MASSHEALTH

DOWNGRADES ELDER & DISABLED IMMIGRANTS

The state is finally taking action on that group of roughly 3,000 elderly and disabled “special status” immigrant members who had been able to enroll in MassHealth Essential since last June, and were the subject of much debate last budget season. The state sent notices this month to all members in this category.

According to the new regulations, these immigrants will continue to be eligible for this program IF they:

• never had a sponsor,
• have a sponsor who is deceased or
• have a sponsor who has a family income (including the sponsored immigrant) of less than 200% of the federal poverty level (through March 31, 2005 - $2,082 per month for a family of two).

If the sponsor has more income than 200%FPL, the immigrant will no longer be eligible for MassHealth Essential and will be terminated from coverage. The immigrant will then only be eligible for MassHealth Limited or, if already receiving EAEDC, Limited and EAEDC Medical.

The notices sent by the Office of Medicaid included a “Questions for Immigrants with Sponsors” form, which members must fill out and return by January 1, 2005. If members fail to return the form by January 1 st, or return the form with incomplete information, the state will send a second warning notice before terminating them from MassHealth altogether.

What immigrants are affected?

This rule only applies to the elderly and disabled on MassHealth Essential; no other group of immigrants is affected.

Only those who have a sponsor who filled out a Form I-864, also called an “Affidavit of Support under Section 213A” or “an enforceable affidavit of support” will be affected by this change.

Some people who got the notice do not have a sponsor or have a sponsor who signed an unenforceable affidavit of support; they should answer “no” to the question about whether they have a sponsor.

All the following things must be true for an elderly or disabled immigrant with MassHealth Essential to be affected by this new rule:

• The immigrant is a lawful permanent resident (green card holder)
• The immigrant became a lawful permanent resident because a family member filed a relative petition (Immigrants who became lawful permanent resident in other ways will either not have any sponsor or will have a sponsor who signed a different form than the enforceable Form I-864).
• The immigrant has had a green card for less than five years.

If you are confused about whether your immigrant client/patient has a sponsor who signed Form I-864, please, call MIRA or MLRI*

Remember the five year bar eventually ends!

On the five year anniversary of becoming a lawful permanent resident (or first getting parole status), an elderly or disabled immigrant is eligible for MassHealth Standard regardless of the sponsor’s income. BUT, people age 65 or over will not be automatically upgraded by the MassHealth computer system. Please call MIRA or MLRI about elders close to the 5-year mark*.

Does this change affect immigrants receiving EAEDC?

Yes. Elderly and disabled “special status” immigrants receiving EAEDC should now be getting MassHealth Essential, and are also subject to these new rules. However, if they lose MassHealth Essential due to their sponsor’s income level, they will still receive EAEDC-Medical benefits in addition to MassHealth Limited. EAEDC-Medical covers drugs and doctor visits. MassHealth Limited does not.

What are the options if the sponsor’s income is over 200% FPL?

The immigrant will be able to retain MassHealth Limited for emergency coverage, and will have Free Care/Uncompensated Care at hospitals and community health centers. People on EAEDC will also retain EAEDC-Medical for prescriptions and doctor visits. All the immigrants affected will also be eligible to apply for Prescription Advantage, which covers drugs with copayments starting at $7. To apply, call 1-800-AGE-INFO (applicants may need a copy of the December MassHealth notice to apply). Nongroup insurance is also available from commercial insurance companies. Residents of Massachusetts cannot be denied nongroup coverage because of age or disability. However, the cost of coverage is prohibitive.

See Q&A from MIRA for more information.

* Contacts: Carly Burton at MIRA 617-350-5480 x208, cburton@miracoalition.org or Vicky Pulos at MLRI, 617-357-0700 Ext. 318, vpulos@mlri.org

-Adapted from e-mails from Kim Simonian, MPH, Partners Community Benefits, MASSHEALTH ALERT: Did your patient/client receive a “Questions for Immigrants with Sponsors” form from the Office of Medicaid?, from MLRI and MIRA, 12/04, and The MIRA Bulletin, Vol. 6, No. 12, 12/04.