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Thursday, July 17, 2014

Health Coverage Available for Immigrants Turned Away Due to Website Glitch

Rachel Dolan

Enrollment Policy Analyst

An update to the application on Healthcare.gov means that recent, lawfully present immigrants are now able to buy health insurance through the Affordable Care Act marketplace. They are also eligible to receive financial assistance to pay for that coverage. Until the U.S. Department of Health and Human Services (HHS) fixed the application in early June, recent, lawful immigrants who sought health coverage during the open enrollment period were turned away. Now, the task remains to find those who were denied coverage and offer them another chance to enroll.

Who will be affected by HHS’ amendment to allow lawful immigrants to get health coverage?

Federal law bars immigrants who have been in the United States fewer than five years from enrolling in Medicaid, even if they would otherwise qualify because they have low incomes and meet other state criteria for getting Medicaid. (About half the states make an exception for pregnant women and children. And six states prohibit any immigrant from getting Medicaid, no matter how long they have been in the United States.)

But the Affordable Care Act includes a special provision for these immigrants to enable them to buy health insurance in the marketplace and to qualify for financial help to make that coverage more affordable.

Recent lawful immigrants can buy health insurance through the marketplace regardless of whether their state has opted to expand Medicaid

In designing the Affordable Care Act’s health insurance marketplaces, the Medicaid expansion was intended to be universal. The special provision for immigrants was designed to ensure that lawfully present immigrants wouldn’t fall through the cracks of programs the Affordable Care Act offers. 

In states that have expanded Medicaid, those with incomes below 138 percent of poverty qualify for Medicaid. Those with incomes from 138 to 400 percent of poverty qualify for financial help to buy coverage in a health insurance marketplace.

But in states that have not expanded Medicaid, the picture is more complicated: Those with incomes between 100 percent and 400 percent can get financial help in the marketplace. Those with incomes below 100 percent are only able to get coverage if they qualify for the state’s more modest Medicaid program because they belong to certain special populations,  including children, pregnant women, parents, seniors, or they have a disability and also have a very low income (usually well below the federal poverty level for non-pregnant adults).

In designing the Affordable Care Act’s health insurance marketplaces, the Medicaid expansion was intended to be universal. The special provision for immigrants was designed to ensure that lawfully present immigrants wouldn’t fall through the cracks of programs the Affordable Care Act offers. 

For the vast majority of people, qualifying for premium tax credits requires an income between 100 to 400 percent of the federal poverty level. The rules are different for recent lawful immigrants.

How much financial help will immigrants below the poverty level receive?

For the marketplace to determine the tax credit these immigrants will receive, their income is treated as if it were 100 percent of the federal poverty level, which means that the person’s monthly premiums can only be equal to 2 percent of his or her income. His or her cost-sharing (copayments, co-insurance, etc.) is also significantly reduced.

Health insurance marketplace resolved issue that may have wrongly denied coverage to immigrants

The recent immigrants who were wrongly denied health coverage due to this issue applied through the marketplace during the first open enrollment period. Most likely, the marketplace referred them to the state’s Medicaid program as potentially eligible for Medicaid. But then they were subsequently denied Medicaid due to their status as immigrants and were still unable to complete enrollment through the marketplace.

To address this problem, the marketplace application has a new question to help consumers who are not eligible for Medicaid or CHIP due to their immigration status and whose immigration status cannot be immediately verified through the Department of Homeland Security (DHS).

If consumers indicate they were denied for Medicaid or CHIP, the new question will ask if they were denied due to immigration status. Consumers with eligible immigration statuses will then be able to elect health coverage.

The new question will help specifically identify individuals with incomes below 100 percent of poverty who are ineligible for Medicaid or CHIP based on immigration status, but who may be eligible for an advance premium tax credit (APTC) and cost-sharing reductions (CSRs). This question allows consumers who fall into this group to continue with their applications and enroll in a health plan for which they may have previously been determined ineligible.

Raising awareness is crucial to ensure that any person wrongly denied coverage who wants health insurance is able to sign up through the marketplace

Now that the system is working properly, the challenge is to find the individuals affected, many of whom may have already tried to apply through Healthcare.gov and were told they were ineligible for tax credits and Medicaid in their state. If the marketplace gave someone an incorrect eligibility determination, he or she is eligible for a special enrollment period, which allows him or her to enroll in a qualified health plan (outside the set open enrollment period).

However, many of these people may not be aware of this and may be discouraged from seeking health coverage again in the future. Enrollment assisters and others engaged in outreach in communities with many new immigrants should help spread the word to their clients. States can help with this effort, too, by reviewing their files to check for individuals who healthcare.gov referred and whom they subsequently denied for Medicaid because of immigration status. States and HHS should conduct targeted outreach to these individuals to help them get covered.

During the upcoming 2014 to 2015 open enrollment period, navigators, assisters, and others conducting outreach in immigrant communities can also communicate this coverage option to immigrant individuals and families.