MGH Community News

Special Supplement To The MGH COMMUNITY NEWS October 2000

IMMIGRANT HEALTH ACCESS


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).

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.
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.

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:

  1. Created two distinct groups of legal immigrants ("qualified" and "not-qualified") for the purposes of determining eligibility for federal benefits
  2. Placed a ban (either 5 years or until citizenship) on most immigrants who entered the country after August 22, 1996 from receiving federal health benefits
  3. Deemed the income of the sponsor as available to the immigrant and had sponsors sign legally enforceable agreements to this effect. NOTE: This provision has NOT yet been implemented in Massachusetts.
  4. Created verification and reporting requirements.

Created two distinct groups of legal immigrants ("Qualified" and "Not-Qualified") for the purposes of determining eligibility for federal benefits.
"Qualified immigrants" are those who are:

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.
PRUCOL includes:

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
Source: MIRA Coalition October 2000

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


"QUALIFIED"
(See list above)
Refugees & Others PRUCOLs No Proof Of Status
MassHealth Standard YES if:
  1. Receiving SSI; OR
  2. Veteran, spouse or dependent of veteran
  3. Entered the US as of 8/22/96- if entered later, barred for first 5 years in US unless covered under other eligible categories.
  4. Were granted immigration status after 8/22/96 and:
    · 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:
  1. Receiving SSI OR
  2. Received Medicaid or in a LTC facility as of 6/30/97 OR
  3. Had an application for LTC pending as of 7/1/97
NO
MassHealth Basic YES if:
  1. Meet general eligibility requirements; OR
  2. 65 and over and Ineligible for Standard because of Immigration restrictions
YES YES if:
  1. Meet general eligibility requirements OR
  2. 65 and over and Ineligible for Standard because of immigrant restrictions
NO
MassHealth Family Assistance YES if:
  1. Meet general eligibility requirements; OR
  2. Family with kids under 19 or pregnant woman and Ineligible for Standard because of immigrant restrictions
YES YES if:
  1. Meet general eligibility requirements; OR
  2. Family with kids under 19 or pregnant woman and Ineligible for Standard because of immigrant restrictions
NO
MassHealth CommonHealth YES if:
  1. Meet general eligibility requirements OR
  2. Disabled and Ineligible for Standard because of immigrant restrictions
YES YES if:
  1. Meet general eligibility requirements OR
    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

Public Charge
(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.

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
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."

Some additional programs that are exempt from verification (there are others):


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