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Immigrant Eligibility for Health Coverage and Other Public Benefits in [INSERT STATE]�

Name, organization

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Agenda

Immigration Overview
Immigrant Benefits Classifications
Eligibility for Benefit Programs
Resources
Questions & Answers

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Immigration Overview

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Common Immigration Pathways

Family-Based Immigration
Humanitarian Immigration

Includes refugees, people granted asylum, people granted discretionary relief

Visas

Immigrant and non-immigrant

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Family-Based Immigration

U.S. Citizens and Lawful Permanent Residents can petition for certain relatives

Immediate Relatives of U.S. Citizens
spouses
unmarried minor children (under 21-years-old); and
parents (petitioner must be at least 21-years-old)

Other relatives of U.S. Citizens

Siblings
Adult/Married Children

Relatives of LPRs

Spouses and children
Unmarried adult children

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Must wait for a visa

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Affidavit of Support

Family-based immigrants are required to have an Affidavit of Support signed by a sponsor who commits to supporting them if needed and potentially to repay the cost of certain benefits

Sponsors must show that they can support a household that includes the immigrant and any dependents at 125% or more of the FPL
Normally the relative who submitted the petition signs the Affidavit of Support. If they don’t have enough income they can get a joint sponsor
A portion of the sponsor’s income may be ‘deemed’ to be available to the immigrant when they apply for certain benefits. There are exceptions to these deeming rules.

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Benefits Classifications

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Immigrant Eligibility Generally

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Meet income and any other requirements

State resident

Eligible immigration status

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“Qualified Immigrant”/ “Qualified Non-Citizen” Status

1996 Welfare Reform restricted immigrant access to FEDERAL benefits

Created two categories for benefits eligibility: “Qualified” and “Not Qualified”
Applies to “federal means-tested public benefits” on or after August 22, 1996, including Federally-Funded Medicaid (except for Emergency Medicaid)

Generally, individuals who have a “Qualified” non-citizen immigration status are:

Eligible to enroll in full-scope Federally Funded Medicaid, if they are otherwise eligible for Medicaid in their state of residence.

Full scope: all services covered by the state’s Medicaid program for the given eligibility group which is also eligible for federal reimbursement at the state’s matching rate.

With certain exceptions, individuals who are not “Qualified” cannot receive full-scope Federal-Funded Medicaid coverage. But as you will see, in [INSERT STATE] there are other Medicaid-Like programs for many (but not all) individuals who are not “Qualified”.

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Five Year Bar

Federal law requires that many Qualified non-citizens meet a five-year waiting period (also called the “five-year bar”) before becoming eligible for Federal Medicaid.
This five-year waiting period begins when a person receives their qualifying immigration status.

A person who enters the U.S. on or after 08/22/96 must live in the U.S. for 5 years after being lawfully admitted.
A person who entered the country under a classification which is exempt from the 5-year residency requirement remains exempt even if they are adjusted to LPR Status

Source: https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Marketplaces/Downloads/Immigration-Fact-Sheet.pdf

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“Qualified” Immigrants or Non-citizens for Federally Funded Medicaid

Qualified immigrant is an individual who, at the time they apply for, receive, or attempt to receive public benefits:

Is a legal permanent resident (LPR, also known as a green card holder); Subject to the Five-Year bar
Is granted asylum; NOT Subject to the Five-Year bar
Is admitted to the U.S. as a refugee; NOT Subject to the Five-Year bar
Is paroled into the U.S. for a period of at least one year;
Has been granted withholding of deportation; NOT Subject to the Five-Year bar
Has been granted conditional entry; NOT Subject to the Five-Year bar

While individuals granted conditional entry are not technically exempt from the five-year bar, by definition, they entered the U.S. and obtained qualified immigrant status prior to August 22, 1996, meaning they are not subject to the bar.

