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Webinar Q&A: Access to Health Coverage for Immigrants Living with HIV

March 2015

ACE TA Center

The following questions and answers come from the January 28, 2015 ACE TA Center webinar, Access to Health Coverage for Immigrants Living with HIV.

Questions

  1. How is longer residence in the U.S. for immigrants associated with poorer health outcomes? This seems counter intuitive.

  2. Do the laws regarding same-sex marriage in the state influence Marketplace eligibility?

  3. Is income determined based on household size or through one's modified adjusted gross income (MAGI)? This is important given the case example indicated Eva was including Antoine on her taxes.

  4. Is there a Federal written policy that defines household size? Household size in general can prove to be problematic when one or more in a "household" does not assist an applicant such as living with a friend or roommate?

  5. With regards to lawfully present individuals enrolled in a Marketplace health plan, will the citizenship verification that occurred mid-2014 will occur again in 2015?

  6. Where can I find more information on Deferred Action for Childhood Arrivals (DACA)? What federal benefits are DACA eligible for?

  7. How can we find out which states offer state Medicaid for those impacted by DACA or Deferred Action for Parents of Americans (DAPA)?

  8. Would someone who has a “dependent” student visa qualify for ACA enrollment?

  9. What can serve as documentation to support a DACA/ DAPA application? Can health centers offer letters?

  10. People who are in the visa waiver program, what are they eligible for?

  11. What is the next step for people who lost their coverage? Will they need to re-apply or could we call the Marketplace to resolve this issue?

1. How is longer residence in the U.S. for immigrants associated with poorer health outcomes? This seems counter intuitive.

Recent studies have found that many immigrants have poorer health outcomes after immigrating to the U.S. The research demonstrating this refers to this pattern as “The Immigration Paradox.” The research shows that diet, family structure and social support, stress and other factors can lead to poorer health outcomes for immigrants after they arrive in the U.S.

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2. Do the laws regarding same-sex marriage in the state influence Marketplace eligibility?

Yes, people who live in a state that does recognize same sex marriage would be eligible IF they were married in a state that does recognize same sex marriage. The decision by the federal government to have its Marketplace respect legally married same-sex couples followed the U.S. Supreme Court’s decision from June, 2013, to strike down some of the provisions of the Defense of Marriage Act (DOMA).

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3. Is income determined based on household size or through one's modified adjusted gross income (MAGI)? This is important given the case example indicated Eva was including Antoine on her taxes.

Generally speaking, eligibility for health insurance coverage through Medicaid and Marketplace under the Affordable Care Act (ACA) is determined by both their household size and their MAGI.

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4. Is there a Federal written policy that defines household size? Household size in general can prove to be problematic when one or more in a "household" does not assist an applicant such as living with a friend or roommate?

Generally speaking, your household size includes you and your spouse, if you have one, and any children that live with you plus any tax dependents even if they don’t live with you. If you claim someone as your tax dependent, even if they are not applying for health insurance and even if they are not living with you, you do have to include them on your application. The Marketplace will count income for each of these people and consider this as part of your household income.

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5. With regards to lawfully present individuals enrolled in a Marketplace health plan, will the citizenship verification that occurred mid-2014 will occur again in 2015?

Last year, after the first open enrollment period, there were a number of data matching issues, also known as inconsistencies, where a person’s immigration status or citizenship could not be immediately verified against government databases. Although individuals were generally allowed to enroll in coverage, the Federal Marketplace asked for additional documentation from individuals to resolve the inconsistency. The notices sent to consumers indicated that if an inconsistency was not resolved, the consumer was at risk of losing their coverage. There have been similar inconsistencies this year, but we do not know how many.

What’s important for consumers to know is that if they receive a notice requesting additional documentation, they should provide it as soon as possible to prevent a loss in coverage. It is better to upload documentation directly on the Marketplace, but consumers and assisters should keep records of documentation sent to the marketplace.

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6. Where can I find more information on Deferred Action for Childhood Arrivals (DACA)? What federal benefits are DACA eligible for?

The DACA program was created in 2012 to provide relief from deportation for certain undocumented young people who were brought to the US as children. DACA grantees are not eligible for federal health affordability programs, including Medicaid/Children’s Health Insurance Program (CHIP) and the ACA. However, some states do offer coverage options for this group using state-only funds. Learn more about DACA.

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7. How can we find out which states offer state Medicaid for those impacted by DACA or Deferred Action for Parents of Americans (DAPA)?

Although DACA grantees are not eligible for federal Medicaid, some states do provide access to Medicaid to this group using state-only funds. We expect the same federal restrictions will apply to the new DAPA program (Deferred Action for Parents of Citizens and Lawful Permanent Residents).

Some states, like California and New York, offer state-funded Medicaid for DACA recipients because they are considered permanently residing under color of law or “PRUCOL,” which is a term that is used for immigrants who the government knows are in the United States but they are taking no action against them. It is based on this classification that they are eligible for state-funded Medicaid in California, New York and other states. There are also different programs available to individuals regardless of immigration status, and that DACA recipients may access. For example, in Illinois, under their “All Kids Program”, children regardless of their immigration status have access to health care programs.

See this comprehensive list of health coverage options for immigrants by state, including programs that offer coverage options to individuals regardless of their status.

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8. Would someone who has a “dependent” student visa qualify for ACA enrollment?

Under the ACA, anyone who is lawfully present may be eligible for coverage under the ACA, including the Marketplace and subsidies. Student visas are a type of non-immigrant visa for people who come to the U.S. on a temporary basis, in this case to study. Yes, someone with a student visa or a derivative student visa, a dependent, is considered lawfully present for purposes of the ACA, including to access the Marketplace and to obtain subsidies. However some non-immigrant visas, including student visas, have specific requirements that stipulate that these individuals have no intention of abandoning their residency abroad. And since eligibility for a Marketplace plan requires that a person establish state residency, this may conflict with the terms of some of these visas.

The National Immigration Law Center (NILC) recommends that if an individual is in this situation, they should consult with an immigration attorney to see if enrolling in ACA health insurance coverage will violate the terms of their visa.

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9. What can serve as documentation to support a DACA/ DAPA application? Can health centers offer letters?

NILC has a web page dedicated to questions related to DACA including how much it costs and what documents are needed to apply.

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10. People who are in the visa waiver program, what are they eligible for?

Persons in the U.S. under the visa waiver program would not be eligible for Medicaid, CHIP, or the ACA. Under the visa waiver program, a person may enter the U.S. for less than 90 days without a visa. Because they can only be in the country for such a limited time without a visa, they would not be able to establish residency for any of these programs.

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11. What is the next step for people who lost their coverage? Will they need to re-apply or could we call the Marketplace to resolve this issue?

It depends on each individual circumstance. If a person has lost their coverage due an unresolved inconsistency, there is a process in place to regain coverage. In some cases, the Center for Medicare and Medicaid Services (CMS) and Health and Human Services (HHS) will send notices asking people to submit supporting documentation even after they have lost their coverage. If appropriate documents are submitted and CMS/HHS successfully resolves the case, the person would be eligible for a special enrollment period and can get retroactive coverage.

In other instances, for other individuals it might make more sense to re-apply in this current open enrollment period. If there is no need for retroactive coverage then individuals might want to apply during this open enrollment period.

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