Barriers to Immigrants’ Access to Health Insurance and Health Care – Legal barriers – Confusion around eligibility rules families-need-to-know/ families-need-to-know/ – Public charge – Sponsor deeming and liability – Verification & documentation – Confidentiality and reporting fears - outreach/pdf/ice-aca-memo.pdf outreach/pdf/ice-aca-memo.pdf – Linguistic and cultural barriers materials.html; materials.htmlhttp:// – Fear of immigration enforcement - outreach/pdf/ice-aca-memo.pdf outreach/pdf/ice-aca-memo.pdf – Residency and other program requirements

Who’s Eligible for Federal Non-emergency Medicaid and CHIP? 2 Two categories of immigrants for federal benefits eligibility purposes under “welfare reform” (PRWORA of 1996): ELIGIBLE = “Qualified”: Categories defined by statute – – LPRs, refugees, asylees, parolees, Cuban/Haitian entrants, certain DV and trafficking survivors and their derivatives, certain conditional entrants – Qualified immigrants who entered the U.S. on or after August 22, 1996 must wait at least five years in qualified status (also known as the “five- year bar”) – Some exemptions NOT ELIGIBLE = “Not qualified”: Anyone who is not a citizen or “qualified” immigrant, such as— – Undocumented immigrants – PRUCOLs (other lawfully present individuals) – Temporary visa holders

Exceptions in Medicaid and CHIP 3 In 2002 HHS granted states the option to provide prenatal services to pregnant women under the “unborn child” option in CHIP. – See NILC coverage maps at CHIPRA of 2009 granted states the option to provide Medicaid/CHIP to “lawfully present” children and pregnant women and waive the 5-yr bar - State variation Medicaid for treatment of emergencies available if not eligible for Medicaid based on immigration status – Emergency Medicaid expands as Medicaid expands, with full FMAP FMAP-Foster-Care-CHIP.pdf (Q #5) FMAP-Foster-Care-CHIP.pdf

WA OR CA NV ID MT WY CO UT NM AZ TX OK KS NE SD ND MN WI IL IA MO AR LA AL TN MI PA NY VT GA FL MS KY SC NC MD DC IN DE CA OH WV NJ CT MA ME RI VA NH MI Health Coverage for Pregnant Women | January 2014 KEY Medicaid for lawfully residing pregnant women, regardless of date of entry CHIP or other medical coverage for pregnant women, regardless of immigration status Alaska Hawaii

WA OR CA NV ID MT WY CO UT NM AZ TX OK KS NE SD ND MN WI IL IA MO AR LA AL TN MI PA NY VT GA FL MS KY SC NC MD DC IN DE CA OH WV NJ CT MA ME RI VA NH MI Health Coverage for Immigrant Children | January 2014 KEY Medicaid/CHIP for lawfully residing children, regardless of date of entry Medical coverage for children, regardless of immigration status Medical coverage for lawfully residing children (statewide), and for children regardless of immigration status in some counties Alaska Hawaii

Immigrants and the ACA “Lawfully Present” Individuals On road to citizenship (e.g., Lawful Permanent Resident (LPR)) Permission to stay indefinitely in the U.S. without pathway to citizenship (e.g., TPS) Permission to stay temporarily (e.g., visa holders) Exception: DACAmented individuals See n-status-and-the-marketplace/ n-status-and-the-marketplace/ Undocumented Individuals who lost permission to remain in the U.S., or entered the U.S. without permission Emergency Medicaid No Marketplace/Exchange access No ACA subsidies Exempt from individual mandate Remain eligible for FQHCs and other programs available regardless of status

Immigrant Eligibility for Medicaid/CHIP/ACA Refugees, Asylees, & Other Humanitarian Immigrants Lawful Permanent Residents (Green Card Holders) Other Lawfully Present Individuals (except DACA) Undocumented Immigrants & DACAmented Immigrants Adults 18 & over Children under age 18 Pregnant women Medicaid X Until after first 5 years STATE OPTION During first 5 yrs STATE OPTION During first 5 yrs X STATE OPTION If under 21 or pregnant X (Except emergency services) CHIP X Until after first 5 years STATE OPTION During first 5 years STATE OPTION During first 5 yrs X STATE OPTION If under 21 or pregnant X STATE OPTION Prenatal care services only ACA: full price X ACA: subsidies X ACA: mandate X