March 28, 2019Katie Condon Grace & Vicky Pulos

• Complicated benefit eligibilityrules.

• Added complexity forimmigrant eligibility

• Language access

• Fears of adverse immigrationconsequences:• Removal

• Public Charge

• Changing federal landscapeincreasing threats.

• To qualify for comprehensive MassHealth and to qualify to purchaseinsurance through the Health Connector, people must satisfy bothfinancial and non-financial eligibility criteria.

• Benefits available to U.S. citizens and eligible Immigrants:• MassHealth

• Connector Care

• Safety net benefits with no citizenship/immigration requirements:• Health Safety Net program (HSN)

• Children’s Medical Security Plan (CMSP)

• MassHealth Limited

• MassHealth Standard for Pregnant women.

• 5 Types of MassHealth Coverage:

1) MassHealth Standard:• The “good” MassHealth

2) MassHealth CommonHealth:• For certain disabled adults & disabled children with income too high for

Standard

3) MassHealth CarePlus:• 2014 Medicaid expansion for 21-64 under Affordable Care Act

4) MassHealth Family Assistance:• Includes CHIP for children in families with income too high for Standard• Also the benefit for most “PRUCOL” immigrants.

5) MassHealth Limited:• Emergency care for those not eligible for Standard/CarePlus due to

immigration eligibility rules (the only all-immigrant program)

• Private Insurance through HealthInsurance Connector

• Subsidized for individuals withincome from 0-300% FPL(PlanTypes 1-3)& no access to otherinsurance

• 0-100% FPL (Plan Type 1) is onlyfor lawfully present immigrants noteligible for MassHealth due to itsimmigrant eligibility rules

• After being found eligible mustselect a plan & pay any premiumdue by a deadline to be enrolled

• Qualified Aliens• Not Barred

• Barred

• Lawfully Present Aliens• Includes all Qualified aliens

• Plus added groups (Non-Qualified Lawfully Present)

• Persons Residing in the US Under Color of Law (PRUCOL)• Used for immigrants who are not Lawfully Present but who are known to

USCIS and who DHS is not contemplating removing.

• Undocumented• No status or out of status

Lawfully Present

Undocumented PRUCOLQualified –Not Barred

Qualified -Barred

More comprehensive health benefits

• For certain Qualified Aliens(LPR, Paroled, battered), theymust:1. Have their qualifying

immigration status for 5 years(“meet the 5-year bar”), or

2. Satisfy additional factors thatexempt them from the 5-yearbar.

• Until either of these occur,they will be considered“Qualified – Barred”.

• After either of these occur,then they will be considered“Qualified – Not Barred”.

• Group A - Some qualified aliens are never barred:

• Asylee;• Refugee;• Granted withholding of deportation or withholding of removal under

immigration laws;• Veteran or active duty military and spouse, widow and dependent child/ren• Cuban/Haitian entrant, including a Cuban or Haitian;

• Paroled into US after 1980• Applicant for Asylum, or• Subject to a non-final order of exclusion;

• American Indian born in Canada or other member of federally recognizedtribe;

• Victim of trafficking and his or her spouse, child, sibling, or parent;• Conditional entrant granted before 1980;

• Group B – Qualified aliens who were subject to the 5 year bar but who are no longer barredbecause they met the 5 years or additional factors exempt them from the 5-year bar:

• Legal permanent resident (LPR/Green Card Holder);• Paroled into the U.S. for at least1 year; or• Battered spouse and child/ren, or battered child and parent;

• Battered in US by US Citizen or Legal Permanent Resident spouse or parent, or family member orspouse or parent,

• No longer living with abuser, and• With approved or pending petition that will lead to permanent resident status (petition has been

found to establish a “prima facie case”).AND

• Had Permanent Resident/Paroled/Battered Immigrant status for 5 or more years; or• Had such status for less that 5-years, but exempt from the 5-year bar because:

• Entered US prior to 8/22/96 (regardless of status at time of entry) & continuously present untilbecoming Permanent Resident/Parolee/Battered Immigrant

• Veteran on Active Duty military and his/her spouse, widow, or dependent child/ren• Iraqi or Afghan Special Immigrant• American Indian born in Canada (or other member of federally recognized tribe)• Cuban or Haitian who became a Legal Permanent Resident under certain special laws (not through a

family member or employer)• Amerasian born in Vietnam during Vietnam War era• Before becoming Legal Permanent Resident (LPR), individual was a:

• Refugee, Asylee, Granted withholding of deportation, Cuban Haitian Entrant, Trafficking Victim.

• Individuals with one of thefollowing statuses who have hadthat status for less than 5 years, ordo not meet the exceptions on theprevious slide, are considered“Qualified – Barred”:• Lawful Permanent Resident

(LPR/Green Card holder)• Paroled into the U.S. for at least one

year• Battered Spouse and child/ren, or

battered child and parent• Battered in US by US Citizen or Legal

Permanent Resident spouse or parent, orfamily member or spouse or parent,

• No longer living with abuser, and• With approved or pending petition that

will lead to permanent resident status(petition has been found to establish a“prima facie case”).

