Helping LEP Immigrants & Refugees Access Health/Affordable Care Act"

Welcoming Communities Conference

Jeannine Peterson MPAHamilton Health Center

October 26, 2015

Identify what types of health care insurance coverage is available

Identify who is eligible for health care coverage

Where to go for help in applying for coverage

Where to go to access medical and dental services

Objectives

Types of CoveragePublic and Privately Funded

Programs

Provides free health insurance for low income adults and children

Have incomes at or below 138% of the federal poverty level

Are lawfully present, or, in an eligible qualified immigration status.

Medical Assistance – Medicaid (MA)

“Qualified” Immigrant Status

Lawful Permanent Residents (“LPRs” or “green card holders”)

Refugees

Aslyees

Cuban/Haitian entrants

Conditional entrants

Individuals paroled into the US for more than one year

Certain domestic violence and trafficking survivors and their children

Persons granted withholding of deportation/removal

Pregnant women

Children under age 21

Refugees

Asylees

Cuban and Haitian Entrants

Plus others

Refer to the Pennsylvania Medical Assistance Handbook for a full listing of those considered to be “Lawfully Present”

“Lawfully Present”

Provides health coverage for individuals over age 65 or who have been receiving Social Security Disability Income for over 2 years.

Only available to U.S. Citizens and Legal Permanent Residents (LPRs or “Green Card Holders”) who have been in the United States for at least 5 years.

Individuals without the requisite work credits may have to pay for Medicare, even if eligible based on immigration status.

Medicare

Provides free or low-cost health insurance to children up to age 19 whose families are lawfully present and earn too much to qualify for MA

No family makes too much money to get CHIP. Depending on income some coverage is free others pay premium

Comprehensive and includes both physical, behavioral, dental, vision, and hearing services, as well as prescription drugs, emergency care and in-patient services

Children’s Health Insurance Program – CHIP

Marketplace – Obamacare◦ Health insurance plans that provide

comprehensive coverage at an affordable price for many low-income consumers

◦ An immigrant must be lawfully present to enroll in a Marketplace plan and to receive financial help paying for the plan

◦ Undocumented immigrants are excluded from enrolling in the marketplace, even from buying a plan at full cost.

Affordable Care Act/ACA

Medical Assistance Medicaid or MA

Must be living in PA and planning to be here indefinitely

No time requirement, can travel in and out of the state as long as you plan on returning (example: migrant or seasonal workers)

No permanent address required but you must be able to check their mail regularly

Residency Eligibility Requirement

Important because income and resource limits vary by category

Each category covers a specific population: children, pregnant women, parents, healthy adults, disabled adults, disabled children, the elderly – and there are more

Now every Pennsylvanian fits into an MA category as long as they meet the residency requirements, are low income, and have the eligible immigration status

MA Categories

Each MA category has its own income and resources limits, which vary based on the applicant’s household size

“Income” - the money an individual receives every month, from sources such as employment, pensions, government benefits, etc

“Resources” - generally the 5 things an individual owns, such as savings and checking accounts, retirement accounts, the cash value of life insurance policies, etc

.

Income and Resource Limits

“Qualified” Immigrants Adults Must wait five year before being

eligible for MA unless you meet certain criteria

Immigration Status

Pregnant women (through the 60-day post-partum period)

Children under age 21

Refugees and asylees (even if they now have a green card)

Cuban/Haitian entrants;

Survivors of trafficking

Immigrants whose deportation is being withheld;

Certain veterans and their families

Certain people who have lived in the U.S. continuously since before 8/22/1996 who are now legal immigrants

Refer to the Pennsylvania Medical Assistance Handbook for a full listing of those without a waiting period

No waiting period for MA

Lawfully Present (residing)

Children under 21& Pregnant Women State option: PA Chose to expend Medicaid to this group

This group does not need to meet the more stringent standard of “qualified” immigration status that applies to adults

No 5 year bar: can get MA coverage as soon as they enter US as long as they meet other eligibility requirements (residency and income)

There are other categories of Lawfully Present listed in the MA handbook

Immigration Status

Called HealthChoices State is divided into regions with each region

having certain insurance companies under contract to the PA Department of Human Services

Recipient must select a MA insurance company i.e. UPMC, Gateway, Health Partners, United, etc

Recipient must select a Primary Care Provider (PCP) If an insurance company or PCP isn’t selected one

will be chosen for you Mental Health and Substance Abuse Services are

“carved out”, that is, they are managed separately

PA’s MA Managed Care Program

Emergency Medical Assistance

For People with Medical Conditions

Health care coverage for any immigrant regardless of their immigrant status as long as they meet EMA requirements. This includes undocumented immigrants and those “qualified” immigrants who fall within the five year bar

Temporary MA coverage to treat a specific medical condition known as an Emergency Medical Condition (EMC); usually an acute problem

After the treatment of the condition, the MA coverage ends

What is Emergency Medical Assistance (EMA)

A medical condition with acute symptoms including severe pain, that without immediate attention, could result in: oHealth being in serious jeopardy oSerious impairment to bodily functions oSerious dysfunction of any body organ or part

