Health Programs & Immigrants in the County of Los Angeles February, 2010 Presented by: Donald Nollar Maternal and Child Health Access ©Copyright 2007, Maternal and Child Health Access

Medi-Cal Medi-Cal is a program that pays for medically necessary health and mental health services for many low-income people. Medi-Cal is a program that pays for medically necessary health and mental health services for many low-income people. Unfortunately, not all families with low income or health care needs qualify. Unfortunately, not all families with low income or health care needs qualify. There are certain requirements one has to meet in order to be eligible for Medi-Cal There are certain requirements one has to meet in order to be eligible for Medi-Cal

Requirements for Medi-Cal Eligibility 1.Linkage 2. CA Residency 3. Income 4. Immigration Status - determines level of benefits

Linkage Under age 21 Under age and older 65 and older Disabled or blind Disabled or blind Pregnant Pregnant A parent with minor children A parent with minor children Caretaker Relative Caretaker Relative Breast or Cervical Cancer Breast or Cervical Cancer TB TB

Linkage End Stage Renal Disease End Stage Renal Disease Cal WORKs Cal WORKs Foster Care Foster Care Supplementary Security Income (SSI) Supplementary Security Income (SSI) Refugee or Political Asylee Refugee or Political Asylee In a nursing home In a nursing home

Is Medi-Cal Free? Family’s income determines whether their Medi-Cal will be: No cost Medi-Cal No cost Medi-Cal All services and visits provided free of cost All services and visits provided free of cost Share of Cost Medi-Cal Share of Cost Medi-Cal Each month the family may have to pay, or agree to pay, some of their health care bills before Medi-Cal will pay for their family’s medical expenses. This is called “Share of Cost” Each month the family may have to pay, or agree to pay, some of their health care bills before Medi-Cal will pay for their family’s medical expenses. This is called “Share of Cost” Families DO NOT have to pay anything in months that they do not have medical or dental bills or don’t get medical or dental care. Families DO NOT have to pay anything in months that they do not have medical or dental bills or don’t get medical or dental care.

RESOURCES SOMETIMES COUNT Resources, stuff you own and money in the bank, counts for some Medi-Cal programs. You can have up to $2000 in resources for 1 person, $ 3000 for 2 people, For each additional person add $ Resources are not counted for pregnant women or children in the Percentage Programs

California Residency California residency means that the person wants to live and stay in California and does not have any plans to leave. California residency means that the person wants to live and stay in California and does not have any plans to leave. State residency has nothing to do with federal immigration status. State residency has nothing to do with federal immigration status.

How does Immigration Status Impact Eligibility? Immigration status will determine the level of benefits your client can be eligible for. Restricted Medi-Cal Restricted Medi-Cal Pregnancy-related - up to 90 days postpartum, including family planning, abortion, perinatal care, basic dental services, nursing home and renal dialysis services. Pregnancy-related - up to 90 days postpartum, including family planning, abortion, perinatal care, basic dental services, nursing home and renal dialysis services. Emergency services - danger to life or limb. Emergency services - danger to life or limb.

PRUCOL  PRUCOL stands for: Permanently Residing in the U.S. Under Color Of Law  This is not an immigration category, it is a public benefits term used in Medi-Cal. It means that the Department of Homeland Security is aware that the immigrant is in the U.S. but has no intent to deport the immigrant.

PRUCOL Undocumented immigrants who would otherwise only be eligible for restricted scope benefits can get full-scope benefits if they are in the process of adjusting their immigration status. Undocumented immigrants who would otherwise only be eligible for restricted scope benefits can get full-scope benefits if they are in the process of adjusting their immigration status. PRUCOL will only determine the scope of benefits. The family or individual still has to have a link to the Medi-Cal program. PRUCOL will only determine the scope of benefits. The family or individual still has to have a link to the Medi-Cal program.

Minor Consent Medi-Cal Also know as “Sensitive Services”, Minor Consent is a program that allows minors between the ages of 12 and 21 to apply for Medi-Cal on their own without their parents consent. There are no immigration or income requirements Applicants must re-apply each month services are needed. Services are limited to : Pregnancy Care Abortion Contraception Sexual assault and STD treatment Mental Health services Drug and Alcohol treatment

Child Health and Disability Prevention (CHDP) The CHDP Program is a Federal and State preventive health care program that provides free health check-ups for many low-income infants, children, teens, and young adults age 0-19 The CHDP Program is a Federal and State preventive health care program that provides free health check-ups for many low-income infants, children, teens, and young adults age 0-19 CHDP helps identify and prevent health problems. CHDP helps identify and prevent health problems. Immigration status does not matter Immigration status does not matter

Healthy Families Healthy Families is a state program that provides low-cost health insurance for many low-income children between the ages of 0-18 that do not qualify for free, full scope Medi-Cal. There is a monthly cost of between $ $17.00, depending on the family’s income. There is a monthly cost of between $ $17.00, depending on the family’s income. There are also $ 5.00 co-payments when receiving certain non-preventive health and dental services. There are also $ 5.00 co-payments when receiving certain non-preventive health and dental services. Children need to be U.S. citizens or legal permanent residents. Children need to be U.S. citizens or legal permanent residents.