Is a Cuban or Haitian entrant; NOT Subject to the Five-Year bar
Is lawfully residing in the United States in accordance with a Compact of Free Association (individuals from the Republic of the Marshall Islands, the Federated States of Micronesia, and the Republic of Palau);
Was born in Canada and is at least 50 percent American Indian, or is a member of a tribe recognized by the federal government. NOT Subject to the Five-Year bar
Certain Amerasian Immigrants NOT Subject to the Five-Year bar
People with Iraqi or Afghan special status. NOT Subject to the Five-Year bar

Source: https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Marketplaces/Downloads/Immigration-Fact-Sheet.pdf

See also: https://www.nilc.org/issues/economic-support/overview-immeligfedprograms/. and CBPP 2020 OE8 Part III slide deck

LPRs are non-citizens who have been granted authorization to live and work in the United States on a permanent basis. As proof of that status, the person is granted a Permanent Resident Card, Form I-551 (formerly called Alien Registration Card, also known as green card). After five years of permanent residency, these persons may access p

Currently, a qualified immigrant means an individual who, at the time they apply for, receive, or attempt to receive public benefits: • Is a legal permanent resident (LPR, also known as a green card holder); • Is granted asylum; • Is admitted to the U.S. as a refugee; • Is paroled into the U.S. for a period of at least one year; • Has been granted withholding of deportation; • Has been granted conditional entry; • Is a Cuban or Haitian entrant; • Is lawfully residing in the United States in accordance with a Compact of Free Association (individuals from the Republic of the Marshall Islands, the Federated States of Micronesia, and the Republic of Palau); or • Was born in Canada and is at least 50 percent American Indian, or is a member of a tribe recognized by the federal government.6 The statute also treats as qualified immigrants certain: (1) survivors of battery or extreme cruelty, as well as some of their family members; and (2) victims of severe forms of trafficking, as well as some of their family members.7

A Qualified Alien or Non-citizen is an immigrant who may access public benefits. To be a qualified non-citizen, the immigrant falls into one of the following groups listed on the slide.

Lawful Permanent Resident (LPR) – A Lawful Permanent Resident is a person who immigrated legally but is not yet an American citizen. LPRs are non-citizens who have been granted authorization to live and work in the United States on a permanent basis. As proof of that status, the person is granted a Permanent Resident Card, Form I-551 (formerly called Alien Registration Card, also known as green card). After five years of permanent residency, these persons may access public benefits if they meet the program requirements (e.g. income, age).

What is the difference between a refugee or asylee? Both have fled their home countries due to any number of reasons such as war, famine, religious/racial/ethnic persecution. A refuge flees to a neighboring country, lives in a camp, and works with a resettlement organization to be placed in another country, such as the United States. Once a refugee arrives on U.S. soil, they have the “qualified” immigration status. An asylee has already arrived and is here when they make application for asylum. An asylee is not eligible for public benefits while their application is pending. Once asylum request is granted, they are considered qualified non citizens.

The Violence Against Women Act provides immigration relief to victims of domestic violence. This type of relief applies equally to women and men. Abused spouses and children of a US Citizen or LPR may file to adjust their immigration status under VAWA. Abused parents of a US citizens may also file. VAWA is a self-petitioning form – applicants do not need a sponsor. After approval, the person can be placed in deferred action to prevent removal from the US, can work in the US, and can adjust status to lawful permanent resident.

US Military

Cuban and Haitian entrants are considered qualified non-citizens due to Humanitarian Parole rules. These rules state that non-citizens may be able to request parole into the United States based on humanitarian or significant public benefit reasons. For Cuban and Haitian entrants, it falls under the Family Reunification Parole program.

As an aside, “both the special parole policy for arriving Cuban nationals, commonly known as the “wet foot/dry foot” policy, and the Cuban Medical Professional parole Program expired on January 12, 2017. The Cuban Family Reunification Parole Program remains in effect.” (USCIS).

There are many other special humanitarian special statuses with rules for each. You may review the electronic version of our Citizenship Eligibility Desk Aid document for links to specific policy.

Citizens of the Marshall Islands, Micronesia, and Palau who are living in one of the U.S. states or territories (referred to as Compact of Free Association or COFA migrants)

Note: Effective December 27, 2020 COFA migrants are considered “qualified non-citizens” and are eligible for Medicaid, if they meet all of the eligibility criteria for their state.

What is the difference between a refugee or asylee? Both have fled their home countries due to any number of reasons such as war, famine, religious/racial/ethnic persecution. A refuge flees to a neighboring country, lives in a camp, and works with a resettlement organization to be placed in another country, such as the United States. Once a refugee arrives on U.S. soil, they have the “qualified” immigration status. An asylee has already arrived and is here when they make application for asylum. An asylee is not eligible for public benefits while their application is pending. Once asylum request is granted, they are considered qualified non citizens.

