify their immigration status

• Contact your local support staff at OHIP for

additional help

• Rev. 3.28.16

37 Lost or Expired Immigration Documents

• Immigration status for public health

insurance is based on immigration documents issued by USCIS

– Immigrants are required by law to carry immigration documentation

• May have lost documents or may be carrying

documents that have expired

– Refer these immigrants to USCIS for replacement documents

109

Expired Documents

• Generally, expired immigration documents

cannot establish an immigrant’s status

– Exception: Lawful Permanent Resident card

• r I-151 or I-551 (“Green Card”) is still valid

even if expiration date has passed

• Immigrant should be encouraged to renew their

Green Card

110

Verifying Expired Documents

• If using an expired immigration document:

– Send a G-845 (Documentation Verification Request) to USCIS

• http://uscis.gov
• Go to Forms and Fees

– Use the Systematic Alien Verification for Entitlements (SAVE) Program

• https://www.uscis.gov/save

111

• Rev. 3.28.16

38 Verifying Expired Documents, cont’d.

– Advise the immigrant that s/he needs to renew their documents with USCIS

• Many immigrants do not renew their

documents because of the fees involved in renewals

• USCIS can waive their fee if the applicant can

establish that s/he is unable to pay the fee

– Use the immigration status on the submitted documentation to determine eligibility

112

Replacing or Renewing USCIS Documents

• If the individual needs to replace a lost

document or renew an expired document they can:

– Contact USCIS directly

• Information can be found at www.uscis.gov

– Contact The New York State New Americans Hotline

• 1-800-566-7636
• http://www.newamericans.ny.gov

113

WMS Coding

Upstate

114

• Rev. 3.28.16

39

Systems Entries

• Social Security Number Code
• State/Federal Charge Code
• Citizenship/Alien Indicator Code
• Date of Status
• Date Entered Country
• Medicaid Coverage Codes

115 116

Social Security Number Code (SSN)

117

• Rev. 3.28.16

40

WMS Screen 2

118

SSNs and Immigrants Match

• Not all Immigrants are eligible to receive a

Social Security Number

– Must apply for Social Security Number

• Immigrants may have Social Security

Numbers that may be validated through SSA

119

SSN Codes

• Rev. 3.28.16

41

SSN Code “2”

“SSN Applied For”

• For immigrants who have applied for an

SSN but who have not yet received the SSN or a denial

121

SSN Code “4”

“SSN Not Applied For”

• For non-immigrants and undocumented

aliens that are only eligible for the treatment of an emergency medical condition

122

SSN Code “N”

“State Benefit Eligible Alien”

• For aliens who have not received work

authorization from the USCIS, or

• Whose immigration status prevents them

from being authorized by the USCIS to work in the United States

123

• Rev. 3.28.16

42

SSN Code “N”

“State Benefit Eligible Alien”, cont’d.

• The purpose of this code is to identify a

Medical Assistance (MA) applicant or recipient who has

– Met all MA eligibility requirements including pursuing an SSN – But has been denied an SSN by the Social Security Administration (SSA), solely due to immigration status

124

State and Federal Charge Code (St/Fed Chgs) Citizenship/Alien Indicator Code (Cit/ACI)

125

WMS Screen 3

126

• Rev. 3.28.16

43 Citizenship/Alien Indicator Codes (Cit/ACI)

127

Citizenship/Alien Indicator Code

• Indicates that the individual is:

– A citizen – A Qualified Alien – A PRUCOL – A lawfully residing temporary non-immigrant – An undocumented or temporary non- immigrant who is only eligible for treatment of emergency medical conditions

• Pregnant women do not require a

Citizenship/Alien Indicator Code

128

State/Federal Charge Codes

129

• Rev. 3.28.16

44 State/Federal Charge Codes, cont’d.

• State/Federal Charge Codes tell NYS

when the immigrant is eligible for federal funding for their Medicaid costs

• Immigrants eligible for federal funding:

– Qualified Aliens not subject to the five year ban or who have lived in the U.S. for more than five years – Non-immigrants eligible for treatment of an emergency medical condition – No State/Federal Charge Code is needed for these immigrants

130

State/Federal Charge Codes, cont’d.

