COVERAGE FOR IMMIGRANTS UNDER HEALTH CARE REFORM January 27, /03/2014 WEBEX PRESENTATION V

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2 COVERAGE FOR IMMIGRANTS UNDER HEALTH CARE REFORM January 27, /03/2014 2

3 Deferred Action for Childhood Arrivals (DACA) On June 15, 2012, the Secretary of Homeland Security announced that certain individuals who came to United States under the age of 16 and meet specified criteria may request consideration of DACA status for period of two years, subject to renewals. DACA immigrants are considered to be lawfully present. DACA is considered PRUCOL under the deferred action status category. Self-attestation of DACA status is acceptable. The MC13 form is no longer required for DACA status prior to verification of immigration status through the Federal Data Hub (HUB). WEBEX PRESENTATION IV 08/21/2014 3

4 (Continuing with DACA) Full-scope Medi-Cal benefits must be granted to the applicants while DACA immigration status is verified, if otherwise eligible. The California Healthcare Enrollment, Eligibility and Retention System (CalHEERS) is currently not programed to recognize DACA eligibility; therefore, manual update of benefits is necessary in the Medi-Cal Eligibility Data System (MEDS) by using EW20. o Staff must also input on MEDS an S in the Citizen/Alien indicator field for other documented full scope alien by using EW30. DACA status verification includes: o o o Employment Authorization Document (EAD) with status code C-33 Form I-797 Notice of Action Other immigration documents: will require Systematic Alien Verification for Entitlements (SAVE) process. WEBEX PRESENTATION IV 08/21/2014 4

5 (Continuing with DACA) If The county is unable to determine the claimed immigration status via the HUB The manual SAVE verification of claimed DACA status fails The applicant fails to provide verification of EAD or I-797 for DACA status within the 90-day period An applicant provides documentation other than EAD or I-797 The SAVE process for other documentation does not verify satisfactory immigration status Then An MC13 form should be used along with manual verification process by using SAVE. The applicant must be given a 90-day reasonable opportunity period to provide documentation. Medi-Cal benefits must be reduced to restricted scope. It must be verified through the SAVE process. Medi-Cal benefits must be reduced to restricted scope. Note: DACA immigrants are not allowed to purchase insurance coverage through the Covered California health benefit exchange. WEBEX PRESENTATION IV 08/21/2014 5

6 Refugee Medical Assistance Program (RMA) The RMA Program continues to exist; however, o Immigrants who are eligible for benefits under the RMA program should now be evaluated under the new Affordable Care Act (ACA) MAGI Medi-Cal methodology beginning January o Individuals eligible for Medi-Cal (MAGI and Non-MAGI), Advance Premium Tax Credits (APTC) or Cost Sharing Reduction (CSR), and RMA benefits should be aided under the most advantageous program. Individuals not eligible for Medi-Cal (MAGI or Non-MAGI) benefits will continue to receive the full 8-month time limited Medi-Cal benefits under the RMA program, if otherwise eligible. WEBEX PRESENTATION IV 08/21/2014 6

7 (Continuing with RMA) If Eligible for Select MAGI Medi-Cal and RMA MAGI Medi-Cal APTC/CSR and RMA RMA Non-MAGI Medi-Cal with no SOC and RMA Non-MAGI Medi-Cal Non-MAGI Medi-Cal with SOC and RMA RMA WEBEX PRESENTATION IV 08/21/2014 7

8 Undocumented Immigrant in Need of Long-Term Care (LTC) benefits are eligible under State funded LTC Program (Non-MAGI aid code 55 and all restricted MAGI aid codes) 06/03/2014 8

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11 Note: 06/03/

12 Situation: Undocumented pregnant mother with two US citizen children is applying aid for herself and her children. Her household income is under 100% FPL. Question: Would the undocumented pregnant mother qualify for MAGI Parent Caretaker Relative Restricted Services aid code M4 or for Pregnant Woman Undocumented aid code M0? Answer: The mother is a Parent/Caretaker Relative, so she should be aided under aid code M4, if otherwise eligible. Since her income is under 100% of the FPL, she is eligible under both MAGI categories (Pregnant and Parent/Caretaker Relative); however, the parent caretaker/relative category takes precedence over the pregnancy category. 06/03/

13 The HCR MAGI Aid Code Desk below is from MCP Call-Out /03/

14 Situation: Married undocumented parents are applying for aid for their two US citizen children. Both parents are employed and their combined household income is $5,500, which is over 266% of the FPL. Parents file taxes jointly and claim both children as dependents. Question: What would be the correct eligibility determination be for these children, since they exceed the allowed income for eligibility under MAGI? Are the parents able to purchase coverage through Covered California? Answer : Based on the household income, the children are eligible to APTC. Since the undocumented parents are tax filers they would be able to purchase a Covered CA plan for their children. In this situation LEADER Eligibility Summary for MAGI will display as FAIL for the children; however, it should also display aid code X1, which indicates that they are eligible for subsidized coverage (APTC). 06/03/

