The Affordable Care Act and Covered California have made it very clear that undocumented immigrants can not purchase health plans through the new market place or receive tax credits to reduce monthly health insurance premiums. There are a number of different categories of immigration status that do qualify individuals and families to receive premium assistance to help pay for health insurance.
Most immigrants are eligible for premium assistance
Some of the different scenarios and exclusions to Medicaid are addressed in the Health and Human Services brief The Affordable Care Act: Coverage Implications and Issues for Immigrant Families, which can be downloaded at the end of the post.
- As with Medicaid, undocumented adults and children will not be eligible for subsidies in the exchanges; in addition, they will be barred from purchasing unsubsidized coverage through the exchanges.
- Lawfully residing immigrant children will retain current coverage options in Medicaid and CHIP in states that currently provide them through September 30, 2019
- Eligibility provisions for pregnant immigrant women with five years or less of residency in the United States in the 18 states (including DC) that elected this coverage option under CHIPRA, will not be subject to the special MOE provision for children
- The ACA will substantially expand access to insurance Medicaid coverage for poor and near-poor adults who are citizens (both native born and naturalized) and for most lawfully residing noncitizens that have been in the country more than five years. Alabama, Mississippi, North Dakota, Ohio, Texas, Virginia, and Wyoming restrict coverage among qualified immigrants, even after the five-year ban, to Legal Permanent Residents with 40 quarters of work, military members and veterans (and their spouses/children), refugees, asylees and other immigrants in protected statuses (Fortuny and Chaudry, 2011).
- Lawfully residing immigrant adults who have been in the country five years or less will not be eligible for Medicaid coverage, and neither would undocumented immigrants. As now, lawfully residing immigrant children who have been in the country less than five years will be eligible for Medicaid coverage at state-option.
- Qualified non-citizens will be eligible for exchange subsidies, regardless of how long they have been in the U.S. Their access to the exchanges and available subsidies will be the same as for citizens, and will represent a substantial increase in the affordability of insurance for low and moderate income immigrants. Lawfully present immigrants with five years or less of US residency, without access to employer sponsored insurance, will be able to receive both premium tax credits and cost sharing tax credits towards approved plans that meet the essential benefits package outlined in the ACA. This includes such immigrants whose incomes are below 133 percent FPL and so, but for immigration status, would receive Medicaid.
Immigration status and the Marketplace
Following is a list of immigration statuses that qualify for Marketplace coverage. Healthcare.gov website
- Lawful Permanent Resident (LPR/Green Card holder)
- Cuban/Haitian Entrant
- Paroled into the U.S.
- Conditional Entrant Granted before 1980
- Battered Spouse, Child and Parent
- Victim of Trafficking 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)
- Individual with Non-immigrant Status (includes worker visas, student visas, and citizens of Micronesia, the Marshall Islands, and Palau)
- Temporary Protected Status (TPS)
- Deferred Enforced Departure (DED)
- Deferred Action Status (Deferred Action for Childhood Arrivals (DACA) is not an eligible immigration status for applying for health insurance)
- Lawful Temporary Resident
- Administrative order staying removal issued by the Department of Homeland Security
- Member of a federally-recognized Indian tribe or American Indian Born in Canada
- Resident of American Samoa
Applicant for any of these statuses:
- Temporary Protected Status with Employment Authorization
- Special Immigrant Juvenile Status
- Victim of Trafficking Visa
- Adjustment to LPR Status
- Withholding of Deportation or Withholding of Removal, under the immigration laws or under the Convention against Torture (CAT)*
*Only those who have been granted employment authorization or are under the age of 14 and have had an application pending for at least 180 days are eligible
With Employment Authorization:
- Registry Applicants
- Order of Supervision
- Applicant for Cancellation of Removal or Suspension of Deportation
- Applicant for Legalization under IRCA
- Legalization under the LIFE Act
Documentation may be a challenge
The next challenge for the immigrant is to verify status and residency. After applying for qualified health plan through an exchange like Covered California, he or she will need to upload documents to verify the status. This will probably entail scanning the document into a computer to be attached to the application or through a separate part of the on-line process. It’s also possible that the state exchange or federal government running the state exchange will accept mailed photo copies of documents.
To support Marketplace applications, the following documents may be required or used, depending on the individual situation:
- Permanent Resident Card, “Green Card” (I-551)
- Reentry Permit (I-327)
- Refugee Travel Document (I-571)
- Employment Authorization Card (I-766)
- Machine Readable Immigrant Visa (with temporary I-551 language)
- Temporary I-551 Stamp (on passport or I-94/I-94A)
- Arrival/Departure Record (I-94/I-94A)
- Arrival/Departure Record in foreign passport (I-94)
- Foreign Passport
- Certificate of Eligibility for Nonimmigrant Student Status (I-20)
- Certificate of Eligibility for Exchange Visitor Status (DS2019)
- Notice of Action (I-797)
- Document indicating membership in a federally recognized Indian tribe or American Indian born in Canada
- Certification from U.S. Department of Health and Human Services (HHS) Office of Refugee Resettlement (ORR)
- Office of Refugee Resettlement (ORR) eligibility letter (if under 18)
- Document indicating withholding of removal
- Administrative order staying removal issued by the Department of Homeland Security
- Alien number or 1-94 number
- Proof of residency such as a utility bill
Certified Enrollment Counselors and Certified Agents Assistance
If the process of scanning or uploading the necessary documents is beyond your scope, there should be Certified Enrollment Counselors (CEC) and Certified Insurance Agents(CIA) that can help you with the process. Before the CEC or CIA can assist with the application, the applicant must delegate the assisting individual in the on-line process for Covered California. Once the CEC or CIA accepts the delegation, they will be able to work on the health insurance application.
The HHS brief summarized the immigrant eligibility
- Naturalized citizens and lawfully residing immigrants who have been in the US for more than five years will have the same opportunities to obtain more affordable health insurance coverage as native-born citizens under the ACA: those with incomes below 138 percent of the FPL will be eligible for Medicaid and those with incomes between 138 and 400 percent of the FPL that lack access to “affordable” employer-sponsored coverage will qualify for subsidized coverage under the new exchanges. Thus, the ACA is expected to lead to substantial reductions in uninsured rates among these immigrant groups. Projected impacts will be strongest for immigrants who live in states that do not currently cover many non-elderly adults in their Medicaid programs and in those that achieve high take up among the Medicaid and exchange eligible population.
- Lawfully residing immigrants who have been in the US for five years or less will have access to coverage through the health insurance exchanges and to premium and cost-sharing subsidies, but generally will not be eligible for Medicaid/CHIP (except for children who can be covered at state option). Given that many in this group have incomes below 138 percent of the FPL but will not be eligible for Medicaid coverage, some may continue to face affordability barriers even after the ACA is fully implemented.
- Unauthorized immigrants will not be allowed to purchase insurance from the exchanges, receive subsidies for exchange coverage, or enroll in full-scope Medicaid and thus will likely remain uninsured at very high rates. Their access to primary and other forms of outpatient care will depend on the ability and willingness of local safety net providers, such as community health centers, to serve them, which will likely vary from area to area.
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