• They have “not met the 5-yearbar” or are not exempt from it.

Using a Legal Permanent Resident Card(Green card) to Determine if Qualified Alien

is Barred or Not Barred

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?

14

• All Qualified aliens (both Not Barredand Barred) are Lawfully Present:• Asylee;• Refugee;• Granted withholding of deportation or

withholding of removal under immigrationlaws (but not including CAT);

• Veteran or active duty military and spouse,widow and dependent child/ren;

• Cuban/Haitian entrant;• American Indian born in Canada or other

member of federally recognized tribe;• Victim of trafficking and his or her spouse,

child, sibling, or parent;• Conditional entrant granted before 1980;• Amerasian born in Vietnam during Vietnam

War era, Iraqi or Afghan special immigrant;• Legal permanent resident (LPR/Green Card

Holder);• Paroled into the U.S. for at least 1 year, or• Battered spouse and child/ren, or battered

child and parent;• Battered in US by US Citizen or Legal

Permanent Resident spouse or parent, orfamily member or spouse or parent;

• Granted withholding of deportation orremoval under the Convention AgainstTorture (CAT);

• Individuals with valid non-immigrantstatus (including worker visas, studentvisas, U-visas);

• Temporary Protected Status (TPS);

• Deferred Enforced Departure (DED);

• Deferred Action Status (NOT DeferredAction for Childhood Arrivals – DACAis PRUCOL for health benefitspurposes)

• Applicant for:• Special Immigrant Juvenile Status;• Adjustment to LPR status with an approved

visa petition;• Victim of trafficking visa;• Asylum who has either been granted

employment authorization, or is under 14 andhas had an application for asylum pending forat least 180 days;

• Withholding of Deportation or Withholding ofRemoval, under the immigration laws or underthe Convention Against Torture (CAT) who haseither been granted employmentauthorization, or is under 14 and has had anapplication for withholding of deportation orremoval under the immigration laws or underCAT pending for at least 180 days;

• Granted administrative stay ofremoval by the Department ofHomeland Security (DHS);

• Lawful temporary resident;

• Individuals with employmentauthorization under 8 CFR 274a.12(c)including:• Registry applicants;

• Those under an order of supervision;

• Applicants for Cancellation of Removal ofSuspension of Deportation;

• Applicants for Legalization under IRCA;

• Applicants for Temporary Protected Status(TPS);

• Persons granted legalization under the LIFEAct.

• Remember : No 5-year bar to belawfully present.

CategoryCode

Expiration Date

AlienRegistrationNumber

• Granted indefinite stay of deportation;

• Granted indefinite voluntary departure;

• Have approved immediate relative petition, entitled to voluntary departure,and whose departure the U.S. Department of Homeland Security (DHS) doesnot contemplate enforcing;

• Granted voluntary departure by DHS or an Immigration Judge, and whosedeparture DHS does not contemplate enforcing;

• Living under order of supervision who do not have employment authorizationunder 8 CFR 274a.12.(c);

• Have entered and continuously lived in the United States since beforeJanuary 1, 1972;

• Granted suspension of deportation, and whose departure DHS does notcontemplate enforcing;

• Have a pending application for Asylum under 8 USC 1158, or forwithholding of removal under 8 USC 1231, or under the Convention AgainstTorture (CAT), who have not been granted employment authorization, or areunder the age of 14 and have not had an application pending for 180 daysor more;

• Granted Deferred Action for Childhood Arrivals (DACA) or who have apending application for DACA;

• Have filed an application, petition, or request to obtain a lawfully presentstatus that has been accepted as properly filed, but who have noy yetobtained employment authorization and whose departure DHS does notcontemplate enforcing;

• Any noncitizen living in the United States with the knowledge and consent ofDHS, and whose departure DHS does not contemplate enforcing.

• Entry without inspection

• Out of Status

• Visa overstay, etc.

• Not “eligible Immigrants”for purposes of healthbenefits.

• For a complete list ofimmigrant types & citesto regulations, see:

• Understanding the ACA inMassachusetts: Immigrants’Eligibility for MassHealthand other subsidizedcoverage, 2018.

• Additional materials.

Lawfully Present

Undocumented PRUCOLQualified –Not Barred

Qualified -Barred

More comprehensive health benefits

• Benefits available to U.S.citizens and eligible Immigrants:• MassHealth• Connector Care

• Safety net benefits with nocitizenship/immigrationrequirements:• Health Safety Net program

(HSN)• Children’s Medical Security Plan

(CMSP)• MassHealth Limited• MassHealth Standard for

Pregnant women.

