Health Coverage for Immigrants
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The document provides an overview of immigrant eligibility for public health coverage in San Mateo County, including Medi-Cal and Covered California. It details eligibility criteria based on immigration status, income levels, and available exemptions from health insurance mandates. Additionally, it addresses public charge concerns related to receiving health benefits and offers resources for further assistance.
Health Coverage for Immigrants
- 1. t LEGAL AID SOCIEY OF SAN MATEO COUNTY Immigrants and Public Health Coverage Benefits in San Mateo County: An Overview
- 2. t LEGAL AID SOCIEY OF SAN MATEO COUNTY Agenda • Will I have a tax penalty if I don’t have health insurance? • Who is eligible for Medi-Cal and Covered California? • How will I prove my immigration status? • What if my family has members with different immigration statuses? • What other health coverage programs are available to me if I’m not eligible for Medi-Cal or Covered CA? • Will using public health coverage cause “public charge” issues if I want to become a citizen or LPR?
- 3. t LEGAL AID SOCIEY OF SAN MATEO COUNTY Immigrants and the Individual Mandate • Citizens and lawfully present Immigrants need to have health insurance or they may face a tax penalty. • Immigrants who are not “lawfully present” are not subject to the individual mandate or any tax penalty. • There are many other exemptions to the individual mandate, including where obtaining insurance causes a financial hardship. • If you have questions about tax penalties for not being insured, you can talk to your tax preparer, or contact Legal Aid’s Health Consumer Center.
- 4. t LEGAL AID SOCIEY OF SAN MATEO COUNTY What is Medi-Cal? Medi-Cal, California’s Medicaid program, provides healthcare coverage for low-income families and individuals. Jointly funded by the Federal and State government; Medi- Cal is the primary source of health insurance coverage for approximately 12 million Californians The Affordable Care Act greatly expanded the Medi-Cal program through the MAGI Medi-Cal program, but there are still many different Medi-Cal programs, each with their own eligibility criteria.
- 5. t LEGAL AID SOCIEY OF SAN MATEO COUNTY Full scope MAGI Medi-Cal Program: Who is eligible?  Those 19 to 64 years of age  California residents  Income at or below 138% FPL ($2,795 gross monthly income for family of 4) Household membership and income uses IRS rules –some types of income are exempt  No resource limits  US Citizens /Qualified Immigrants, and those “permanently residing in the US under color of law”
- 6. t LEGAL AID SOCIEY OF SAN MATEO COUNTY Full scope Medi-Cal for Children and TLICP: who is eligible? Children up to age 19 California residents Income at or below 266% FPL ($5,387 gross monthly income for family of 4) Household membership and income uses IRS rules –some types of income are exempt Income between 160% ($3,240 for a family of 4) and 266% FPL must pay small premiums and cost sharing No resource limits Children up to age 19 are eligible for full scope Medi-Cal regardless of immigration status
- 7. t LEGAL AID SOCIEY OF SAN MATEO COUNTY Immigration status and eligibility for and Full-Scope Medi-Cal • “Qualified Immigrants” are eligible. This includes: – Lawful Permanent Residents (Green Card holders) – Refugees, asylees, or those granted withholding of deportation, conditional entry, or paroled into the US for at least one year; Cuban and Haitian entrants – Battered spouses and children with a pending or approved U-Visa or VAWA application – Victims of Trafficking with approved T-visa or where application sets out clear right
- 8. t LEGAL AID SOCIEY OF SAN MATEO COUNTY Other non-citizens eligible for full scope Medi-Cal • Those “permanently residing under color of law” or “PRUCOL” – Medi-Cal has a list of statuses that are“PRUCOL” These are also listed on the Medi-Cal MC 13 form. – The MC 13 form includes category for those with good faith belief that Department of Homeland Security knows they are here and doesn’t intend to deport them. • DACA and TPS recipients are eligible. • All children up to 19 years of age are eligible regardless of immigration status
- 9. t LEGAL AID SOCIEY OF SAN MATEO COUNTY What is Covered California? Covered CA, California’s Health Insurance Exchange, provides affordable private healthcare coverage for families and individuals. Californians can buy a health plan that offers comprehensive health benefits through Covered CA and depending on income may be eligible for financial assistance in the form of tax credits to reduce premium payments and cheaper out-of-pocket costs. (APTCs and CSRs) Enrollment is limited to once a year open enrollment periods unless you have a right to a “Special Enrollment Period”
