New York State Immigrant Eligibility for Medicaid Family
New York State Immigrant Eligibility for Medicaid, Family Health Plus, and Child Health Plus Adapted from © from 2012©The Research Foundation for SUNY/BSC/CDHS Adapted 2012 The Research Foundation for SUNY/BSC/CDHS
Modules Module One – Introduction to Immigration Categories • Overview • Citizens • Overview of Qualified Aliens • Overview of PRUCOL Aliens • Immigrants’ Concerns Adapted from © 2012 The Research Foundation for SUNY/BSC/CDHS 2
Modules Module Two • Part A – Systems Issues for Immigrants • Social Security Number for Immigrants • Systems entries for Upstate and NYC • Part B – Documentation for Immigrants • Types of Documentation for Immigration Categories • Part C – Examples Adapted from © 2012 The Research Foundation for SUNY/BSC/CDHS 3
Modules, continued Module Three: Qualified Aliens • Who they are/description of each category • Familiarity to references on status and codes • Systems coding • Refugee Medical Assistance Adapted from © 2012 The Research Foundation for SUNY/BSC/CDHS 4
Modules, continued Module Four • Part A – PRUCOL • PRUCOL Alien categories and Non. Immigrants • Who they are • Documents that verify their status • Systems entries • Part B - Examples Adapted from © 2012 The Research Foundation for SUNY/BSC/CDHS 5
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. Adapted from © 2012 The Research Foundation for SUNY/BSC/CDHS 6
Who is Eligible? To be eligible for MA or FHP an individual must be a Citizen, National, Native American or be an immigrant in “satisfactory immigration status”. Adapted from © 2012 The Research Foundation for SUNY/BSC/CDHS 7
Who is Eligible? Citizens U. S. Citizens include: • Born in the United States • Naturalized U. S. citizens • Nationals • Native Americans (includes Native Americans born in Canada or belonging to a federally recognized tribal group) Adapted from © 2012 The Research Foundation for SUNY/BSC/CDHS 8
Certificate of Naturalization Adapted from © 2012 The Research Foundation for SUNY/BSC/CDHS 9
Who is Eligible? Citizens U. S. Citizens include: • Born in the United States • Naturalized U. S. citizens • Nationals • Native Americans (includes Native Americans born in Canada or belonging to a federally recognized tribe). Adapted from © 2012 The Research Foundation for SUNY/BSC/CDHS 10
Who is Eligible? Immigrants All immigrants in a satisfactory immigration status may be eligible for: • Medicaid * • Family Health Plus * *As long as the applicant meets the other eligibility requirements of the program. Adapted from © 2012 The Research Foundation for SUNY/BSC/CDHS 11
Personal Responsibility and Work Opportunity Reconciliation Act of 1996 • PRWORA identified certain categories of immigrants who were not eligible for federally funded public programs if they: • Entered the US on or after August, 22 1996 and • Have not resided in the US in a qualified alien status for at least five years • This is known as the “federal five year ban” Adapted from © 2012 The Research Foundation for SUNY/BSC/CDHS 12
Personal Responsibility and Work Opportunity Reconciliation Act of 1996 • Established new immigration categories • Qualified Aliens • Non-Qualified Aliens Adapted from © 2012 The Research Foundation for SUNY/BSC/CDHS 13
Federal Five Year Ban • Qualified Aliens were eligible for public programs • Established five year ban on application for public programs for some groups. • Non-Qualified Aliens, including PRUCOL, were not eligible for public programs Adapted from © 2012 The Research Foundation for SUNY/BSC/CDHS 14
Aliessa v. Novello and Adamolekun v. Novello Court Cases Restored Medicaid coverage to residents of NYS who were: • Qualified Aliens who entered the US on or after August 22, 1996 • PRUCOLs regardless of when they entered the US Adapted from © 2012 The Research Foundation for SUNY/BSC/CDHS 15
Aliessa v. Novello and Adamolekun v. Novello Court Cases, con’t. • 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 Adapted from © 2012 The Research Foundation for SUNY/BSC/CDHS 16
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. Adapted from © 2012 The Research Foundation for SUNY/BSC/CDHS 17
Who Is Eligible? Immigrants Satisfactory Immigration Status includes: • Qualified Aliens • PRUCOL (persons Permanently Residing Under Color of Law) Adapted from © 2012 The Research Foundation for SUNY/BSC/CDHS 18
Qualified Aliens • Qualified aliens are persons who usually live and work here with the permission of the federal immigration agency. • There is no five year waiting period for health benefits. • Some immigrants are not eligible for Medicaid benefits with Federal Financial Participation. Adapted from © 2012 The Research Foundation for SUNY/BSC/CDHS 19
Qualified Aliens Qualified aliens include: • Lawful Permanent Residents (“Green Card” holders/LPR’s) • Refugees • Asylees • Persons granted withholding of deportation or removal Adapted from © 2012 The Research Foundation for SUNY/BSC/CDHS 20
Qualified Aliens Qualified aliens include: • Persons paroled into the U. S. for at least one year • Cuban-Haitian entrants • Amerasians • Battered individuals and their dependents • Conditional entrants • Veterans or active U. S. armed forces and their immediate family members • Victims of a severe form of human trafficking Adapted from © 2012 The Research Foundation for SUNY/BSC/CDHS 21
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 being L= Law in the country Adapted from © 2012 The Research Foundation for SUNY/BSC/CDHS 22
PRUCOL, continued • 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 the immigrant, at least for the time being Adapted from © 2012 The Research Foundation for SUNY/BSC/CDHS 23
PRUCOL, continued Two groups: • “knowledge and permission” • “knowledge and acquiescence” • Acquiescence is to agree by default or inaction Adapted from © 2012 The Research Foundation for SUNY/BSC/CDHS 24