• No federal funding is available to:

– Certain Qualified Immigrants within the five year ban – PRUCOL immigrants

• Exceptions apply for certain pregnant women and

children under 21

• These immigrants require a State/Federal

charge code to ensure proper State/Federal shares

131

State/Federal Charge Code 30

• S/F Charge Code 30 is only assigned

when an immigrant is not otherwise eligible for “regular” Medicaid and eligibility for the Refugee Medical Assistance (RMA) program has been determined

• S/F Code 30 must be removed at the end
• f the initial eight-month eligibility period

132

• Rev. 3.28.16

45

Alien Number Date Entered Country (DEC) Date of Status (DOS)

133

WMS Screen 4

134

Alien Number

• File number assigned by USCIS
• Found on immigration document
• Enter 9 digit code

– Do not enter the “A” – If less than 9 digits, zero fill to the left of the first digit

135

• Rev. 3.28.16

46 Date Entered Country (DEC) and Date of Status (DOS)

• The Date Entered Country (DEC) is the

date the immigrant physically entered the United States

– Date may or may not be the same as the Date

• f Status (DOS)

– Must be same date or earlier than DOS

• The Date of Status (DOS) is the date the

immigrant was granted or achieved his or her qualified immigration status

136

DEC and Federal Medicaid

• Eligibility for federal Medicaid is based on

the DEC date for some qualified immigrants

– May be subject to the five year ban

137

DOS and DEC Requirements

• Both DOS and the DEC are required case

record elements for all applicants/recipients except those with ACI codes of:

– “C” - citizen – “O” - PRUCOL immigrants (optional) – “E” - Undocumented and Temporary Non- Immigrants

138

• Rev. 3.28.16

47 Requesting a Change to the DOS or DEC

• Both the DOS and DEC fields have been

“locked” and any changes to these fields will result in the following errors:

– 1410 – DOS Changes Prohibited For Qualified Aliens – 1417 – Date Changes to DEC are Prohibited – 1439 – Changes to DOS and DEC are Limited to Day Only

139

Requesting a Change to the DOS or DEC, cont’d.

• Upstate Inter-Agency Date Of Status

(DOS) and Date Entered Country (DEC) Transmittal Form (LDSS-4929)

– GIS 08 MA/014 – GIS 13 MA/03

140

MA Coverage Codes (CV. CODE)

141

• Rev. 3.28.16

48

WMS Screen 5

142 143

Medicaid Coverage Codes Coverage Code 07

• Emergency Services Only- used for

undocumented adult immigrants or certain temporary non-immigrants who are not NYS residents who are eligible for Medicaid for the treatment of an emergency medical condition only

– Includes temporary non-immigrant Pregnant Women who fail the residency review but are

• therwise eligible

144

• Rev. 3.28.16

49

Coverage Code 11

• Legal/Alien - Full Coverage - used for

Qualified Aliens in the Federal 5 year ban, PRUCOL and temporary non- immigrants who are NYS residents who are fully eligible for Medicaid

– Can be used for both non SSI-R immigrants and SSI-R immigrants – Includes PRUCOL Pregnant Women and Children under 21

145

Coverage Code 01

• Full Coverage - used for immigrants who

are eligible for Federal reimbursement:

– Non SSI-Related who are fully eligible for Medicaid – Pregnant Women who are fully eligible for Medicaid as an FFP Qualified Alien or status unknown – Institutionalized immigrants who have documented 60 months of resources and are not subject to a transfer penalty

146

Coverage Code 19

• Community Coverage with CB-LTC - used

for SSI-R immigrants who are eligible for Federal reimbursement and have documented current resources

147

• Rev. 3.28.16

50

Coverage Code 20

• Community Coverage w/o LTC - used for

SSI-R immigrants who are eligible for Federal reimbursement and have attested to their resources

148

Other MA Coverage Codes

• Additional Coverage Codes that can be

used even if in Federal 5 year ban:

– CC 06 – Provisional Eligibility Excess Income – CC 09 – Medicare Savings Program Only

• QMB, SLIMB, QI, QDWI

– CC 18 – Family Planning Services Only – CC 30 – PCP Full Coverage

149

Check for Understanding

Part 4

150

• Rev. 3.28.16

51

Summary

We are now able to:

• Interpret immigrant eligibility guidelines for

government funded health insurance programs

• Identify the different immigration statuses
• Recognize immigrants’ concerns
• Review acceptable forms of documentation
• Understand WMS coding for each

immigration category

151

• Rev. 3.28.16