0. ONUS Region 9 Meeting September 19, 2017
Is immigration status always a barrier to obtaining Medicaid coverage for an organ transplant? 
ONUS Region 9 Meeting
September 19, 2017

1. LegalHealth’s Mission
Since 2001 LegalHealth has partnered with medical professionals to address the nonmedical needs of low-income people with serious health problems. LegalHealth is part of the New York Legal Assistance Group, a nonprofit law office. LegalHealth is funded through private foundations and its partners.
LegalHealth is the largest medical-legal partnership in the country.
LegalHealth partners with 30 health care facilities in NYC and Long Island.

2. Immigration Status as a Barrier to Organ Transplant
Ibrahima, a 47 year old man, came to the US in 1996 from Guinea, which had a military government. He overstayed his tourist visa, making his undocumented, and has lived here and raised a son supporting his family driving a livery car. Over seven years ago, Ibrahima was diagnosed with End Stage Renal disease and began 3x week dialysis. His physicians thought he was a good candidate for a kidney transplant, however, he only had Emergency Medicaid and could not be listed.
Sound familiar?

3. Is Immigration Status Always a Barrier to an Organ Transplant?
Here’s Ibrahima today
… One year post kidney transplant
What changed for him?

4. Learning Objectives
Provide basic understanding of insurability of immigrants.
Nationally
New York & Vermont State level
Raise awareness of role of immigration attorney when considering insurability of an immigrant patient
Familiarize you with special circumstances that may lead to changed immigration status
Answer questions

5. Emergency Medicaid
Emergency Medicaid provides payment for treatment of an emergency medical condition for people who meet all Medicaid eligibility criteria in the state (such as income and state residency), but don’t have an eligible immigration status.
Emergency Medicaid does not cover organ transplants

6. National Landscape
Most people in the following groups are eligible for coverage through the Health Insurance Marketplace (ACA):
U.S. citizens
U.S. nationals
Lawfully present immigrants
Generally, undocumented immigrants aren’t eligible to buy Marketplace health coverage, or for premium tax credits and other savings on Marketplace plans.

7. National Landscape: “Lawful present” includes
“Qualified non-citizen”
5-year waiting period for many qualified non-citizens to receive Federal Medicaid or CHIP
Exceptions include, refugees, asylees, or LPRs who used to be refugees or asylees
Humanitarian statuses or circumstances (including Temporary Protected Status, Special Juvenile Status, asylum applicants, Convention Against Torture, victims of trafficking)
Valid non-immigrant visas
Legal status conferred by other laws (temporary resident status, LIFE Act, Family Unity individuals)
full list of immigration statuses eligible for Marketplace coverage.

8. Vermont expanded Medicaid eligibility under Affordable Care Act
Lawfully residing children and pregnant women are now eligible for Medicaid during 5-year waiting period.
Funded by State Medicaid dollars

9. New York has long had more expansive Medicaid eligibility
Qualified residents during 5-year waiting period
TPS, DACA (until expiration)
PRUCOL aliens
Funded through ACA Medicaid Expansion dollars for the Essential Plan and NYS Medicaid dollars

10. New York: PRUCOL
NYS Constitution and Alliessa case establishes NYS Medicaid eligibility for individuals permanently residing under color or law (PRUCOL)
PRUCOL is not an immigration status
PRUCOL is New York State’s benefit eligibility category for Medicaid
PRUCOL alien’ refers to an alien who is permanently residing in the United States with the “knowledge and permission or acquiescence” of the federal immigration agency and whose departure from the U.S. the agency does not contemplate enforcing.’
18 NYCRR § (j)(1)(ii); State of New York Department of Health Information Letter (08-OHIP/INF-4).

11. PRUCOL There is no PRUCOL application filed with immigration.
Rather, immigration filings may make a client PRUCOL under the NY rules, such as:
Pending application for a green card
Approved Relative Petition (I-130) but no green application has been filed
Aliens who have applied for or been granted medical deferred action
Aliens who have applied for other immigration statuses including:
TPS (Temporary Protected Status) & DACA (being cancelled);
U/T Visa as a victim of a qualifying crime/trafficking;
VAWA for abused spouses of USCs or LPRs
Stay of Removal/Deportation or under an Order of Supervision
Other applications for a permanent/long term benefit

12. Who Is Not PRUCOL? Visitors with valid visitors’ visas
Generally, persons with denied applications for immigration relief
Persons with final orders of deportation, unless deportation is being deferred/under Order of Supervision
Persons who never filed for any immigration benefit or are ineligible for any immigration benefit

13. Role of Immigration Attorney for Patient
Comprehensive screening and immigration intervention is to move people up the “flag pole” to more regularized status and greater protections, benefit eligibility and travel options.
Citizen
Lawful Permanent Resident
Semi-status
Lawful Non-immigrants
Unlawfully present

14. Important Factors in Legal Analysis and Recommendations
Every client presents with his/her own set of facts and each case must be examined carefully considering that client’s:
Immigration History
Criminal History
Medical Needs
Cases often require months of evaluation/waiting for immigration records

15. What changed for Ibrahima?
Ibrahima’s physician referred him to the onsite legal clinic at the hospital. The attorney met with him to do a full immigration screening, analyzed his immigration history, and determined that upon his son’s 21st birthday, the son could file a family relative petition for Ibrahima. After the petition was filed and acknowledgment of receipt was received, Ibrahima was eligible to apply for NY Medicaid. Not only has he been transplanted, but he is also in the process of adjusting his status to become a lawful permanent resident (a/k/a green card).

16. Public Charge
Applying for Medicaid or CHIP, or getting savings for health insurance costs in the Marketplace, doesn’t make someone a "public charge." This means it won’t affect their chances of becoming a Lawful Permanent Resident or U.S. citizen.
There’s one exception. People receiving long-term care in an institution at government expense may face barriers getting a green card.

17. Concluding Remarks
No one size fits all approach for clients when we are in the immigration arena.
LegalHealth clinics and locations can be found at
Contact information: Julie Brandfield, Esq., Associate Director, LegalHealth