Legal Immigrant Health Coverage Update

Last month, the MGH Community News reported that Governor Patrick, submitted, along with his budget vetoes, a separate $269 million supplemental budget. This supplemental budget included $70 million for health care for about 30,000 legal immigrants who the legislature had proposed cutting from Commonwealth Care. A final supplemental budget bill passed the legislature on July 29 th. The final bill includes $40 million in Commonwealth Care funding for this population, and permits the Secretary of HHS and the Connector to devise a plan to cover the 30,000 eligible legal immigrants that does not exceed $40 million. Full Commonwealth Care for this many people would cost around $130 million, so this is far less than the cost of full benefits and the $70 million proposed by the Governor. If no plan can be devised, the $40 million can be added to the Health Safety Net Trust Fund, which reimburses hospitals and community health centers for free care provided to low income uninsured.

As staff were informed by e-mail earlier this month, there was a short-term reprieve for this group while the legislature considered options. So while originally intended to take place on July 31 st, the immigrant cut from Commonwealth Care will not take effect at least through August. However a warning letter was sent to those impacted by the change prior to this reprieve. Individual advocacy efforts on behalf of this population should focus on ensuring that Commonwealth Care has accurately identified member as falling into this category. It is not uncommon for Commonwealth Care to have an incorrect immigration status, or for them to be unaware that the immigration status has changed since the member was determined eligible for Commonwealth Care.

Should the patient be correctly identified as one of the legal immigrants who should still be eligible for coverage? These include (there are other categories we are less likely to see in our population, see the full list):

• Legal permanent residents (green card holders) who have had their status for 5 or more years (i.e. legal permanent residents on Aug. 1, 2004 or earlier are qualified and eligible on Aug. 1, 2009)
• Legal permanent residents who have had their status for less than 5 years are qualified and eligible IF-
• They have been continuously living in US from before Aug. 22, 1996 (the date the federal rules took effect) until obtaining legal permanent resident status
• Example: Nina came to US as child in 1974 and was undocumented until 2006 when she became a legal permanent resident; she is qualified and eligible
• US entry date does not appear on the green card; it is asked for on MBR & is easily overlooked
• They had a qualified and eligible status before becoming a recent legal permanent resident
• Example: Boris entered the US as a refugee in 2006 and became a legal permanent resident in 2008; he is qualified and eligible
• Prior eligible status is usually indicated by the code on the green card e.g. RE-6 is one code for refugees; it is easily overlooked
• They are veterans or in active service in US armed forces or served under US command in certain conflicts and their spouses and dependent children
• Veteran status will not appear on immigration documents. It is asked for on MBR and easily overlooked
• They are domestic violence victims no longer living with the abusive family member, and their children (or the non-abusive parent of an abused child)
• Codes on green cards will indicate domestic violence for some immigrants e.g. Code B2-1 is one such code. But other immigrants will have green cards without a distinctive code. The domestic violence question is asked on MBR but is often overlooked

• People who have one of the statuses or conditions listed below are qualified and eligible regardless of date of entry (there is no 5-year rule for them)
• Refugees, people granted Political Asylum, and people granted Withholding of Deportation (these are all people who fled political persecution in their home countries)
• Victims of severe forms of trafficking and their children (these people have been victims of forced labor/slavery or sex trafficking and are now working with authorities)
• Certain victims of domestic violence who are no longer living with their abusive family member and their children (or the nonabusive parent of an abused child)
• This information sometimes appears on immigration documents but sometimes does not. The MBR asks about it but the question and answer are often overlooked.
• Someone does not have to be a green card holder to be protected by this rule.
• Certain veterans or active duty personnel who served in US military or under US command in certain conflicts and their spouses and children
• Veteran status does not appear on immigration documents. The MBR asks about it but the question and answer are often overlooked.
• Iraqi and Afghani Special Immigrants
• Qualified eligible status for these immigrants are time-limited to 8 months for Iraqis and 6 months for Afghanis

• Also look for Special Status Aliens who had an application pending for a change in status from immigration officials or the courts when they applied for Commonwealth Care, and have now obtained an eligible qualified status or become naturalized US citizens
• Applicants for political asylum or withholding of deportation who have now been granted political asylum or withholding of deportation
• Applicants for adjustment of status who are now legal permanent residents and are in one of the groups who are not required to wait 5 years to be qualified and eligible
• Legal permanent residents who have become naturalized U.S. citizens (spouses of US citizens only have to wait 3 years as green card holders to become US citizens)
• Legal permanent residents who have just met their 5 years (or will be meeting it soon).

-Adapted from: “ Legislature Moving Towards Partial Legal Immigrant Funding. What’s Next?”, A Healthy Blog, http://blog.hcfama.org/?p=3342 July 29, 2009, retrieved 8/3/09; “ Temporary Reprieve for Legal Immigrants in CommCare, Budget Saga Continues”, “A Healthy Blog” – HCFA, http://blog.hcfama.org/?p=3296 dated 7/17/09, retrieved 7/21/09; and “ NEW INFORMATON: IMMIGRANTS on COMMONWEALTH CARE” e-mail, Kim M.Simonian, MPH, Associate Director, Patient Access, Partners HealthCare, Community Benefit Programs, July 17, 2009 .

 

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