Last fall we blogged about how the Affordable Care Act (ACA) helps immigrants by providing new and strengthening current health insurance coverage opportunities. Unfortunately, some immigrants have encountered problems in accessing these coverage opportunities. Advocates have been working with the federal government to fix these problems. Below are some new resources that may help smooth the path for immigrants to health insurance coverage.
Lawfully present immigrants are eligible to purchase private health insurance plans in the health insurance marketplaces. This checklist and fact sheet on immigration document types can assist in preparing to complete the application. Applicants need to prove or verify their identity as part of the application process. This fact sheet from the federal government offers information for applicants in answering the identity verification questions. Also, when immigrants are completing an application on the federal marketplace, they may be asked about their immigration status. This new fact sheet from the federal government provides information on how to answer these questions. Open enrollment for 2014 coverage ends March 31, 2014. If an applicant has not enrolled in coverage by then and he or she does not qualify for a special enrollment period, then he or she generally cannot enroll in 2014 coverage until the next open enrollment period, which begins November 15, 2014. If the applicant enrolls in a plan by March 31, 2014, he or she will not have to pay any penalty.
Lawfully present immigrants may qualify for federal financial help to lower the cost of their monthly premiums and cost-sharing (e.g., co-payments, deductible, co-insurance) to help them afford a private insurance plan through the Marketplaces. Lawfully present immigrants with household income between 100% and 400% of the federal poverty level (FPL) are eligible for premium tax credits; lawfully present immigrants with income between 100% and 250% FPL are eligible for the cost-sharing reduction subsidies. To qualify for this federal financial help, applicants cannot be offered affordable health insurance through their job or be eligible for Medicaid. This website (also available in Spanish) helps people find out if they qualify for the financial help.
Most lawfully present immigrants who meet Medicaid program requirements, such as income and state residency, can enroll in Medicaid after they have been in the United States for five years or more. Some groups of lawfully present immigrants (including refugees, asylees, and pregnant women and children in some states) do not have to wait five years before they may enroll in Medicaid. Immigrants will benefit greatly in states that choose to add the ACA’s new Medicaid eligibility category, which will expand that program to all adults under age 65 with household income of less than 138% of the FPL. Use of Medicaid does not affect one’s immigration status (public charge decision) unless the Medicaid use is for long-term care, such as nursing home care.
Lawfully present immigrants with household incomes of less than 100% of the FPL are also eligible for the private Marketplace coverage and can get help paying premiums and cost sharing if they are ineligible for Medicaid (either because they are not lawful permanent residents (LPRs) or because they are LPRs with less than five years of residency). For instance, if a lawfully present immigrant who has a household income of 90% FPL has been in the United States just two years, he or she should qualify for a private plan on the Marketplace and receive both premium tax credits and cost sharing reduction subsidies. If the applicant is mistakenly told by the Marketplace that he or she does not qualify, the applicant should file an appeal. If the Marketplace mistakenly informs the applicant that he or she is Medicaid eligible, the applicant could choose to apply to Medicaid and receive a Medicaid denial before attempting again to enroll in Marketplace coverage. Applicants can now report a Medicaid denial on the Marketplace application. Many organizations are working to to help individuals experiencing difficulties in enrolling eligible immigrants in ACA’s coverage, including the National Immigration Law Center (NILC), Community Catalyst’s In The Loop, and the Sargent Shriver National Center on Poverty Law, to name just a few.
Undocumented immigrants may not buy health insurance through the Marketplaces, even at full cost. However, until this is remedied, undocumented immigrants need to know that:
- Community health centers, strengthened by ACA funding, will still accept patients regardless of immigration status.
- Emergency rooms will continue to treat undocumented immigrants for free or at very low cost.
- Many hospitals have charity care obligations that essentially provide free care to low-income patients, regardless of immigration status.
- Undocumented immigrants may purchase health coverage through an employer or a spouse’s employer.
- Undocumented immigrants may purchase private health insurance off of the Marketplace.
- And some state-funded Medicaid programs are open to immigrants regardless of immigration status.
Undocumented immigrants also need to understand that, if they have family members who are U.S. citizens or lawfully present, these family members are required to have health insurance under the law starting in 2014, or face a penalty at tax time, unless they qualify for some exemption. (If you are undocumented, you don’t need to apply for an exemption to the penalty because this will be handled when you file your taxes in 2015.) This means that undocumented parents who have lawfully present or U.S. citizen children must ensure that their children have health insurance (through a child-only private Marketplace plan or through Medicaid, for instance). It’s important to remember that only those individuals in a family who are applying for health insurance are required to provide citizenship and immigration status. So undocumented parents applying through the Marketplace for private or Medicaid coverage for their eligible family members will not be asked for a Social Security Number for themselves (only for the applicants).
Many groups of immigrants are eligible to enroll in the Marketplace plans, and they should be encouraged to do so. The information they provide in their Marketplace applications is NOT shared with immigration authorities. Since October 2013, Immigration and Customs Enforcement (ICE) has had a policy that the information provided in Marketplace application will not be the basis for carrying out immigration enforcement action. Simply put, this information will not be used for immigration enforcement purposes.
There is no charge to individuals who receive in-person help in enrolling in Medicaid or Marketplace coverage. The ACA provides federal funding to train and certify in-person consumer assisters to walk individuals through all of their health insurance coverage options. You can find an in-person assister by going to your Marketplace’s website. These assisters cannot and will not charge individuals for this enrollment assistance, including answering questions post-enrollment. The Ms. Foundation for Women recently published a series of fact sheets in English and Spanish describing ACA health coverage options; these fact sheets include links for help in obtaining coverage and also feature information for consumer assisters who work with immigrant populations.
The road to coverage has had a few bumps for applicants in general, and immigrant applicants have encountered more than most. We will continue to work with the Marketplace to highlight and fix these bumps so that eligible individuals and families can get the coverage they need.