Special Supplement To The MGH COMMUNITY NEWS October 2000
IMMIGRANT HEALTH ACCESS
Health programs that are available regardless of immigrant status (i.e., open to those who have no proof
of immigration status- a term preferred to "undocumented" when applying for benefits): Children's Medical
Security Plan, Free Care, Healthy Start, MassHealth Limited, the Pharmacy and Pharmacy Plus programs, the
Home Care program for seniors offered through the ASAPs or Aging Services Access Points (formerly known as
state homecare corporations). These programs should not require a social security number for application.
Clients should be advised NOT to supply a false social security number.
The 1996 Welfare Reform law cut back on the eligibility of LEGAL immigrants for federally funded social
supports such as SSI and federally funded portions of food stamps and Medicaid (known as MassHealth Standard
in Massachusetts). It, and the Immigration reform act that soon followed, made some important changes in
other aspects of immigration such as "Sponsor Deeming" and removal of some rights to due process that have
had a chilling effect on many immigrants, making them reluctant to apply for some programs for which they
are eligible. The changes it made that apply to MassHealth Standard are:
Created two distinct groups of legal immigrants ("Qualified" and "Not-Qualified") for the purposes of
determining eligibility for federal benefits.
Those who do not fall under this category or Not-Qualified may be those with no proof of status, or they
may be those who are here "Permanently Residing Under Color of Law" (PRUCOL). These people are in the US
legally and are known to the INS, and whom the INS is not planning to immediately deport, but have a lower
status when it comes to benefits eligibility.
MassHealth is divided into separate programs based on eligibility criteria and benefit levels. MassHealth Standard
has the most restrictive eligibility as it is federally funded and the only level that covers long-term care.
Other levels of MassHealth are state funded, and are progressively less restrictive. See chart below for the type
of immigration status and the level of MassHealth or other health program for which they qualify.
Massachusetts Immigrant Health Care Coverage Eligibility
HOW TO USE THIS CHART: evaluate categorical and financial eligibility first
and then look at this for immigration status.
The category of "Refugees and Others" below includes refugees, asylees, people
granted Withholding of Removal/Deportation, Cuban/Haitian Entrants, Certain Native Americans outside the US,
and Amerasian immigrants.
YES = Eligible NO = Not Eligible
Public Charge
Many immigrants are understandably cautious about this and have heard horror stories. The INS still asks questions about use of
health benefits, but they are not to use this to disqualify someone based on public charge. There is also understandable fear
that the rules will change.
Verification of Immigration Status and Required use of Social Security Numbers
Some additional programs that are exempt from verification (there are others):
Joscelyn and Ellen recently attended a training on immigrant health care access presented
by the MIRA (Mass. Immigrant and Refugee Advocacy) Coalition. Health Care eligibility for immigrants
is a complicated a subject, parts of which have been covered in previous editions of the MGH Community
News (can be found on Social Service Department website: Public Charge- July 1999;
MassHealth- February 1998).
This is where it gets complicated. Some people are eligible for health benefits that provide higher levels
of coverage. So one shouldn't assume that people should only apply for those listed above. But the
decision grids are complex. What follows is an overview, but due to space constraints every possible
situation is not covered. Please contact a specialist in immigration and/or the CRC before advising your
clients. And another warning- do not send people to INS to clarify their immigration status without first
consulting an experienced immigration attorney. Also not everyone either knows or clearly states their
official status. The training went over how to read various immigration documents to determine someone's
status. Consult the CRC for questions about this or to get a copy of guides to reading the codes.
"Qualified immigrants" are those who are:
PRUCOL includes:
Source: MIRA Coalition October 2000
"QUALIFIED"
(See list above)Refugees & Others
PRUCOLs
No Proof Of Status
MassHealth Standard
YES if:
· Received Medicaid or has been in a LTC facility as of 6/30/97 OR
· Had an application for LTC pending as of 7/1/97
YES
NO unless:
NO
MassHealth Basic
YES if:
YES
YES if:
NO
MassHealth Family Assistance
YES if:
YES
YES if:
NO
MassHealth CommonHealth
YES if:
YES
YES if:
Disabled and Ineligible for Standard because of immigrant restrictions
NO
MassHealth Limited
N/A
N/A
N/A
YES
Other Barriers to Immigrants Accessing Health Care
(This topic was covered also in the July 1999 edition). Those who are applying for a "green card" or LPR status who have been
sponsored by a family member or those with a green card who leave the country for more than 6 months can be denied a green card
if immigration judges that they will, in the future, rely for their support on public benefits- will be a "Public Charge".
In May of 1999 INS clarified the definition of this to PRIMARILY dependent on public benefits.
NOTE: Clients should NEVER divulge their undocumented status. Always say instead, "I have no proof of immigration status"
or "I'm not eligible for the benefit."
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