15 Scenario #2 is addressed in the Q&A (4 & 5) section of the below AD 06/03/

16 Situation: An undocumented 26 year old is applying for aid and claiming PRUCOL on his MC13. His income is within 138% of FPL. Question: Since the applicant is claiming PRUCOL status, what would be the appropriate aid code be under MAGI? Would we give the applicant the full scope aid code that corresponds to their income level? Answer: Once an individual has declared PRUCOL status, the individual can be in any aid code for the program she/he is otherwise eligible for. There are no specific MAGI aid codes for individuals claiming PRUCOL status. For example, a PRUCOL, single individual with income below 138% FPL, may be eligible for MAGI Medi-Cal under aid code M1. 06/03/

17 MC13 Section B, Question 5 captures the applicant s PRUCOL information 06/03/

18 Situation: Undocumented mother and daughter (19 year old student) applying for aid. Household income is within 138%. On the MC13, mother is claiming her daughter as PRUCOL under Deferred Action for Childhood Arrival (DACA) category. Question: What type of Medi-Cal coverage is the 19 years old eligible for? Answer : Under PRUCOL, DACA individuals are considered to be legally present. This population is eligible for state funded fullscope coverage under MAGI/Non-MAGI Medi-Cal. DACA individuals can declare their immigration status by Self-Attestation; MC13 is not required prior to HUB verification. 06/03/

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20 Situation: Single adult male is applying for aid for himself. On the SSApp, the applicant has declared his immigration status as lawfully present with employment authorization visa. His income is within 138% of the FPL. Question: What is the coverage for individuals with an employment visa applying for Medi-Cal. If they are lawfully present, are they treated as LPR s or Undocumented? Answer: Individuals with employment authorization visas are considered lawfully present; however, they are not legal permanent residents. Therefore, their eligibility will be based on the undocumented category and they will be only eligible for restricted benefits under MAGI/Non-MAGI Medi-Cal, if otherwise eligible. NOTE: Individuals who are lawfully present may purchase unsubsidized coverage through the Covered CA exchange. 06/03/

21 Situation: A married couple with a US citizen child are applying for Medi-Cal benefits for their household. On the SSApp, the husband and wife both declare their immigration status as lawfully present with a student visa. They are both unemployed and do not file taxes. Question: What type of coverage is the family eligible for? Answer: The US citizen child would be eligible for full-scope benefits under MAGI. The parents are eligible for restricted- scope benefits under MAGI (aid code M4). A student visa is a temporary visa; although they are lawfully present they are not considered LPRs. NOTE: Individuals who are lawfully present may purchase unsubsidized coverage through the Covered CA exchange. 06/03/

22 For Scenarios #5 & 6, see AD Coverage for Immigrants Under Health Care Reform, dated 1/27/14. 06/03/

23 Situation: LPR mother and US citizen child are applying for Medi- Cal. The mother is employed and earns $1, monthly. The applicant s husband, also an LPR, resides out of the country and sends $3, monthly to his wife and child. Husband and wife file taxes jointly; however, husband s earnings are declared as exempt Foreign Earned Income Exclusion. Question #1: What income is counted and who is included in the household on this case? Answer: In this scenario, the husband s entire income will be counted. Although husband is providing monthly support to wife, tax filer information is needed to accurately determine his gross income prior to Foreign Earned Income Exclusion. The husband will be counted in household due to tax filer household regulations, but will not be applying for aid. 06/03/

24 Situation: LPR mother and US citizen child are applying for Medi- Cal. The mother is employed and earns $1, monthly. The applicant s husband, also an LPR, resides out of the country and sends $3, monthly to his wife and child. Husband and wife file taxes jointly; however, husband s earnings are declared as exempt Foreign Earned Income Exclusion. Question #2: If the household is eligible, what type of benefits do they qualify for? Answer: At this time, based on the total reported income of $4, ($1,200 + $3,000), the household is over 266% of FPL to qualify for MAGI benefits. They are only eligibility for APTC/CSR benefits category. 06/03/

25 Question : What do we do when the CalHEERS incarceration field indicates Pending status? How do we go about processing these cases? Answer : Contact should be initiated with applicant and self attestation may be accepted to update the CalHEERS status to Pass if applicable. LEADER Case Comments must be updated to reflect the contact method and the corrective actions taken. BURGER 06/03/

26 The CalHEERS Assistance Information Sub-Screen - Immigration Ctzn/Docs tab should not be completed for individuals with student or employment visas. By doing so, LEADER will incorrectly aid the undocumented individual with full-scope benefits. 06/03/

27 The CalHEERS Assistance Information Sub Screen, in the General tab, for the How many members are in the household? field, Unborn children need to be included in the household determination. Note: Please refer to Implementation of Health Care Reform AD dated 03/17/2014, Page 12 and /03/

28 If the household does not file taxes, The Case Individual Information screen Primary Tax Filer field must be update with N for all household members. 28

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30 ADDITIONAL RESOURCES For questions please us at: Visit our Health Care Reform webpage at: To download WebEX presentations, please use this link: 06/03/