Healthy Kids Is a program that provides health coverage for children between the ages of 0-18 who are not eligible for regular or free cost Medi-Cal, and Healthy Families. Is a program that provides health coverage for children between the ages of 0-18 who are not eligible for regular or free cost Medi-Cal, and Healthy Families. At the moment they are not taking applications for children between the ages of 6-18 At the moment they are not taking applications for children between the ages of 6-18 This program requires a monthly payment of $0-$6 depending on your income. This program requires a monthly payment of $0-$6 depending on your income. There is also a small co-payment when receiving non preventive health and dental services. There is also a small co-payment when receiving non preventive health and dental services. Immigration status does not matter Immigration status does not matter

Kaiser Permanente Child Health Plan A program that provides health coverage for children between the ages of 0-18 who are not eligible for free cost Medi-Cal or Healthy Families. A program that provides health coverage for children between the ages of 0-18 who are not eligible for free cost Medi-Cal or Healthy Families. This program requires a monthly payment of $8-$15 depending on you income. This program requires a monthly payment of $8-$15 depending on you income. There are small co-payments when receiving certain non preventive health and dental services. There are small co-payments when receiving certain non preventive health and dental services. Immigration status does not matter. Immigration status does not matter. Program is currently NOT open for Program is currently NOT open for new enrollment. new enrollment.

California Children’s Services (CCS) CCS is a statewide program that coordinates and pays for medical care and therapy services for children under 21 years of age with certain physically disabling conditions or diseases. CCS is a statewide program that coordinates and pays for medical care and therapy services for children under 21 years of age with certain physically disabling conditions or diseases. CCS provides: CCS provides: Treatment, such as doctor services, hospital and surgical care, physical therapy and occupational therapy, laboratory tests, X-rays, orthopedic appliances and medical equipment. Treatment, such as doctor services, hospital and surgical care, physical therapy and occupational therapy, laboratory tests, X-rays, orthopedic appliances and medical equipment. Medical case management to help get special doctors and care for your child when medically necessary, and referral to other agencies, including public health nursing and regional centers. Medical case management to help get special doctors and care for your child when medically necessary, and referral to other agencies, including public health nursing and regional centers. A Medical Therapy Program (MTP), which can provide physical therapy and/or occupational therapy in public schools for children who are medically eligible. A Medical Therapy Program (MTP), which can provide physical therapy and/or occupational therapy in public schools for children who are medically eligible. Generally, there are no costs. Families who earn more than $40,000 per year may have small costs. All Healthy Families children are automatically eligible. Generally, there are no costs. Families who earn more than $40,000 per year may have small costs. All Healthy Families children are automatically eligible.

California Kids California Kids provides moderately priced preventative and primary health care benefits to children ages California Kids provides moderately priced preventative and primary health care benefits to children ages There is no income limit and immigration status doesn’t matter. There is no income limit and immigration status doesn’t matter. Monthly premiums are $49 per child and co- pays range from $10 to $110. Monthly premiums are $49 per child and co- pays range from $10 to $110. Does not cover hospitalization. Does not cover hospitalization.

Family PACT Family PACT provides family planning services, sexually transmitted disease diagnosis and treatment and gynecological exams to men and women who do not qualify for Medi-Cal. Income must be at or below 200% FPL. Immigration status does not count. Women over 40 may also receive a screening mammogram.

Cancer Detection Program This program provides free mammograms and Pap smeers to women whose income level is at or below 200% FPL. Immigration status does not count. For cervical cancer screening women must be 25 or older. For breast cancer screening women must be 50 or older.

Breast & Cervical Cancer Treatment Program (BCCTP) The Breast and Cervical Cancer Treatment Program provides Medi-Cal coverage to individuals who have received a diagnosis of breast or cervical cancer. Applicants must apply through a participating provider. The income limit is 200% of the Federal Poverty Level. U.S. Citizen and Qualified Immigrant women can obtain full scope Medi-Cal coverage through this program. Men and undocumented women can obtain restricted Medi-Cal that is limited to their treatment.

Public Private Partnership (PPP) This free program is available for low-income people of all ages if they have no other health insurance and meet the income guidelines. This free program is available for low-income people of all ages if they have no other health insurance and meet the income guidelines. Provides primary care services like visits to the doctor’s office, medicine, family planning, prenatal care, and regular check-ups Provides primary care services like visits to the doctor’s office, medicine, family planning, prenatal care, and regular check-ups Services provided at certain county, community and private providers Services provided at certain county, community and private providers Immigration status does not matter. Immigration status does not matter.