Does not necessarily require ER visit Does not include any services related to

organ transplants

What is an EMC

Eligible for EMA if experiencing a high risk pregnancy

Labor and Delivery automatically covered

Pre natal and post natal covered up to 60 days post delivery

Pregnant Women (undocumented)

Doctors letter required to accompany application

Use the standard MA application form (PA-600HC)

Apply online using the COMPASS system, or via telephone by calling 866-550-4355

Write on the form “Application for EMA only” Immigrant does not have to indicate their

immigrant status (documented vs undocumented)

How to apply for EMA

Doctor determines if condition meets EMC definition and be willing to write the letter◦ Letter must identify what the EMC is

◦ Identify what specific criteria the condition satisfies

◦ What types of medical services will be required for to treat the condition

◦ Identify how long treatment will be required. Recommendation is no longer than 6 months and then condition can be reassessed, unless the doctor knows it will take longer. Longer time frame brings greater scrutiny

◦ Explain what will happen if patient doesn’t get the care that’s needed

Doctors Letter

Residency Income and Resource

Work with doctor and County Assistance Office

Include Medical Records

Other requirements

EMC is usually for short term conditions, but chronic conditions can be covered, but substantiating this will be more difficult

We have resource materials available to you today that may help you with this

EMC – Chronic Conditions

Children’sHealth Insurance Coverage

CHIP

Provides free or low-cost health insurance to uninsured children up to age 19 whose families earn too much to qualify for MA

Includes both physical and behavioral services, including prescription drugs, vision, hearing and dental services as well as emergency care and in-patient services

Uses the same “lawful presence” immigration status utilized for pregnant women and children applying for MA

No income too high for CHIP but may have to pay premium for coverage

CHIP

Use online system – COMPASS same as for MA

If unsure if child is MA or CHIP eligible, apply for MA. The county assistance office will transfer the application to CHIP if family income is too high for CHIP

Apply directly to CHIP if you know the income is too high for MA and child doesn’t have a disability

How to apply

Marketplace Insurance

Obamacare Coverage

Must be “lawfully present” to enroll in a plan and receive financial help paying for the plan

Lawful presence includes: ◦ Lawful Permanent Residents (LPRs or “green-card holders”)

◦ Humanitarian statuses like asylum

◦ Non-immigrant visa holders, including those on work or student visas

“Qualified” immigrants who do not meet the Five Year Bar should also consider the Marketplace

Undocumented immigrants are excluded from enrolling in the marketplace, even from buying a plan at full cost

Marketplace Plan Eligiblity

Premium Tax Credits (PTC) help lower an individual’s monthly health insurance premium (money paid each month to be enrolled in the plan)

Cost Sharing Reductions (CSR) help with out-of-pocket costs (money spent on things like doctor’s visits, lab tests, and prescription drugs.) CSRs are only available to people enrolled in “Silver” level Marketplace plans

Financial Assistance

Only people with household incomes between 138% FPL and 400% FPL can get help paying for Marketplace coverage using PTCs and CSRs exception

Immigrants who are ineligible for MA because of their immigration status can get PTCs and CSRs even if their income is below the traditional 138% FPL floor. This includes immigrants who are ineligible for MA because of the Five Year Bar

Who’s Eligible

Apply online at Healthcare.gov or by calling 800-318-2596

Only during open enrollment periods: ◦ Open Enrollment for 2016 coverage will be

October 15, 2015 through December 15, 2016

◦ Can only enroll outside this period if you have a major life event, such as marriage, divorce or child birth

Must document citizenship or immigrant status

Applying for coverage

Certified Application Organizations have received designation by the Federal Government

Individuals called Certified Application Counselors are able to assist with enrollment into Medicaid, CHIP and the Marketplace

Who are designated: Federally Qualified Health Centers, hospitals, and social service agencies

Getting Assistance to Apply

Identify health care providers that accept your insurance

If uninsured, i.e. do not qualify for Medicaid, CHIP, EMA, or the Marketplace, seek out free clinics or Federally Qualified Health Centers who have sliding fee scale and other types of free services

Do not use the Emergency Room for non-emergency care

You will need to find a doctor within the health care network willing to assist with EMA paperwork

Where to go for health care services

Need routine primary care for children and adults (well child check ups, immunizations, sick care for adults and children)

Need work physical exams, driver physical exams

Women’s annual exams, prenatal care, birth control

Importance of Selecting a Doctor

Dental care

Mental health

Substance Abuse

Other services

Language

◦ Must comply with Title VI of 1964 Civil Rights Act

◦ Any organization that receives federal funding - health care provider, insurance company, the County Assistance Office, must provide interpreting services free of charge

◦ Can be live interpreters or telephone service Social Security Number

◦ Should not be required to receive services at publically funded clinics, for EMA or for CHIP; Do not use false number, just indicate no number

◦ It is required for MA and the CAO can help with this Immigration Status

◦ “Qualified Immigrants must prove their status

◦ Health clinics do not require proof

Barriers to Care

PA Health Law Project’s 2015

◦ MA Eligibility Manual

◦ Health Care for Immigrants: A Manual for Advocates in Pennsylvania

PA Department of Human Services

◦ MA Manual

References

QUESTIONS