Health Care for Immigrants in Massachusetts: 2018 and Beyond
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1 Health Care for Immigrants in Massachusetts: 2018 and Beyond Andrew P. Cohen Supervising Attorney Health Law Advocates Democracy School April 14, 2018
2 Health Law Advocates Non-profit, public interest law firm Pro bono legal services for lowincome Mass. residents (< 300% FPL) Core issues: Legal barriers to care and coverage Appeals of coverage or service denials Medical debt/collections assistance Immigrant Healthcare Access Initiative
3 HLA s Finch cases 2009: Budget pressures caused Mass. legislature to pass law cutting ~40K legal immigrants from Commonwealth Care 2010: HLA filed class action lawsuit 2011: SJC held legal immigrants are a suspect class that get strict scrutiny 2012: SJC held that state law was unconstitutional; coverage restored!
4 HLA s Immigrant Healthcare Access Initiative Free legal services for low-income immigrant clients, regardless of status Trainings about immigrants access to coverage under Mass. public programs Policy advocacy through the Immigrant Healthcare Access Coalition ( IHAC )
5 Immigrant Healthcare Access Coalition (IHAC) Next Meeting TBD: May/June One Federal Street, 5 th Floor (HLA s office) Policy issues Ensuring providers and public programs are welcoming to immigrant patients Language access Access to MassHealth programs
6 Culture of Fear Federal administration is sowing fear States, cities, organizations, and medical providers can help!
7 Privacy Protections Medicaid and the ACA contain privacy protections: Applicant information may be used ONLY for purposes of determining eligibility for programs SAVE System (federal data hub) does NOT save individual info in a database
8 MASSHEALTH PROGRAMS Overview of MassHealth eligibility and programs
9 MassHealth: Overview MassHealth = Medicaid + CHIP State/Federal program Managed care (as primary coverage) Eligibility, generally Adults <138% FPL, Kids <300% FPL BUT: lots of different eligibility categories based on disability, immigration status, age, etc.
10 MassHealth Programs MassHealth Standard Comprehensive benefit package Preventive care, outpatient medical services, nursing home and PCA services, prescription drugs, hospitalization. MassHealth Common Health Same as Standard; only for disabled people MassHealth Family Assistance Rich benefits, but does not cover nursing home or personal care attendant services OR Premium Assistance to help pay for private insurance MassHealth Care Plus Childless, low-income, able-bodied adults age Same as Family Assistance MassHealth Limited Emergency services ONLY
11 IMMIGRANT ELIGIBILITY Eligibility for MassHealth coverage for immigrants with various statuses
12 Health care coverage for immigrants: Overview Type/robustness of coverage is dependent on immigration status However, Mass. residents with low incomes will almost always be eligible for some program, even people without documents
13 Coverage for undocumented immigrants Terms Undocumented = people without statesanctioned immigration or visa status Coverage MassHealth Limited Children s Medical Security Plan Health Safety Net
14 MassHealth Limited Background: MA version of Emergency Medicaid Coverage: Emergency services for acute medical problems, or prevention of a serious health problem Eligibility: Mostly undocumented immigrants Adults: < 138% FPL Kids 1-20: < 150% FPL
15 Children s Medical Security Plan (CMSP) Background: Created by statute in the 1990s Inspiration for CHIP (esp. tobacco tax) Coverage: Primary care and preventive services (no premiums if <200% FPL) Limitations: Caps on Rx ($200/yr), DME, dental ($750), and mental health visits (20) Eligibility: Uninsured children ages 0-18 (i.e. ineligible for MassHealth); Mostly undocumented kids
16 Health Safety Net (HSN) Background: Uncompensated Care Pool created in 1985; became the HSN in 2006 Coverage: Pays for care delivered at acute care hospitals and Community Health Centers Wraps private insurance as secondary coverage; Pays deductibles and co-insurance Limitations: Not insurance Doctors NOT covered, with limited exceptions Does not pay for private insurance copayments
17 Gov. Baker cut coverage for immigrants in 2016 Health Safety Net (HSN) cuts: Eliminated 6 month retroactive period Introduced $500+ deductibles for people earning % FPL Decreased eligibility from 400% FPL to 300% FPL
18 Categories of legal status I Lawfully present non-citizens Qualified noncitizens o Lawful permanent residents (LPRs, i.e. green card holders) >5yrs o Refugees/Asylees, Cuban/Haitian entrant, victims of trafficking Qualified noncitizens barred = LPRs <5 yrs Nonqualified individuals lawfully present ovisa holders/authorized employment otemporary protected status, parolees, etc.
19 Categories of legal status II Non-qualified PRUCOL Permanent Resident Under the Color of Law Including: Pending application for legal status DACA Non-citizen living in U.S. with knowledge/consent of DHS whose departure won t be enforced Indef. stay of deport. or indef. voluntary departure Suspension of deportation
20 Access to Coverage - I MassHealth Standard Infants <1yr, lawfully present, <200% FPL Kids ages 1-20, lawfully present, <150% FPL Adults ages 21-64, qualified lawfully present, <138% FPL - (or MH Care Plus if childless) Elderly adults ages 65+, qualified lawfully present, <100% FPL Pregnant women, any status(!), 200% FPL
21 Access to Coverage - II MassHealth Family Assistance Kids 1-20, lawfully present, % FPL Infants to elderly, PRUCOL, <300% FPL Disabled adults, non-qualified or barred lawfully present, <100% FPL MassHealth Common Health Disabled children 1-18, PRUCOL, no $ limit Disabled young adults 19-20, PRUCOL, <150% FPL
22 Access to Coverage - III Connector Care (i.e. public subsidies for private coverage, ObamaCare ) Adults ages 21+, lawfully present, 0-300% FPL Advance Premium Tax Credits (APTCs) Infants to elderly adults, lawfully present, % FPL
23 Special groups: Pregnant women, DACA Pregnant Women MassHealth Standard: <200% FPL oregardless of immigration status Connector Care/Tax credits: % FPL DACA Not Lawfully Present under ACA DACA = eligible for Family Assistance
24 Questions? Andrew P. Cohen, Staff Attorney Health Law Advocates: Toll-free:
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