Health Care for ALL - Mass Legal Services

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Transcript Health Care for ALL - Mass Legal Services

Health care access for
March 6, 2013
Vicky Pulos, MLRI
[email protected]; 617-357-0700 Ext. 318
Comprehensive health benefits
Immigrants must have an eligible immigration
status to receive Any
type of MassHealth except Limited
 Commonwealth
Eligible immigration status
Immigrants must satisfy all the eligibility
rules for MassHealth/Commonwealth
Care that apply to US citizens…
and in addition
 Immigrants must have an eligible
immigration status
Qualified in MassHealth
MassHealth defines “qualified” to mean federally
qualified and currently eligible
MassHealth defines “aliens with special status”
(AWSS) to mean
5-year bar exempt or 5-years met
Federally qualified but 5-year barred
Not federally qualified but permanently residing in US
under color of law (PRUCOL)
2009 federal law change applies new term
“lawfully present” to pregnant women & children
Health exercise # 1
Mrs. Pappas is 66. She has had a green
card for 6 years but is only on
MassHealth Limited and the Health
Safety Net.
What should she be eligible for?
 What steps are needed to correct the
New green cards –May 2010
Does code show status not subject to 5 yr bar?
Is country Cuba, Haiti, Iraq,
Afghanistan, Vietnam, Canada?
Is date 5 or more years ago?
Eligible children & pregnant women
2009 change in Medicaid law
 All “lawfully present” children & pregnant
women federally eligible
No 5-year bar
 Includes other AWSS
Replaces PRWORA rules with
State residence
 Lawful presence
Regulation-free zone for lawfully
present pregnant women & children
Lawfully present pregnant women &
children eligible since 2009
 August 2009 Eligibility Ops memo 09-11
eliminated 5-year bar
 Member booklet recognizes AWSS
children & pregnant women can get MH
Standard (in your materials)
 MassHealth regulations have not yet
been amended
“Lawful presence” –federal definition
Proposed federal Medicaid regulation
defining lawful presence (in your
 Same definition will be used for new
types of subsidized insurance available
in 2014
Exercise # 2
Mrs. Smyth and her 7 year old child
have been in the U.S. with green cards
for 2 years.
 Does either one have a qualified eligible
status for MassHealth benefits?
 What if Mrs. S tells you she is pregnant?
Eligibility checklist for green card
Child (under 19) or pregnant woman,
Status since date 5+ years ago,
U.S. entry date prior to 8/22/96,
Battered immigrant, trafficking victim, veteran,
Prior status was refugee, asylee, deportation
Cuban-Haitian Entrant; Iraqi/Afghani Special
Immigrant; Vietnamese Amerasian; American
Indian (born in Canada or Mexico)
Identifying codes
Keys to codes on specified documents
Green cards
Employment authorization cards
I-94 arrival/departure cards
Visas in foreign passports
MassHealth Advocacy Guide (MLRI)
MassHealth Immigration Advocacy Desk Guide (MLRI)
Office of Medicaid Memos
NILC Tables (in materials)
USCIS website
Tips for helping immigrants get the
best coverage they can
Send in proof of current status AND any prior
qualified status
List U.S. entry date on app. if prior to 8/22/96
Check if domestic violence & veteran
protections apply on application form
Include proof for each family member
Add name, DOB, SSN (if avail) on everything
you send in
Make sure codes & dates on cards and
other immigration papers are legible
Circle & write code/date in margin
New green cards –May 2010
Does code show status not subject to 5 yr bar?
Is country Cuba, Haiti, Iraq,
Afghanistan, Vietnam, Canada?
Is date 5 or more years ago?
