Access To Health Care For Immigrants In California

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ACCESS TOHEALTH CARE FOR IMMIGRANTSIN CALIFORNIAPositive Resource CenterOctober 2018Tanya BroderNational Immigration Law Center

Issues Affecting Access toBenefits2 Immigrant eligibility rules State residency and other eligibility rules Privacy, Confidentiality and Verification Concerns about “Public charge” Concerns about Sponsors Linguistic and Cultural Competence Logistical Barriers The “Climate”

State Residency: Medi-Cal3 Live in CA with intent to reside here, orLive in CA and entered State with jobcommitment or to seek employment, whetheror not currently employed.Children generally assume the residence of theirparents, with an opportunity to establish stateresidence independently.

Immigrant BenefitClassifications4 U.S. Citizens “Qualified” immigrants Entering the U.S. before 8/22/96 Entering the U.S. on or after 8/22/96“Not Qualified” immigrants PRUCOL (Permanently Residing Under Color of Law) Other lawfully present non-citizens Undocumented immigrants

Qualified Immigrants5 Lawful Permanent Residents (LPR)Refugees, Granted Asylum, Withholding ofDeportation/Removal, or ConditionalEntrant status Paroled into U.S. for at least 1 Year Cuban and Haitian Entrants Certain Battered Spouses and Children Certain Survivors of Trafficking

Qualified Battered Immigrants6Must have prima facie case or approved: Visa petition filed by U.S. citizen or LPRspouse/parentSelf-petition under VAWA, orApplication for cancellation of removal/suspension ofdeportation under VAWAParent of battered child and child of battered spouse alsoconsidered “qualified”

Survivors of Severe Form ofTrafficking7 If 18 or over, must be certified by HHS Children under 18 may get HHS “eligibility letter” Eligible for federal benefits to the same extent asrefugees.Derivative beneficiaries of “T” visas also eligible for federalbenefits. Survivors with approved/prima facie case for T visa are“qualified” - but other trafficking victims also are eligible forbenefits.

Not Qualified Immigrants8 ALL Other Non-citizens even if have work authorizationand are lawfully present in U.S.

PRUCOLPermanently Residing Under Color of Law - not an immigrationstatus, but a benefit eligibility category (see MC 13 Form – Statementof Citizenship, Alienage, and Immigration Status). May include persons: with approved immediate relative visa petition who filed application for adjustment to LPR status granted deferred action (including DACA) granted Family Unity status granted a stay of deportation who have lived in the US continuously since before Jan. 1, 1972 who are survivors of domestic violence (certain immigrants) Other persons in the US with the knowledge of DHS whosedeparture that agency does not contemplate enforcing.

Not Qualified Immigrants:Programs Barred10 Federal“Public Benefits” barredState or Local“Public Benefits” barredunless state passes new law

Not Qualified Immigrants:Federal Program Bar11Bar on Federal “Public Benefits”“Public Benefits” defined by federal agencies Executive Order asked them to look again Examples of “public benefit” in lawGrants, Contracts, Loans, Professional or CommercialLicenses provided by governmentRetirement, Welfare, Health & Disability, Housing, PostSecondary Education, Food Assistance, UnemploymentBenefit, FEMA, or any “similar benefit,” ANDAssistance provided to individual, household, orfamily unit, by an agency/funds of federal government

Examples of HHSFederal Public Benefits12 Adoption AssistanceChild Care and Development FundFoster CareIndependent LivingLow Income Home Energy Assistance Program(LIHEAP)(weatherization of single unit buildings)MedicareMedicaid (except emergency medical)Mental Health Clinical Training GrantsRefugee benefits (Cash, Medical, Social Services)Social Services Block Grant (SSBG)Children’s Health Insurance Program (CHIP)Temporary Assistance for Needy Families

Programs Exempt fromFederal Bar13 Emergency Medicaid and other emergency medical servicesImmunizations, testing and treatment for symptoms ofcommunicable diseases (outside of Medicaid)Short-term non-cash disaster reliefCertain housing assistance if receiving on 8/22/96School Lunch and School BreakfastState option to provide WICAND1.2.3.programsdelivered at the community level, not condition assistance on income or resourcesare necessary to protect life or safety