• MassHealth Limited:• Emergency services only

• i.e. ambulance, ER, labor & delivery, dialysis

• Children’s Medical Security Plan (CMSP):• Primary and preventative care only

• Health Safety Net program (HSN)

• Health Safety Net (HSN):• Only acute hospitals and community health centers

• No defined benefits; debt relief

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

• **Exception: MassHealth Standard for Pregnant women – during pregnancyand 60 days post-partum**

• Same application for MassHealth, Connector & safety netprograms

• From page 8 of Member Booklet (Mar 2019):What non U.S. citizens need to know about applying for MassHealthLimited, MassHealth coverage for pregnant women, CMSP, and theHealth Safety Net

Applications and the information on them will be kept confidential. Thismeans that:

Names and addresses will not be sent to immigration enforcementofficials

• Immigrants with an eligibleimmigration status are eligible forMassHealth (depending on income).

• Type of MassHealth depends onwhat “type” of immigrant aperson is and their income.

• Only immigrants with an eligibleimmigrant status who are lawfullypresent can apply for coveragethrough the Health Connector

• PRUCOL, even though “eligibleimmigrant”, cannot apply forbenefits through the HealthConnector.

• Only lawfully present eligibleimmigrants are eligible to obtaininsurance through the Health Connector• No PRUCOL• No Undocumented

• Doesn’t distinguish between Qualified,Qualified- Barred, Qualified- NotBarred

• ConnectorCare: Subsidized plans forindividuals with income from 0-300%FPL(Plan Types 1-3)& no access toother insurance

• 0-100% FPL (Plan Type 1) is only forlawfully present immigrants not eligiblefor MassHealth due to its immigranteligibility rules

• All “eligible immigrants”are potentially eligiblefor comprehensiveMassHealth (depends onincome).

• Unlike Health Connector,includes PRUCOL.

• 5 Types of MassHealth Coverage:

1) MassHealth Standard:• The “good” MassHealth

2) MassHealth CommonHealth:• For certain disabled adults & disabled children with income too high for

Standard

3) MassHealth CarePlus:• 2014 Medicaid expansion for 21-64 under Affordable Care Act

4) MassHealth Family Assistance:• Includes CHIP for children in families with income too high for Standard• Also the benefit for most “PRUCOL” immigrants.

5) MassHealth Limited:• Emergency care for those not eligible for Standard/CarePlus due to

immigration eligibility rules (the only all-immigrant program)

• Mrs. Gutierrez came from ElSalvador 6 years ago with a greencard. Her income is 125% FPL• Is she eligible for MassHealth

Standard?

• What if she has lived in US for 6years but only got her green card3 years ago?• What MassHealth would she be

eligible for?

• What if you learn she does nothave green card but has had awork permit with TPS for 6 years?• What MassHealth would she be

eligible for?

• Ms. O’Neil was batteredby her LPR Spouse. Sheand her 7 year-old sonmoved out of the houseand live together in anapartment. Ms. O’Neil hasa VAWA petition that hasbeen pending for 6months. They have noincome.• For what health benefits is

Ms. O’Neil eligible?

• For what health benefits isher son eligible?

• Susan is 26 & applied forasylum 8 months ago, but hasnot yet gotten a work permit.She lives with relatives & has noincome.• For what health benefits is Susan

eligible?

• Susan gets her work permit, butstill has no job.• Does this change the health

benefits for which she is eligible?

• Susan is granted asylum & isworking part-time .• Does this change the health

benefits for which she is eligible?

• Joao is 15 years-old and heentered the United Stateswithout inspection 8 years ago.• What health benefits it Joao

eligible for?

• Joao applies for SpecialImmigrant Juvenile Status andhis case is pending.• Does this change is health benefit

eligibility?

• Joao receives special immigrantjuvenile status and then adjuststo an LPR.• Does this change is benefit

eligibility?

• Bill introduced in 2019 session of legislature to providecomprehensive coverage to all children without regard toimmigration status

• Bill No. HB 162 & SB 677, An Act To Ensure Equitable HealthCoverage for Children

• Lead sponsors: Rep. Dave Rogers & Sen Sal DiDomenico

• For more information contactNatalie Litton

Policy & Project Coordinator, Health Care for All

(617) 275-2897nalitton@hcfama.org

Get copy of client’s immigration docs

Use tools in materials to figure out eligible status

Ask MassHealth/Connector what computer shows is client’simmigration status

Find out what info was submitted to MassHealth/Connector &how it was verified

Get info corrected informally or appeal

• MLRI fact sheet on safetynet benefits in English &Spanish

• Understanding the ACAin MA: ImmigrantEligibility (2018)

• Enrollment assister infoon maheathconnector.orgunder “Help Center” &“Find Local Help”• Refer to CAC or Navigator

if possible• Health Care for All Help Line

• Mayor’s Health Line

• Local hospitals & communityhealth centers

• Other community-basedorganizations

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

• Katie Condon Grace MetroWest Legal Serviceskcondon@mwlegal.org · 508-620-1830 ext. 238

• Vicky Pulos Massachusetts Law Reform Institutevpulos@mlri.org 617-357-0700 Ext 318