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Staff Access
Basic Needs
Health Care Coverage
Immigrants
Key resource: Understanding the Affordable Care Act in MA: Eligibility of non-citizens for MassHealth & other subsidized health benefits (10/15)
Other states- Immigrant Access to Medicaid - Medicaid Coverage for Immigrants: Eligibility and Verification (from the National Health Law Program).
Due to the flexibility states have to decide which groups of immigrants to cover, there is significant confusion about immigrants’ eligibility from state to state. This issue brief outlines which groups of immigrants states MUST cover, MAY cover and cannot cover with federal Medicaid funding (assuming all other Medicaid eligibility criteria are met.) The brief also includes a flow chart to help evaluate whether a particular individual is eligible for Medicaid coverage.
Undocumented Immigrants
NOTE: also see humanitarian Medical Deferred Action for update.
Subsidized coverage: Undocumented immigrants are not eligible to shop on the state exchanges (The Connector in MA) for health care coverage. Low-income undocumented immigrants are generally only eligible for MassHealth Limited (emergency coverage only) and/or Health Safety Net. One notable exception:
As of 1/1/14 - pregnant women with income up to 200% FPL are eligible for MassHealth Standard regardless of immigration status. Eligibility, once established, continues for the duration of the pregnancy. Eligibility for postpartum care continues for 60 days following the termination of the pregnancy plus an additional period extending to the end of the month in which the 60-day period ends. (See chart below.)
Market-rate coverage: Undocumented immigrants are NOT allowed to purchase private health insurance at full cost through the state insurance exchange(s). (They used to be able to purchase "Commonwealth Choice" plans in MA.) Undocumented immigrants may continue to buy coverage on their own outside the Marketplace, such as through an employer or directly from the plan. Insurers must offer all of their Health Connector plans outside of the Connector.
(Sources: https://www.nilc.org/issues/health-care/, http://mediamatters.org/blog/2013/11/01/5-outlandish-claims-about-immigrants-and-health/196712. and http://sharepoint.partners.org/phs/payerinformation/aca/SitePages/Immigrants%20under%20the%20ACA.aspx)
Individual Mandate- as they are ineligible to purchase coverage under the Affordable Care Act, undocumented immigrans are not subject to the individual mandate fines for lacking coverage.
Deferred Action for Childhood Arrivals (DACA) program members are ineligble for federal subsidies under the ACA. Not eligible for Medicaid, CHIP or ACA. Treated like undocumented immigrants for purposes of health care coverage.
Legal Immigrants
- Some LEGAL immigrants will be eligible for MassHealth. See MassHealth Immigrant Eligibility on our MassHealth Immigrant Eligibility page. Eligible adults will generally either not have been subject to the 5 year bar or will have passed the 5 year bar.
- Advocacy tip- Remember that cerrtain legal immigrants such as asylees and refugees, and those who were asylees or refugees before getting legal permanent resident status (green card holders) are NOT subject to the 5-year bar. If they otherwise qualify they may be eligible for MassHealth.
So if patient has LPR status- ask what status she/he adjusted from.
- Advocacy tip: Children- legal immigrant children are afforded greater access to health care coverage than adults. See the MassHealth Immigrant Eligibility for Children.
- ConnectorCare- most LEGAL immigrants with income up to 300% FPL who are ineligible for MassHealth (for example because over-income, and/or immigration status such as subject to the 5-year bar) may be eligible for ConnectorCare, the program that replaced Commonwealth Care on 1/1/14. Note that ConnectorCare uses MAGI to determine income and household composition.
- Deferred Action for Childhood Arrivals (DACA) program members are ineligble for federal subsidies under the ACA.
The state however will provide coverage for those otherwise eligible under MassHealth Family Assistance.
- Qualified Health Plans (QHPs)- LEGAL immigrants with incomes between 300% and 400% FPL may be eligible for Federal Premium Tax credit subsidies offered on Qualified Health Plans. Note that QHPs use MAGI to determine income and household composition.
"Permanently Residing Under Color of Law" PRUCOL- Definition:
Refers to persons
residing in the U.S. who are known to the immigration authorities and whose
extended presence in the U.S. is tolerated by those authorities although they have
not been granted an official legal status.
Examples of PRUCOL (not a complete list) include individuals:
- Who have temporary protected status
- With deferred action status
- With approved immediate relative petitions
- With indefinite stays of deportations
- With indefinite voluntary departures
- Under an order of supervision
- Who meet the registry date (have been in US since at least 1972)
See Immigrants and the ACA for more benefits detail.
Difference between "Lawfully Present" and "Aliens with Special Status"
“Lawfully Present” is the ACA term for legal immigrants. This replaces the state’s “AWSS” term (Aliens with Special Status); there are some AWSS who are not considered “Lawfully Present” under the ACA. The state will continue to cover them with state dollars under MassHealth.
See Immigrants and the ACA (rev 3-12-14) for more details on who is "Lawfully present" vs "Other AWSS".
NOTE: Previously erroneously reported that disabled under 65 were in ConnectorCare. This revised version states that all disabled and elderly legal immigrants are now in MassHealth Family Assistance.
For More Information: Immigrants and the ACA (includes benefit comparison chart) - Kim Simonian, rev 3-12-14
In the News
Rev 7/17 |