“Special status”legal immigrants
“Special status” or “AWSS” are
MassHealth terms forLegal permanent residents & parollees
during 5-year wait
 Persons residing in US under color of law
(PRUCOL) but not “qualified”
Known by Dept. of Homeland Sec. to be living in
U.S. & DHS is not contemplating removal
No federal matching funds (except for
pregnant women & children)
Elderly & disabled AWSS
For elderly & disabled AWSS adults
under 100% fpl
MH Essential plus Limited
No home health or nursing home care
For seniors, assets under $2000/$3000
 Younger disabled must also have been
unemployed for past 12 mos. (or EAEDC
 Will change in 2014
Commonwealth Care
Subsidized insurance for adults through
 Covers all otherwise eligible AWSS who
are not eligible for MassHealth
 Will be replaced by new forms of
coverage in 2014
Examples 
Temporary Protected Status (TPS)
Applicants for asylum
Applicants for adjustment of status
Living under orders of supervision
Living in U.S. since Jan. 1, 1972 (Registry)
Certain non-immigrants –K, S, U, V, R, & NEW H1B & H-4
Proof will sometimes be code on Employment
Authorization card or I-94
Employment authorization card
Exercise # 3
Mr. Baptiste is 38 and from Haiti. She is
diabetic & has some health problems.
She shows you her work permit. Under
the word “category” on her card it says
 Is she qualified? If not, is she eligible for
any health benefits?
 What else do you need to know?
What about federal health reform?
No change in Medicaid eligibility rules
 Starting in 2014 “lawfully present”
immigrants with income under 400% of
poverty will be able to purchase
affordable insurance from Connector
 Undocumented cannot purchase through
Connector or get tax credit
In 2014
Commonwealth Care will end
 “Lawfully present” will be able to
Purchase insurance through the Connector
 Get refundable tax credits to lower premium
 Get cost-sharing subsidies to lower
deductibles, and copays
Legislation in 2013
Expecting a bill to implement federal
health reform
 Administration is proposing additional
state subsidies to make new coverage
as affordable as Commonwealth Care
 Unclear if elderly & disabled AWSS will
remain in MassHealth or move to
Lawful presence vs. PRUCOL in
Most non-immigrants & most people with work
permits will be considered lawfully present,
includes students & others not now considered
 Some now considered PRUCOL/AWSS will
not be considered “lawfully present” e.g.
applicants who don’t yet have work permits &
Proposal to retain state-funded coverage for
PRUCOL who can’t use Connector
Safety net programs
Health Safety Net: Acute hospital & CHC
 MassHealth Limited: Emergency care
 Healthy Start: Prenatal care only
 CMSP: Primary care for children
Tips for completing application
Never submit a false SSN
 If no pay stubs available to prove income
Can submit letter from employer with wage
& hour info.
 Can submit sworn statement with wage &
hour info & explain no other form of proof is
 Can submit tax return filed with ITN number
Info in materials on safety net
“Health benefits available to ALL” –in
English & Spanish
If an immigrant with papers is
denied all but Health Safety Net…
Get help from an experienced advocate
to see if the denial of other benefits was
 Incorrect decisions can be appealed
 Health Care for All Help Line:
 Legal Aid Referral Line: 800-342-5297
 MIRA Coalition: 617-350-5480
Info in your materials
NILC Guide section on immigration documents
& codes
Immigration section of MassHealth Member
MassHealth memos on identifying PRUCOL &
Cuban-Haitian entrants & H1B & H4 update
Proposed federal definition of “lawfully
USCIS “fact sheet” on public charge-Mass. ed.
MassHealth Regulations
Immigrant eligibility regulations
 130 CMR § 504.002(B)-(D); § 505.008 (for
under age 65)
 130 CMR § 518.002(B)-(D); § 519.009 (for age
 Online at
Under “MassHealth regulations and other
Under “MassHealth regulations”
Under “Eligibility regulations”
Other sources of information
Massachusetts Immigrants & Refugees
Advocacy (MIRA) Coalition:
 National Immigration Law Center,
 Massachusetts Legal Services programs
State agencies
Office of Medicaid
Health Insurance Connector
 Division of Health Care Finance & Policy (info
on Health Safety Net)
 Dept. of Public Health
 Dept. of Elder Affairs