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Federal law also treats as “Qualified Immigrants” and Eligible for Federal Medicaid:

Federal law also treats as “Qualified Immigrants” certain:

(1) survivors of battery or extreme cruelty, as well as some of their family members; and
(2) victims of severe forms of trafficking, as well as some of their family members. (T-Visa holders or HHS certification under Trafficking Victims Protection Act (TVPA)) Exempt from Five Year Bar

The Violence Against Women Act provides immigration relief to victims of domestic violence. This type of relief applies equally to women and men. Abused spouses and children of a US Citizen or LPR may file to adjust their immigration status under VAWA. Abused parents of a US citizens may also file. VAWA is a self-petitioning form – applicants do not need a sponsor. After approval, the person can be placed in deferred action to prevent removal from the US, can work in the US, and can adjust status to lawful permanent resident.

“A non-citizen and their children or parents meet the immigration status requirement for cash and medical if they are:

A LPR or has petition for status pending or approved

A spouse, widow, widower or child of a U.S. citizen or a spouse or child of an LPR

Has been abused (or the noncitizen’s child has been abused) by the U.S. citizen or LPR…

Needs assistance, at least in part, due to the abuse; and

No longer lives with the abuser or plans to live separately within one month after receipt of assistance

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More information about Qualified Battered Immigrants

Individuals who have been abused,

whose child(ren) have been abused or

whose parent has been abused

With a prima facie case or approved:

Visa petition filed by US citizen or LPR spouse or parent
Self-petition under the Violence Against Women Act (VAWA), or
Application for cancellation of removal or suspension of deportation under VAWA

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More information about Survivors of Severe Form of Trafficking

If 18 or over, must be certified by HHS

Children under 18 may get HHS “eligibility letter”

Eligible for federal benefits to the same extent as refugees.

Derivative beneficiaries of “T” visas are also eligible for federal benefits

🡪 Survivors with approved T visa petitions or prima facie case determinations are “qualified”-- but other trafficking survivors may also be eligible for benefits.

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In General, Individuals with the Following Immigration Status are “Not” Qualified for Federal Funded Benefits even if have work authorization and are lawfully present in U.S.�

Individuals who are Undocumented
Individuals with Deferred Action for Childhood Arrivals (DACA)
Individuals with Temporary Protected Status (TPS)
Individuals with Applicants for Asylum
U visa applicants or recipients
Adjustment of status applicants

Federal Funded Medicaid Exceptions :

As a state option: Pregnant People (which in [INSERT STATE] is under the [INSERT STATE NAME] Program)

Emergency Medicaid

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Permanently Residing under Color of Law (PRUCOL)

PRUCOL - not an immigration status, but a benefit eligibility category that generally means that a person is in the U.S. with the knowledge of the Department of Homeland Security (DHS) whose departure the agency does not contemplate enforcing.

PRUCOL may be interpreted differently from program to program!

NOTE: Not every state honors PRUCOL; in fact, most states do not.

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Permanently Residing under Color of Law (PRUCOL)�Note: this slide is for California only

PRUCOL in Medi-Cal, CAPI, IHSS may include persons:

with an approved immediate relative visa petition

who filed an application for adjustment to LPR status

granted deferred action (including DACA)

granted a stay of deportation

who have lived in the US continuously since before Jan. 1, 1972, or

in the US with the knowledge of DHS whose departure the agency does not contemplate enforcing

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Sponsor Deeming�NOTE: include if your state implements Sponsor deeming

If an immigrant with a sponsor who signed an I-864 affidavit of support applies for [insert state program name], a portion of the sponsor’s income may be deemed to be available in determining whether they are income eligible
Exceptions to sponsor deeming vary by program.
Deeming does not apply if:

The sponsored immigrant would go homeless or hungry without the benefit (indigence)
The sponsored immigrant is a victim of domestic violence

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Federal Funded Medicaid [modify for your state]

Federal Funded Medicaid Program	Qualified Immigrants	LPRs who have had that status less than 5 years	Undocumented
ACA Adult Medicaid (at/< 138%FPL), 19-64 years old	Yes	No	No
Insert other federal funded Medicaid program state name	Yes	No	No
Insert other federal funded Medicaid program state name	Yes	No	No.
Insert other federal funded Medicaid program state name	Yes	No	No

PLUS: need to be a STATE resident

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Eligibility for Other Medicaid-like Programs In [NOTE: THIS CHART IS FOR EXCLUSIVELY-STATE FUNDED PROGRAMS THAT ALLOWS UNDOCUMENTED PEOPLE TO BE ELIGIBLE insert state]

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Program Name	Qualified Immigrants	LPRs who have had that status less than 5 years	Undocumented
[insert name for EXCLUSIVELY state-FUNDED Medicaid program] Program	?	?	?
[insert name for EXCLUSIVELY state-FUNDED Medicaid program] Program	?	?	?
[insert name for EXCLUSIVELY state-FUNDED Medicaid program] Program	?	?	?

