March 30, 2017Vicky Pulos, MLRI

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

1

Health Benefits MassHealth

Mass. Health Insurance Connector

Safety net benefits

Health Safety Net Program (HSN)

Children’s Medical Security Program (CMSP)

MassHealth Limited

2

Safety net benefits MassHealth Limited –emergency services only e.g.

ambulance, ER, labor & delivery, dialysis

Health Safety Net-acute hospital & CHC only

Children’s Medical Security Program –primary &preventive care only

3

Is it safe for undocumented toapply? Same application for MassHealth, Connector & safety

net programs

Page 8 of Member Booklet:

“Applications and the information on them will be keptconfidential. This means that:

Names and addresses will not be sent to immigrationenforcement officials.”

4

Sensitive locationshttps://www.ice.gov/ero/enforcement/sensitive-loc

“…. DHS is committed to ensuring that people seeking toparticipate in activities or utilize services provided at anysensitive location are free to do so without fear or hesitation.

What does the Department of Homeland Securitymean by the term “sensitive location”?

Locations covered by these policies would include, but notbe limited to:

…

Medical treatment and health care facilities, such ashospitals, doctors’ offices, accredited health clinics, andemergent or urgent care facilities;….”

5

Questions on application if applyingfor safety net benefits

Do you have SSN? Y or N.

If N, why? Just applied; noncitizen exception; religiousexception.

Are you a US citizen? Y or N

If you are a noncitizen, do you have an eligibleimmigration status? Y or N

If N or no response, no more questions aboutimmigration status, no documents required, safety netbenefits only

6

The Health Safety Net Program Formerly called Uncompensated Care Pool or Free

Care

For services at acute Hospitals or Community HealthCenters

No defined benefits; debt relief

0-150% FPL full HSN; 150-300% FPL partial HSN(deductible)

Primary (for uninsured); Secondary (forunderinsured)

7

For Health Safety Net Program

Must submit proof of identity

Govt. issued photo ID or ID with physical description

List of documents (pp 43-44 of Member Booklet)

Affidavit by someone who can verify your identity if nodocument available

8

MassHealth coverage types130 CMR § 505 &519 (eligibility) 450.105(benefits)5 Types of MassHealth

MassHealth Standard –the “good” MassHealth MassHealth CarePlus-2014 adult Medicaid expansion per

Affordable Care Act MassHealth CommonHealth-for certain disabled adults &

disabled children with income too high for Standard MassHealth Family Assistance-includes CHIP for children in

families with income too high for Standard; & also the benefitfor most PRUCOL

MassHealth Limited-emergency care for those not eligible forStandard/CarePlus due to immigration eligibility rules (the onlyall-immigrant program)

9

Mass. Health Insurance Connector Marketplace for purchase of insurance

Unsubsidized

Subsidized

ConnectorCare 0-300% FPL(Plan Types 1-3)

0-100% FPL (Plan Type 1) is only for lawfully presentimmigrants not eligible for MassHealth due to its immigranteligibility rules

Premium Tax Credits only 300-400% FPL

No access to other insurance

10

MassHealth income levels

11

MassHealth benefits

12

Also in on-line materials ConnectorCare flyer describing benefits, copayments

& premiums at different income ranges in English &Spanish

MLRI fact sheet on safety net benefits in English &Spanish

Understanding the ACA in MA: Immigrant Eligibility(2015)

13

How immigration status affectseligibilty for health benefits Immigrants may be eligible for the same coverage as if

they were US citizens

Immigrants may be eligible for different coverage thanif they were US citizens or

Immigrants may only be eligible for safety net benefits

14

When are non-citizens eligible for thesame health benefits as U.S. citizens?

Pregnant women

Children

Adults

15

Pregnant womenEligible for sameMassHealth

benefits as US citizensregardless of

immigration status duringpregnancy & 60 days post-partum

16

Adults

Must be Qualified & notbarred to be eligible forsame MassHealthbenefits as US citizens

17

Children & Young Adults

Children from birth toage 18

Young adults age19 & 20with income ≤ 150% FPL

Must be Lawfully Presentto be eligible for sameMassHealth benefits asUS citizens

18

Qualified (never barred) Refugees, asylees, deportation withheld

Cuban-Haitian entrants

Trafficking victims

Veterans/Active duty, spouse & dependents

Iraqi/Afghan Special Immigrants

American Indians (born in Canada or Mexico)

Amerasians (born in Vietnam during war)

19

Qualified (may be barred) Legal Permanent Resident

Paroled into US for 1 year or more

Battered immigrant with pending petition (includingchild of battered parent or parent of battered child ifnot living with abuser)

20

5-year bar Applies to LPR, Paroled, Battered unless

In status above for 5 or more years

Arrived in US prior to 8/22/96 & continuously presentuntil getting status above

Was in never-barred status before becoming LPR (e.g.refugee, asylee, etc)

Is LPR with never-barred status (e.g.Veterans, someCuban-Haitian entrants, Iraqi/Afghan SI; Amerasians;some American Indians)

21

Legal Permanent Resident Card

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?