Pre-Pay Pre-pay is another way clients can pay their bills at a Los Angeles County Hospital or Clinic. The costs are $60 for a clinic visit, $80 for County Hospital ambulatory care visits, $80 for Comprehensive Health Center urgent care visits, $120 for County Hospital emergency room visits and $400 for Out-patient Surgery clinics. Pre-natal services cost $60 for the first 7 visits (remaining visits are free) and $2000 for the Child Delivery Plan. This method of payment is available to any resident of Los Angeles County. You must pay within 7 days of treatment.

Outpatient Reduced Simplified Application Program (ORSA) ORSA is a program that provides free or low cost outpatient care at Los Angeles County health clinics and hospitals for individuals that are not eligible for Full Scope Medi-Cal. ORSA is a program that provides free or low cost outpatient care at Los Angeles County health clinics and hospitals for individuals that are not eligible for Full Scope Medi-Cal. Once eligible, ORSA can be renewed yearly. Once eligible, ORSA can be renewed yearly. Immigration status does not matter Immigration status does not matter

Ability to Pay (ATP) The ATP program assists individuals and families to obtain in-patient care at County hospitals at no cost or at a lower cost, or to cover County hospital or clinic bills that are over 6 months old. The cost for services under ATP depends on the household’s income and resources. Immigration status does not matter.

Public Charge What is “Public Charge”? Being primarily dependent on government benefits for subsistence Being primarily dependent on government benefits for subsistence Demonstrated by receiving cash for Demonstrated by receiving cash for Income maintenance, or Income maintenance, or Institutional long term care at government expense. Institutional long term care at government expense. For adjustment: Likely to become a public charge For adjustment: Likely to become a public charge For deportation: Has become a public charge within 5 years of entry For deportation: Has become a public charge within 5 years of entry

PUBLIC CHARGE IS NOT RELEVANT FOR : ASYLEES ASYLEES REFUGEES REFUGEES VAWA VAWA CERTAIN CUBANS, HAITIANS, AND NICARAGUANS (Cuban Adjustment Act, NACARA, Haitians Refugee Immigration Fairness Act) CERTAIN CUBANS, HAITIANS, AND NICARAGUANS (Cuban Adjustment Act, NACARA, Haitians Refugee Immigration Fairness Act) REGISTRY APPLICANTS REGISTRY APPLICANTS (residing in U.S. continuously since 1/1/72) APPLICANTS FOR NATURALIZTION APPLICANTS FOR NATURALIZTION  (exception: fraudulent use of benefits) Others not listed Others not listed

Department of Homeland Security Rules EXAMPLES OF SUPPLEMENTAL BENEFITS THAT ARE NOT A PUBLIC CHARGE CONCERN MEDI-CAL MEDI-CAL (Except when used for Long Term Nursing Home Care or Institutionalization) COUNTY HEALTH PROGRAMS COUNTY HEALTH PROGRAMS FOOD STAMPS FOOD STAMPS HEALTHY FAMILIES HEALTHY FAMILIES WIC WIC TRANSPORTATION VOUCHERS SPECIAL PURPOSE GRANTS NON-CASH BENEFITS OF CALWORKS HOUSING BENEFITS

TOTALITY OF CIRCUMSTANCES TEST Receipt of benefits is not an automatic public charge Receipt of benefits is not an automatic public charge USCIS must look at the Totality of the Circumstances USCIS must look at the Totality of the Circumstances

SPONSORSHIP Old Affidavit – before 12/19/97 (not legally binding) Old Affidavit – before 12/19/97 (not legally binding) New Affidavit – after 12/19/97 – legally binding obligation to support immigrant, may be required to repay means-tested benefits received by immigrant New Affidavit – after 12/19/97 – legally binding obligation to support immigrant, may be required to repay means-tested benefits received by immigrant  As of 12/19/97, affidavit is mandatory and legally enforceable. Note: This presentation focuses primarily on new affidavits of support. affidavits of support.

SPONSORSHIP Affidavits of Support Agreement by Sponsor To Support the Immigrant at 125% of the FPL (active duty military 100% of FPL) Agreement by Sponsor To Support the Immigrant at 125% of the FPL (active duty military 100% of FPL) Act as Security that Immigrant Will Not Become a Public Charge Act as Security that Immigrant Will Not Become a Public Charge

SPONSORSHIP Duration of Sponsorship  immigrant becomes a citizen  immigrant has 40 work quarters  immigrant leaves U.S.A. permanently  immigrant or sponsor dies

SPONSORSHIP Income deeming from sponsor to immigrant NOT for Medi-Cal

Maternal and Child Health Access is available as a resource for health program technical assistance and enrollment. Please call us at, (213) (213) www.mchaccess.org Maternal and Child Health Access