PLUS: need to be a STATE resident

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Qualified Immigrants: �Other Major Federal Programs

Supplemental Security Income (SSI) severely restricted for immigrants

Federal TANF, Medicaid (non-emergency) 5-year waiting period for qualified immigrants who entered U.S. on or after 8/22/96, with exceptions

Federal SNAP (food stamps) 5-year waiting period for qualified immigrant adults, with exceptions

NOTE: If applicable, insert your state name and the state program names: In [insert your state], the [insert state program names] programs cover many of the immigrants who are ineligible for the federal programs

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Immigrant Eligibility for Major [INSERT STATE] Programs

Full-Scope [insert state name for Medicaid-like program/s]

Adults: Qualified immigrants & ???

Children up to age 19??:

Pregnant women: regardless of status??

NOTE for California: Trafficking survivors and U visa applicants/holders are eligible for all state & local programs

[insert state name for food stamp/SNAP program/s]: Qualified immigrants (plus) ?? Deeming rules apply??

[insert state name for food stamp/SNAP program/s]: Qualified Immigrants and ??. Deeming rules apply??

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SSI/Cash Assistance Programs for Immigrants (CAPI) and IHSS

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SSI Eligibility

Receiving SSI or application pending on August 22, 1996

Qualified immigrants with disabilities, who were lawfully present in the U.S. on 8/22/96

LPRs with credit for 40 quarters of work history. Post 8/22/96 entrants are subject to the 5-year bar

Refugees, asylees, granted withholding of deportation/ removal, Cuban/Haitian entrants, Amerasian immigrants, Iraqi and Afghan Special Immigrants, trafficking victims, only during first 7 years after obtaining status
Veterans, active duty military, spouses, surviving spouses, & children
Members of federally recognized Indian tribes or American Indians born in Canada

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Eligibility for ACA Marketplace coverage in [insert state name and if state has state-specific marketplace]

Lawfully Present

Qualified

Marketplace Uses

"Lawfully Present" Eligibility Standard

Medicaid & CHIP Use "Qualified Immigrant" Eligibility Standard

Source: http://www.healthreformbeyondthebasics.org/wp-content/uploads/2020/09/2020_OE8-Part-III_Immigrant-Eligibility.pdf

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Lawfully Present Noncitizens:�ACA Marketplace

All “qualified” immigrants

Others authorized to live and/or work in the U.S., e.g.

temporary protected status (TPS)
deferred action (except DACA)

Applicants for: adjustment to LPR, asylum, and certain other statuses

Individuals with valid nonimmigrant status (visas)

Complete list:

https://www.healthcare.gov/immigration-status-and-the-marketplace/

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Health Insurance, Lawfully Present Immigration Categories Eligible for ACA Marketplace Coverage

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All the Categories Listed in these Two Boxes are Eligible for the ACA Marketplace Coverage:

Source: http://www.healthreformbeyondthebasics.org/wp-content/uploads/2020/09/2020_OE8-Part-III_Immigrant-Eligibility.pdf

Much less restrictive than Medicaid. NOTE: Even though many ppl who are Deferred Action are eligible, DACA recipients (800,000 people across the US) are not. They have permission to work in the US etc but are still not eligible.

Immigrants are deemed lawfully present if they: • Meet the definition of qualified immigrant; • Have a nonimmigrant status and have not violated the terms of the status under which they were admitted or to which they changed after admission; • Have been paroled into the U.S. for less than 1 year, unless they were paroled for prosecution, for deferred inspection, or pending removal proceedings; • Belong to one of the following classes: o Currently in temporary resident status; o Currently under Temporary Protected Status (TPS), or have a pending application for TPS and have been granted employment authorization; o Have employment authorization under certain subsections of 8 CFR § 274a.12(c); o Family Unity beneficiaries; o Currently under Deferred Enforced Departure pursuant to a decision made by the President; o Currently in deferred action status; or o Have an approved visa petition and a pending application for adjustment of status.

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Health Insurance, ACA Coverage and Non-Immigrant Visas

Q: Are consumers with a temporary work permit eligible to apply for Marketplace coverage? Can they receive financial assistance through the Marketplace?

A: Consumers who are lawfully present (including those with a valid nonimmigrant visa, such as a worker visa) may be eligible to enroll in Marketplace coverage.

