1. Barriers to Immigrants’ Access to Health Insurance and Health Care – Legal barriers - http://nilc.org/access-to-bens.html http://nilc.org/access-to-bens.html – Confusion around eligibility rules - http://nilc.org/immigrantshcr.html; http://nilc.org/immigrantshcrsp.html; https://www.healthcare.gov/what-do-immigrant- families-need-to-know/ http://nilc.org/immigrantshcr.html http://nilc.org/immigrantshcrsp.htmlhttps://www.healthcare.gov/what-do-immigrant- families-need-to-know/ – Public charge - http://nilc.org/pubcharge.html http://nilc.org/pubcharge.html – Sponsor deeming and liability - http://nilc.org/affidavits.html http://nilc.org/affidavits.html – Verification & documentation - http://nilc.org/document.html?id=35; https://www.healthcare.gov/help/immigration-document-types/; https://www.healthcare.gov/help/citizenship-and-immigration-status-questions/ http://nilc.org/document.html?id=35 https://www.healthcare.gov/help/immigration-document-types/ https://www.healthcare.gov/help/citizenship-and-immigration-status-questions/ – Confidentiality and reporting fears - http://www.ice.gov/doclib/ero- outreach/pdf/ice-aca-memo.pdf http://www.ice.gov/doclib/ero- outreach/pdf/ice-aca-memo.pdf – Linguistic and cultural barriers - https://www.cuidadodesalud.gov/es/; http://marketplace.cms.gov/getofficialresources/other-languages/other-languages- materials.html; http://www.hhs.gov/open/execorders/13166/index.html https://www.cuidadodesalud.gov/es/ http://marketplace.cms.gov/getofficialresources/other-languages/other-languages- materials.htmlhttp://www.hhs.gov/open/execorders/13166/index.html – Fear of immigration enforcement - http://www.ice.gov/doclib/ero- outreach/pdf/ice-aca-memo.pdf http://www.ice.gov/doclib/ero- outreach/pdf/ice-aca-memo.pdf – Residency and other program requirements

2. 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

3. 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 http://www.nilc.org/healthcoveragemaps.htmlhttp://www.nilc.org/healthcoveragemaps.html CHIPRA of 2009 granted states the option to provide Medicaid/CHIP to “lawfully present” children and pregnant women and waive the 5-yr bar - http://nilc.org/facts-chipra.htmlhttp://nilc.org/facts-chipra.html State variation - http://www.nilc.org/document.html?id=159 http://www.nilc.org/document.html?id=159 Medicaid for treatment of emergencies available if not eligible for Medicaid based on immigration status – Emergency Medicaid expands as Medicaid expands, with full FMAP - http://www.medicaid.gov/Federal-Policy-Guidance/downloads/FAQ-12- 27-13-FMAP-Foster-Care-CHIP.pdf (Q #5) http://www.medicaid.gov/Federal-Policy-Guidance/downloads/FAQ-12- 27-13-FMAP-Foster-Care-CHIP.pdf

4. 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

5. 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

6. 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 http://www.nilc.org/acadacafaq.html http://www.nilc.org/acadacafaq.html See https://www.healthcare.gov/immigratio n-status-and-the-marketplace/ https://www.healthcare.gov/immigratio 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

7. 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