Health Coverage for Immigrants

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LEGAL AID SOCIEY OF SAN MATEO COUNTY
Immigrants and Public
Health Coverage Benefits
in San Mateo County:
An Overview

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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?

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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.

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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.

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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”

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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

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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

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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

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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”

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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)

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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)

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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

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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.)

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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

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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

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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.

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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 vehículo 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

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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

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Additional Resources
• National Immigrant Law Center – nilc.org
• California Immigrant Policy Center – caimmigrant.org
• LIBRE Project – thelibreproject.org

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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

Health Coverage for Immigrants

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