AG’s List of Programs“Necessary to Protect Life or Safety” Child protection & adultprotective servicesViolence and abuseprevention, includingdomestic violence Mental illness or substanceabuse treatment Short-term shelter orhousing assistance Programs during adverseweather conditions Soup kitchens, food banks,senior nutrition programsMedical & public health services& mental health, disability,Substance abuse servicesnecessary to protect life or safetyPrograms to protect life & safetyof workers, children & youth, orcommunity residentsOther services necessary for theprotection of life or safety

Non-Profit Agencies15 Non-profit charitable organizations arenot required to determine, verify orotherwise ask for proof of an immigrant’sstatus applies to immigrant restrictions in the 1996 welfareand immigration lawsNon-profits can create a safe environment forimmigrants and their family members who areseeking services

CA Programs AvailableRegardless of Status Medi-Cal for childrenEmergency Medi-CalPrenatal care (Medi-Cal)Medi-Cal Access Program(MCAP, formerly AIM)Long-term careEarly Breast Cancer Detectionand Breast and CervicalCancer TreatmentIMPACT (prostate cancer)California Children’s Services(CCS)Healthy Kids (Children’sHealth Initiatives) Health Programs in somecounties (Healthy SF)Community clinicsFamily PACTMinor consent servicesMental health servicesADAP & OA-HIPPRegional Center ServicesWomen Infants andChildren (WIC)School lunch andbreakfast

Angie and Nadia17Angie works in a health clinic, a non-profitorganization that receives federal funds. Patientscan be treated at the clinic, regardless of theirincome.Nadia, an undocumented woman with HIV, seekstreatment at the clinic.1.2.3.Is Nadia eligible for treatment?Is Angie required to verify Nadia’s immigrationstatus?Is Angie required to report Nadia to theDepartment of Homeland Security?

Immigrant Eligibility for MajorCalifornia ProgramsFull-Scope Medi-Cal Adults: Qualified immigrants & PRUCOL; Children & Pregnant women:regardless of statusCalFresh/California FoodAssistance Program (CFAP)Qualified immigrants (plus)Deeming rules apply. CalWORKs Qualified immigrants & PRUCOL. Deeming rules apply NOTE: Trafficking survivors andU visa applicants/holders areeligible for all state & localprogramsSSI/Cash AssistanceProgram for Immigrants(CAPI) and IHSSQualified Immigrants andPRUCOL. Deeming rules apply.

Andrea19Andrea applied to become an LPR based onher marriage to a U.S. citizen, but does nothave her green card. She has a disability.Which services can she receive?What if her husband is abusive?

Kim and her Family20 Kim is a 28-year-old mom with one child, age6. Both are LPRs who entered the U.S. in 2015.Kim lost her job. Are mom and child eligible fornutrition assistance or health coverage?Kim’s mother travels to U.S. from Japan to visit.When her visa expires, she overstays. Grandmaslips, breaks her arm, and is taken to theemergency room. Is she eligible for Medi-Cal?

21Survivors of Trafficking and other SeriousCrimes in CA: TraffickingSurvivors can getstate and localbenefits beforecertified for federalbenefits12 months, extended ifT visa application orContinued Presencerequest filed U visa applicants/holders get state andlocal benefitsContinues unless U statusfinally deniedState RCA and RSSavailable for traffickingsurvivors & U visaapplicants/holders

Clare, Mike and Tyler22 Clare and her boyfriend Tom are undocumented. Tomis in jail due to domestic violence. Clare has twochildren, Mike, an undocumented teenager, and Tyler, asix-year old, born in the U.S. Clare is pregnant. Whichbenefits can they receive?