Consumers who are lawfully present may also be eligible for financial assistance through the Marketplace, if they meet the other eligibility requirements. ��Source: Assister Guide to the Immigration Section of the Online Marketplace Application

https://marketplace.cms.gov/technical-assistance-resources/assister-guide-to-immigration-section.PDF

https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Marketplaces/Downloads/Immigration-Fact-Sheet.pdf

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Health Insurance, Immigration Categories NOT Eligible for ACA Marketplace Coverage

Largest Categories of Immigrants Who are NOT eligible:

Undocumented immigrants
DACA

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Programs Available Regardless of Status

Emergency Medicaid

Includes testing and treatment for symptoms of COVID-19

[insert state Medicaid like program for pregnant women regardless of status if applicable in your state]
[insert state Medicaid like program for children regardless of status if applicable in your state]
Early Breast Cancer Detection and Breast and Cervical Cancer Treatment [if applicable in your state]

Community Health Centers
Women Infants and Children (WIC)
School meals/pandemic EBT
Food banks and shelters
Head Start
Disaster Relief
Public Health Programs
Senior Centers
Charity care from hospitals if applicable in your state]

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Non-Profit Agencies

Non-profit charitable organizations are not required to determine, verify or otherwise ask for proof of an immigrant’s status

applies to immigrant restrictions in the 1996 welfare and immigration laws

Non-profits can create a safe environment for immigrants and their family members who are seeking services

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Angie and Nadia

Angie works in a non-profit community health center that receives federal funds. Patients can be treated at the clinic, regardless of their income.

Nadia, an undocumented woman who suspects she has COVID-19, seeks testing and treatment at the clinic (after calling first).

Is Nadia eligible for testing and treatment? (poll: yes/no)
Is Angie required to verify Nadia’s immigration status? (poll: yes/no)
Is Angie required to report Nadia to the Department of Homeland Security?

(poll: yes/no)

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A Look at Some Common Documents

Things to remember:

People with a given status may have different kinds of documents

A document isn’t always a card. For example it may be a stamp in a passport, a record on a computer, letter from the Office of Refugee Resettlement, or a decision from an immigration judge or court.

In many programs, verification of status is done through the USCIS’ SAVE process.

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Commonly Used Documents

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LPR I-551 “Green Card”

Sample I-551 (green card)

The appearance of these cards has changed over time.

USCIS Number

Expiration date.

An expired I-551 can be used to verify LPR status. Lawful permanent resident status does not end when a card expires.

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Employment Authorization Document

I-766 Employment Authorization Document
USCIS Number
Expiration Date

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I-94 Arrival and Departure Record

Online System

Paper Record

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I-797 Notice of Action

Receipt Number (may be at the bottom)

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Some of the Documents Typically Used by Lawfully Residing Immigrants

Lawfully Residing Immigrant Categories:

https://www.nilc.org/wp-content/uploads/2015/11/lawfully-residing-imm-categories-CHIPRA-2016-07.pdf

Documents Typically Used by Lawfully Residing Immigrants:

https://www.nilc.org/wp-content/uploads/2015/11/docs-typically-used-by-immigrants.pdf

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Resources on Immigrant Eligibility for Benefits and Services

NILC: Major Benefit Programs Available for Immigrants in California (table)

NILC: Benefits for Immigrant Survivors of Trafficking, Domestic Violence and Other Serious Crimes in California

NILC: Overview of Immigrant Eligibility for Federal Programs (table)

NILC: Lawfully Residing Immigrants Eligible for Medicaid and CHIP (narrative)

NILC: Documents Typically Used by Lawfully Residing Immigrants

PIF: Quick Guide: Immigrant Eligibility for Public Programs During COVID-19

Western Center on Law and Poverty: Up-to-Date COVID information

Brooks, Tricia, Allexa Gardner, Jennifer Tolbert, Rachel Dolan, and Olivia Pham, March 2021, “Table 3: State Adoption of Options to Cover immigrant Populations, January 2021,” in Medicaid and CHIP Eligibility and Enrollment Policies as of January 2021: Findings from a 50-State Survey, Kaiser Family Foundation, http://files.kff.org/attachment/Table-3-State-Adoption-of-Options-to-Cover-ImmigrantPopulations-January-2021.pdf

Coverage for lawfully present immigrants on Healthcare.gov: https://www.healthcare.gov/immigrants/lawfully-present-immigrants/

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