Immigrants Limited to the Treatment of an Emergency Medical Condition • Undocumented: People without immigration documentation • Temporary non-immigrants: Visitors to the US, e. g. , short term visa holders, students, tourists who are not adjusting their status with USCIS NOTE: Undocumented and/or Nonimmigrant children may be eligible for Child Health Plus, if they meet certain requirements. Adapted from © 2012 The Research Foundation for SUNY/BSC/CDHS 25
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 • Over-stayed a visa Adapted from © 2012 The Research Foundation for SUNY/BSC/CDHS 26
Undocumented Aliens Only eligible for Medicaid for treatment of an emergency medical condition • A medical condition with acute symptoms that could place the individual’s health in serious jeopardy, result in serious impairment to bodily functions, or cause serious dysfunction of any bodily organ. • DOES include labor and delivery • Does NOT include organ transplants Adapted from © 2012 The Research Foundation for SUNY/BSC/CDHS 27
Undocumented Aliens Only eligible for Medicaid for treatment of an emergency medical condition Adapted from © 2012 The Research Foundation for SUNY/BSC/CDHS 28
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, S, U, V • These individuals would be considered PRUCOL if the individual has failed to adjust their status. Adapted from © 2012 The Research Foundation for SUNY/BSC/CDHS 29
Immigrant Concerns: • Public Charge • Sponsorship • Reporting Adapted from © 2012 The Research Foundation for SUNY/BSC/CDHS 30
Public Charge What is a Public Charge? • Public Charge is the term used by USCIS to describe immigrants who become dependent on public benefits while living in this country. Adapted from © 2012 The Research Foundation for SUNY/BSC/CDHS 31
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 Adapted from © 2012 The Research Foundation for SUNY/BSC/CDHS 32
Exceptions to Public Charge There is one exception to this rule: • Use of Medicaid for long-term institutionalization Adapted from © 2012 The Research Foundation for SUNY/BSC/CDHS 33
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 Adapted from © 2012 The Research Foundation for SUNY/BSC/CDHS 34
Does Public Charge apply to all Immigrant Categories? USCIS does not make a public charge determination when a Lawful Permanent Resident (LPR) applies for citizenship or naturalizes. Adapted from © 2012 The Research Foundation for SUNY/BSC/CDHS 35
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. Adapted from © 2012 The Research Foundation for SUNY/BSC/CDHS 36
Affidavits of Support (AOS) I-864 After December 19, 1997, USCIS required a new AOS from the sponsor of an immigrant applying for an immigrant visa or for adjustment of status. • Only sponsors who signed the new Affidavit of Support can potentially be held liable for repayment of their sponsored immigrant’s use of Medicaid benefits. Adapted from © 2012 The Research Foundation for SUNY/BSC/CDHS 37
Sponsor Deeming and Liability Sponsor Deeming means that a sponsor’s income and resources are included when determining the immigrant’s income and resources. Adapted from © 2012 The Research Foundation for SUNY/BSC/CDHS 38
Sponsor Deeming and Liability • 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. • NYS does not currently use either Sponsor Deeming or Liability Adapted from © 2012 The Research Foundation for SUNY/BSC/CDHS 39
Sponsor Deeming Sponsor deeming will not be applied to immigrants who use: • Emergency Medicaid • CHPlus, or • prenatal care services. Adapted from © 2012 The Research Foundation for SUNY/BSC/CDHS 40
Sponsor Deeming Sponsor deeming also does not apply to immigrants who were not sponsored as part of the USCIS process or who did not have an AOS, e. g. , refugees, asylees, battered individuals, etc. Adapted from © 2012 The Research Foundation for SUNY/BSC/CDHS 41
Sponsor Deeming and Liability: Now Neither Sponsor Deeming nor Sponsor Liability are currently being used by New York State right now for health programs. Adapted from © 2012 The Research Foundation for SUNY/BSC/CDHS 42
Sponsor Deeming and Liability: Future? In the future, NYS may try to make the immigrant’s sponsor liable to repay the immigrant’s Medicaid costs. Adapted from © 2012 The Research Foundation for SUNY/BSC/CDHS 43
Reporting It is New York State’s policy NOT to report information from applications (Access NY) for Medicaid, FHP, CHPlus or prenatal care to the federal immigration agency Adapted from © 2012 The Research Foundation for SUNY/BSC/CDHS 44
Reporting • State has told districts that there is NO duty to report an immigrant’s status to the federal immigration agency. • Immigration status must be confidential unless the federal immigration agency has issued final order of deportation. Adapted from © 2012 The Research Foundation for SUNY/BSC/CDHS 45
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: • children; • treatment of emergency medical conditions; or • prenatal care. Adapted from © 2012 The Research Foundation for SUNY/BSC/CDHS 46
Always Remember… Clients should be strongly discouraged from: • using false information (e. g. social security number) or false documents when applying for any of these programs; and • falsely attesting that they do not have, or can not obtain legal immigration documents or paperwork. Adapted from © 2012 The Research Foundation for SUNY/BSC/CDHS 47
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? Adapted from © 2012 The Research Foundation for SUNY/BSC/CDHS 48
Questions? • Replay the module • Review the training materials or the Immigration curriculum included in the training materials Adapted from ©from 2012 The Research Foundation for SUNY/BSC/CDHS 2012©The Research Foundation of SUNY/BSC/CDHS 49
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