22

23

Don’t confuse 5-year rule inMassHealth

Applies to legal permanent residents, paroled& battered immigrant adults (NOT children)

Does NOT apply to other “qualified” likerefugees –they’re NOT barred for 5 years

“Non-qualified” like TPS do not becomequalified or eligible because they’ve beenhere 5 years

24

Exercise Mrs. Pappas came from Greece 6 years ago with a

green card. Is she Qualified?

Is she subject to 5 year bar?

Is she eligible for MassHealth?

Are your answers different if you learn she only has anexpired tourist visa but has been here for 6 years?

25

Who is lawfully present? Page 1 of 3

All Qualified are also lawfully present

Legal Permanent residents, parollees & batteredimmigrants (NO 5 yr bar to be lawfully present)

Asylees & refugees, etc.

AND people with many more statuses including:

Temporary Protected Status (TPS)

U-visa status

Other non-immigrants like specialty workers & foreignstudents

26

Who is lawfully present? Page 2 of 3

Certain applicants for a status

Sometimes only with a work permit e.g. asylumapplicants

Sometimes no work permit required e.g. applicant forSpecial Immigrant Juvenile status

Most people with employment authorization but notall

DACA excluded from definition of LP

27

Who is lawfully present? p. 3 of 3

For complete list of whois lawfully present & citesto regulations, seematerials: Understanding the ACA in

Massachusetts: Immigrants'Eligibility for MassHealth &other subsidized coverage,2015

28

Lawfully present & Connector Lawfully present immigrants are eligible for the

Connector

Must be lawfully present to get insurance throughConnector

Lawfully present eligible for premium tax credits &subsidies to lower costs of insurance through Connector

29

Exercise Ms. O’Neil is a battered immigrant with a pending

VAWA petition for the past 6 mo. who lives with her 7year old son. They have no income.

Is Ms. O’Neil eligible for MassHealth in same way asUS citizen?

Is her 7 year old son eligible for MH in same way as UScitizen?

Is Ms. O’Neil eligible for the Connector?

30

Insurance cards

31

When are immigrants eligible for differentbenefits than US citizens?

Children

Elderly & disabled adults

Other adults

32

Children If NOT lawfully present

But PRUCOL

Then NOT MassHealthStandard

But Family Assistanceor

CommonHealth(disabled)

33

Elderly or disabled adults If NOT Qualified (with

no bar)

But Lawfully Present orPRUCOL

Then NOT MassHealthStandard, CarePlus orCommonHealth

But Family Assistance

34

Other adults If NOT Qualified

But Lawfully Present

Then ConnectorCare

If NOT Qualified &

Not Lawfully Present

But PRUCOL

Then Family Assistance

35

PRUCOL Permanently Residing Under Color of Law (PRUCOL)

–pre 1996 Medicaid rule Known to INS & INS not contemplating removal

PRUCOL a benefits term not an immigration term

Repealed in federal Medicaid in 1996

PRUCOL still used in MassHealth

36

37

PRUCOL Deferred Action Childhood Arrivals (DACA) aka

Dreamers

Applicants for asylum who don’t have work permits yet

Others not on Lawfully Present list but known toUSCIS & not contemplated for removal

See complete list in materials

38

39

Table 1. Comparing Connector and MassHealth Immigrant Categories

Connector Category MassHealth Categories Code in Computer

System

Eligible

Immigration

Status?

Lawfully

Present –Eligible for

Connector

Qualified QLP

Yes

Qualified Barred QAB

Nonqualified Individual

Lawfully Present

ILP

Not Eligible for Connector Nonqualified PRUCOL NQP

Other (including

undocumented)

UNDOC

No

40

Help applying Enrollment assister info on 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 & health centers

Other community-based organizations

41

Tips for avoiding errors 1 of 2 Are you an eligible immigrant?

If Lawfully present or Nonqualified PRUCOL answer isYES

Supply document info

On paper include legible copy of documents –workerwill be entering numbers from front/back of card intoeligibility system for data match

42

Document numbers needed fordata match

CardNumber

AlienRegistrationNumber

Back of Card

43

Green cards:Nov 2004 – Apr 2010

AlienRegistrationNumber

Card Number

44

Work permit – Since Oct 2011

45

AlienRegistrationNumber

CardNumber

Expiration Date

CategoryCode

Tips for avoiding errors p. 2 of 2 Real time match with federal SAVE system; if match

does not work, need to identify status

On paper application, identify status that correspondsto on-screen list; start from top of list

46

Page 22 of Member Booklet

47

ConnectorCare If you get a tax credit for 2017, do you agree to file a tax

return for 2017? Must say “YES” to get ConnectorCare

If applicant says NO, he or she cannot getConnectorCare

Why? Because subsidy is an “advance premium taxcredit” paid to health plan

48

Trouble shooting tips Get copy of client’s immigration docs

Ask MassHealth what computer shows is client’simmigration status

Find out what info was entered on immigrationscreens–Which document? Was there a match?Status entered if no match?

Get info corrected informally or appeal

49

If an immigrant with papers is deniedall but Limited/Health Safety Net…

Get help from an experienced advocate to see if thedenial of other benefits was correct

There are many mistakes made in this area –oftenbased on incorrect or outdated information suppliedand/or entered into system

51

Other sources of information 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

52