Eligibility for Covered CaliforniaLawfully PresentQualifiedlawfully presentimmigrants are eligible topurchase health coveragethrough state health caremarketplaces No waiting periodexception:People who receiveddeferred action throughDACA are specificallyexcluded

Lawfully Present Noncitizens All “qualified” immigrants Others authorized to live and/or work in the U.S., e.g. temporary protected status (TPS) most with deferred action Applicants for: adjustment to LPR, asylum, and certain otherstatuses Individuals with valid nonimmigrant statusComplete -and-the-marketplace/

Public Charge: Background25 Public Charge is a ground of inadmissibility thatapplies when a person seeks: Admission to the USLawful permanent residence (LPR, a green card)Refugees, survivors of domestic violence, crime, ortrafficking, special immigrant juveniles, other“humanitarian” immigrants - and LPRs applying forcitizenship are not subject to public charge.

Public Charge26 Public charge test is based on all facts relevant toindividuals’ ability to support themselves, including at aminimum, their: Age Health Financial resources Family status Education and skillsOther relevant factors, like an affidavit of support, may beconsidered

Public Charge27 Other potentially relevant factors include the person’s useof public benefits. Under current rules, only two types ofbenefits can be considered: Cash assistance for income maintenance Institutionalization for long-term care at governmentexpenseUSCIS expected to propose new regulations that wouldexpand factors considered in the public charge testdramatically, including the benefits that can be consideredInstructions for consular officers abroad were revised (lessdramatically) in January, and may be revised again toconform with any new rules for decisions made in the US.

Proposed Rules: Not Retroactive28 Under leaked drafts of the proposal, benefits: received before the final date of any newregulations that are currently excluded from the publiccharge assessmentWill not be considered in the Public Chargedetermination

Messages for Consumers29 Some immigrants are NOT subject to public chargePositive factors are balanced against negative factors. Aperson with a negative factor may be able to overcome it by showingpositive factors.Forward Looking. If proposal becomes final, non-cash benefitsused before that time will not be counted. Using benefits now canhelp you or your family members become healthier, stronger andmore employable in the future.Each situation is different. People with questions should consultan immigration attorney about their individual case.Fight back! Let the government know that this proposed rule wouldharm you, your family, community and the country. Organize withothers to weigh in.

Key Issues for Mixed-Status Families Undocumented individuals may apply for coverage on behalf oftheir dependent family members Applications should distinguish between applicants (e.g., U.S.citizen child) & non-applicants (e.g., undocumented parent) Non-applicants are not required to provide their immigration statusNon-applicants without SSNs cannot be required to provide one Never provide an SSN unless officially issued by the SocialSecurity Administration Individual Taxpayer Identification Numbers (ITINs) should not beusedInformation provided on an application may be used ONLY todetermine eligibility for health insurance.30

Health Care Providers Can: Document harm of restrictive policies andbenefits of improving accessMonitor policies to ensure they are implementedproperlyEducate families about available servicesHelp ensure that immigration and health policies areresponsive to families and public health needsAddress the barriers that prevent eligiblefamilies from securing care

Resources Major Benefit Programs for Immigrants in California Public Charge Information (NILC) Sponsored Immigrants and Benefits in CaliforniaProtecting Immigrant Families Campaign Resources Fact sheet on proposed changes to public charge Fact sheet on changes to the Foreign Affairs Manual (FAM) “Things to Keep in Mind When Talking with Immigrant Families” Proposed Changes to Public Charge Policies for Immigrants: Implicationsfor Access to Health Care (Kaiser Family Foundation) National Immigration Law Center:

More Resources Privacy Protections in Selected Federal Benefits Programs Health care Providers and Immigration Enforcement: KnowYour Rights, Know Your Patients' Rights Everyone has Certain Basic Rights, No Matter Who isPresident (Arabic, Chinese, English, Korean, cards also inFarsi and Somali) Know Your Rights Cards from the Immigrant Legal ResourceCenter (Arabic, Chinese, English, Hmong, Korean, Spanish& Vietnamese) Family Preparedness Plans from the Immigrant LegalResource Center

Immigrant Benefit Classifications U.S. Citizens "Qualified" immigrants Entering the U.S. before 8/22/96 Entering the U.S. on or after 8/22/96 "Not Qualified" immigrants PRUCOL (Permanently Residing Under Color of Law) Other lawfully present non-citizens Undocumented immigrants 4

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