Immigrant Eligibility for Health Insurance

 

IMMIGRANT ELIGIBILITY FOR HEALTH INSURANCE IN NORTH CAROLINA

- Who is eligible for Medicaid and NC Health Choice (CHIP)?
- Who is eligible for Marketplace Coverage
- What type of documentation is acceptable?
- What if I don’t have documentation of my immigration status?
- Is a Social Security Number required for Medicaid/CHIP or Marketplace coverage?
- How does an immigrant meet the residency requirement for Medicaid/CHIP or Marketplace coverage?
- What health insurance options are available for undocumented individuals and those with DACA status?
- Will an application for Medicaid or Marketplace coverage have a “public charge” consequence?
- Will an application for Medicaid/CHIP or Marketplace coverage put my undocumented relatives at risk of deportation?

Immigrant Eligibility Insurance Brochure - LSSP  NCJC_Page_2

Who is eligible for Medicaid and NC Health Choice (CHIP)?

NC DHHS Integrated Eligibility Manual, Section 15140: Overview of Alien Eligibility for Medicaid and CHIP

Medicaid and NC Health Choice (CHIP) eligibility is based on three main factors:

  • Being in an eligible category. Eligible Medicaid categories generally include children, pregnant women, caretakers of young children, disabled adults and individuals over age 65.
    • Note: Because North Carolina has not expanded Medicaid under the Affordable Care Act, non-disabled, childless adults in North Carolina cannot qualify for Medicaid no matter how low their income is.
  • Being below the income level for that category. Click here for chart of 2016 Medicaid/CHIP income limits.
  • Having an eligible immigration status
    • Qualified immigrants
      • “Qualified immigrant” is a term of art used in benefits law to designate who is eligible to receive federal public benefits including Medicaid and CHIP.
      • Some examples of qualified immigrants include: lawful permanent residents, refugees, asylees, conditional entrants, persons granted withholding of deportation, certain Cuban/Haitian entrants, certain victims of domestic violence and human trafficking and persons paroled into the U.S. for one year or more.
      • There is a 5-year mandatory disqualification period for certain qualified immigrants if admitted on or after August 22, 1996. This 5 year bar does not apply to children under age 19, pregnant women, veterans/spouses/active duty military, or asylees/refugees/Cuban Haitian entrants/withholding of removal.
    • Lawfully present immigrants
      • In North Carolina, all “lawfully residing” pregnant women (up to 60 days postpartum) and children under age 19 are potentially eligible for Medicaid and NC Health Choice.
      • “Lawfully present” individuals include not only those classified as “qualified” immigrants, but also several other categories of non-U.S. citizens who have permission to live and/or work in the U.S.
      • Some examples of qualified aliens include: U visa holders, Temporary Protected Status, Non-resident visa holders (tourist visas, work visas, student visas, etc), applicants for Asylum, Applicants for Special Immigrant Juvenile Status. For a full list of Lawfully Present Immigrants, see this resource from the National Immigration Law Center.


Who is eligible for Marketplace coverage?

  • ALL lawfully present immigrants are eligible to enroll in marketplace coverage.
    • Note: Individuals with Deferred Action for Childhood Arrivals (DACA) are ineligible for Marketplace and Medicaid/CHIP.
  • Advanced Premium Tax Credits (APTCs) are generally available for applicants between 100 and 400 percent of the federal poverty line. Cost Sharing reductions are available for applicants between 100 and 250 percent of the federal poverty line.
    • If ineligible for Medicaid based on immigration status, may qualify for financial assistance (APTCs & CSRs) in the marketplace even if income is below the poverty line. Click here for a practical guide on obtaining correct marketplace eligibility results for low-income immigrants.
  • Must file taxes for coverage year to be eligible for APTCs. This will require ITIN application for many immigrants.


What type of documentation is acceptable?

  • Click here for a list of common documentation from the National Immigration Law Center.
  • Click here for visuals of common documentation.
  • A photocopy, facsimile, scanned or other copy of a document must be accepted to the same extent as an original document.


What if I don’t have any documentation of my immigration status?

  • For Medicaid, a 90-day Reasonable Opportunity Period must be provided to individuals who have declared themselves to be citizens or nationals of the United States, or an individual having satisfactory immigration status and for whom the county DSS is unable to promptly verify citizenship or satisfactory immigration status by electronic means or documentation.
  • For marketplace coverage, when immigration status can’t be verified through electronic data-matching, the “inconsistency” process is activated. Consumers can enroll in a Marketplace plan based on the attestations on the application and receive advance premium tax credits (APTC) and cost-sharing reductions (CSR) while they resolve the inconsistency.
    • Consumers have 95 days from the date of the eligibility notice to send in documents to resolve an immigration status inconsistency.

 

Is a Social Security Number required for Medicaid/CHIP or Marketplace coverage?

  • A Social Security number is not required for immigrants who are (1) ineligible to receive one or (2) may only be issued an SSN for a valid non-work reason. See 42 C.F.R. § 435.910(h).


How does an immigrant meet the residency requirement for Medicaid/CHIP or Marketplace coverage?

  • To qualify for coverage, applicants must attest that they reside in the state of application.
  • To meet state residence, the individual only has to live in NC or intend to reside in NC, or have entered NC to seek employment or with a job commitment.
  • Alien status has no bearing on the state residence determination of the individual.  These are two completely separate determinations.


What health insurance options are available for undocumented individuals and those with DACA status?

  • Immigrants who are not eligible for Marketplace insurance or full Medicaid/ CHIP coverage due to their immigration status may still qualify to receive payment from Medicaid for treatment of emergency medical conditions including labor and delivery.
  • Individuals only applying for emergency services are not required to provide documentation of immigration status.
  • Employer health insurance may also be available.
  • Free and Reduced Cost Health Clinics may offer services without proof if immigration status. For a list of clinics in Mecklenburg County, click here.


Will an application for Medicaid or Marketplace coverage have a “public charge” consequence?

  • Many immigrants know of the “public charge” rule stating that those who receive government benefits may not qualify for a green card. This rule does not apply to immigrants receiving insurance in the Marketplace with subsidies and most Medicaid/ CHIP cases (exception: Long Term Care Medicaid).
  • Immigrants who are receiving financial help to purchase insurance in the Marketplace can still qualify for a green card.
  • For more information, see this document from the National Immigration Law Center.


Will an application for Medicaid/CHIP or Marketplace coverage put my undocumented relatives at risk of deportation?

  • Family members who are ineligible for public benefits based on their immigration status can still apply for their eligible children.
  • Guidance exists to encourage mixed-status families to apply for health coverage.
    • HHS has issued policy guidance stating that states should not make inquiries into citizenship, immigration status and social security numbers of non-applicants in the household when people apply for Medicaid/ CHIP.
    • 2013 memo from ICE clarifies that marketplace information will NOT be used to pursue immigration enforcement.
    • States may not deny benefits because a non-applicant in the family or household has not provided information on citizenship, immigration status, or SSN.

 

Additional questions?

  • Health insurance navigators are available to provide FREE, one-on-one in person assistance. You can schedule an appointment with a North Carolina navigator in two ways:
  • Policy questions? Contact Louise Pocock, Attorney for Health Care Access.