- 10. t LEGAL AID SOCIEY OF SAN MATEO COUNTY Covered CA Premiums and cost sharing• Premium rates are based on age of individual, geographic region and “Tier” of plan – Plan levels are Platinum, Gold, Silver and Bronze – Platinum plans cost the most, but cover more of your care; bronze plans cost the least but have higher co-pays and deductibles • Premium assistance (APTCs) is available for those with income up to 400% FPL ($8,083 for family of 4) • Cost sharing subsidies (CSRs) are available for those with family income up to 266% FPL ($5,387 for family of 4)
- 11. t LEGAL AID SOCIEY OF SAN MATEO COUNTY Immigration status and eligibility for Covered California, APTCs and CSRs• Lawfully present immigrants are eligible. Lawfully present includes: – Lawful Permanent Residents (Green Card holders) – Refugees, asylees, or those granted withholding of deportation, conditional entry, or paroled into the US for at least one year; Cuban and Haitian entrants – Battered spouses and children with a pending or approved U-Visa or VAWA application – Victims of Trafficking with approved T-visa or where application sets out clear right (parent, child, spouse)
- 12. t LEGAL AID SOCIEY OF SAN MATEO COUNTY Applicants with these statuses are also eligible • Individual with non-immigrant status, lawful temporary residents • Deferred Action Status (except DACA – DACA not eligible) • Temporary protected status with employment authorization • Special Immigrant Juvenile status • Adjustment to LPR status • Withholding of deportation or removal under immigration law NOTE: This list is NOT exhaustive
- 13. t LEGAL AID SOCIEY OF SAN MATEO COUNTY What if my family has members with different immigration statuses? • In many families, not all members have the same citizenship or immigration status; that is not a problem. • Members of the same family can and often do qualify for different programs. • Those family members who are not applying for government health coverage for themselves do not need to provide information about their citizenship or immigration status. (But non-applicants may be asked for some documents to verify income or identity.)
- 14. t LEGAL AID SOCIEY OF SAN MATEO COUNTY What other health coverage programs are available to me if I’m ineligible for full scope Medi-Cal or Covered CA? • Those who don’t qualify for Covered California or Full- Scope Medi-Cal because of immigration status may be eligible for: – Restricted Medi-Cal – Access to Care for Everyone (ACE) (with or without fee waiver) – Kaiser Kids (Income 266% FPL – 322%FPL) – Healthy Kids (Income 322% FPL – 400% FPL) – Minor Consent Services – Medi-Cal Access Program (MCAP) (Formerly AIM) – Child Health and Disability Prevention Program
- 15. t LEGAL AID SOCIEY OF SAN MATEO COUNTY Restricted/Emergency Medi-Cal • For those eligible for MAGI Medi-Cal except for immigration status – Same requirements: income equal to or below 138% FPL and residency in CA • What it covers: – Emergency medical services – Pregnancy related services including termination of pregnancy, pre-natal care, labor and delivery and post- partum care up to 60 days
- 16. t LEGAL AID SOCIEY OF SAN MATEO COUNTY Restricted/Emergency Medi-Cal • Where you can sign up – In person at the local County Office; – At a County hospital after receiving medical services; – LIBRE • Menlo Park/EPA – JobTrain • Redwood City – Fair Oaks Community Center • Half Moon Bay – Coastside Hope • If you or a family member has Restricted Medi-Cal and you believe you should have full scope, you can file an appeal.
- 17. t LEGAL AID SOCIEY OF SAN MATEO COUNTY ACE Program • Requirements – Adults between 19-64 years old – Resident of San Mateo County – Not eligible for any other health program offered by the state or federal government. Ingresos igual o menos de 200% FPL – Recursos de $2,00 por familia, excluye un vehĂculo por adulto. • Emergency services for ACE are only covered at San Mateo Medical Center. • Costs of coverage – Non Fee Waiver • Annual enrollment fee is $360 per person. • This can be paid in monthly installments – Fee Waiver – Income at or below 138% FPL
- 18. t LEGAL AID SOCIEY OF SAN MATEO COUNTY Public Charge • There are rumors in some immigrant communities about the effect of receiving public benefits on one’s immigration status. Receiving health-related public benefits programs does NOT create a public charge problem. • The only possible exception – long-term care Medi-Cal. • For more information, visit: – nilc.org/pubcharge
- 19. t LEGAL AID SOCIEY OF SAN MATEO COUNTY Additional Resources • National Immigrant Law Center – nilc.org • California Immigrant Policy Center – caimmigrant.org • LIBRE Project – thelibreproject.org
- 20. t LEGAL AID SOCIEY OF SAN MATEO COUNTY Questions??? To get help from an attorney on a health care issue call The Legal Aid Society of San Mateo County’s Health Consumer Center Marisol Pimentel, Coordinator (650) 517-8907 Or LIBRE Vanessa Hearne, Coordinator (650) 517-8936