UNDOCUMENTED & UNINSURED: HEALTH ACCESS & PROGRAM ELIGIBILITY

Transcription

1 UNDOCUMENTED & UNINSURED: HEALTH ACCESS & PROGRAM ELIGIBILITY

2 Overview Immigrant Exclusion from Healthcare What is the Affordable Care Act? Band Aid Care: State & County Programs

3 Context Intersection of Health and Immigration Federal immigration policy harms undocumented communities Over $17 billion spent on immigration enforcement in 2010 alone. Over 2 million+ people have been deported within the past 5 years. State-based measures: access and restrictions to services Access to public programs and services: health, education, social services Anti Immigrant State Laws: Arizona SB 1070, Georgia HB 87, Alabama HB 56 Secure Communities program: collaboration between police and immigration Being undocumented in the US results in high potential for social and systematic trauma affecting overall health of immigrants Criminalization, incarceration, and deportation Separation of families and personal relationships Loss of wages, worker exploitation Career and life barriers Fear and lack of trust of authorities and government systems

4 Context Immigrants Restricted from Access to Health Undocumented immigrants and recipients of Deferred Action for Childhood Arrivals (DACA) are ineligible for major provisions of the Affordable Care Act, also known as Obamacare. Undocumented people are the least likely to have seen a doctor in the past year and to use emergency services. 1.5 million undocumented residents of California remain uninsured since ACA went into effect on January 1, About 40% of California s uninsured are undocumented Not eligible for coverage due to immigration status

5 Undocumented & Uninsured: A Report by the Dream Resource Center of the UCLA Labor Center First statewide survey about immigrant youth, by immigrant youth around experiences in health care. Team of 37 immigrant youth surveyed 550 undocumented and DACAmented Californians between the ages of 18 and 32. Conducted face-to-face surveys on the experiences and real life barriers to health care faced by undocumented people.

6 Undocumented & Uninsured Report Findings: Health Coverage & Access Half of uninsured immigrant youth delayed getting medical care they felt they needed. 96% of them reported that the main reason was cost or lack of health insurance. Band-aid services are incomplete and the dominant source of care for the uninsured. 74% of immigrant youth reported they have received services from safety-net programs: Community or County health clinics Public Hospitals Emergency Medi-Cal

7 Undocumented & Uninsured Report Findings: Mixed Status Families 1 in 17 children in the US lives in mixed-status homes where household members have different immigration or citizenship statuses. 56% of immigrant youth reported that family members without insurance did not receive the care they needed. 71% stated that household members without insurance often minimized their health problems.

8 DACA Recipients Exclusion from Affordable Care Act August 15, 2012 President Obama announces the Deferred Action for Childhood Arrivals (DACA) program. DREAM Act-eligible youth, between ages 15 to 30 Protection from deportation Renewable, 2-year work permit August 28, 2012 President Obama releases two official policy announcements excluding DACA recipients as lawfully present immigrants for eligibility purposes: Excluded from the Individual Mandate to have health coverage Ineligible for Health Benefit Exchange & Tax Credits Ineligible for Medicaid and CHIP, except by state option Does not affect other deferred action recipients

9 Employment-Based Coverage Even though undocumented immigrants are not eligible for ACA s provisions, undocumented workers are still able to find health insurance through their employers. However, undocumented, full-time workers and their families are receiving health insurance through their employers at lower rates than citizen and naturalized workers.

10 Emergency Care Available to all regardless of health insurance status Emergency Medical Treatment & Active Labor Act (EMTALA) enacted in 1986 Requires all facilities that provide emergency care to treat patients regardless of insurance status, including undocumented people. Emergency Medical Conditions: Acute, severe symptoms or pain, or if failure to get immediate attention will: Endanger the patient s health Seriously impair bodily functions Cause serious dysfunction to a body organ or body part Excludes organ transplants and continuation of services

11 Federal, State, and County Based Health Access Health care policies at the national, state, and county levels affects access to health for immigrant and undocumented individuals depending on where they live. National Affordable Care Act Medicaid State Covered California Medi-Cal County Ability to Pay (ATP) Safety Net Programs

12 National: Federal Bar to Health Care Exclusion of Undocumented & Recent Immigrants The Personal Responsibility and Work Opportunity Act (PRWORA) of 1996 created qualified and non-qualified immigrant categories for eligibility to federal public benefits, including health care. Qualified Immigrants Legal Permanent Residents Asylees, Refugees, & Parolees Withholding of deportation Battered Immigrants, U-visa Victims of trafficking Cubans, Haitians Non-Qualified Immigrants Undocumented people No visa or permanent resident card Expired visa Recent Immigrants with lawful presence in the US for up to 5 years Temporary work permits Parolees for less than one year People under deportation procedure Temporary Administrative Statuses Stay of deportation Voluntary departure

13 State-Based Access to Health Care Eligibility for Undocumented Residents of California States have the authority to determine health benefit eligibility for non-qualified immigrants by using state funds. California provides the following state-funded services to people who qualify regardless of immigration status: Breast and cervical cancer screenings Prenatal care and limited post-partum care Emergency Medi-Cal Long-term care (Subject to Public Charge ) California also provides state-funded Medi-Cal eligibility to: Recent Immigrant with permanent status in U.S. less than 5 years PRUCOL Immigrants (includes DACA Recipients)

14 Public Charge Immigrants receiving Long-Term Care Public Charge : someone who has become or who is likely to become primarily dependent on the government for subsistence. Immigrants seeking legal status can ONLY become a public charge when receiving health services in Long-Term Care (LTC) Medi-Cal. Long-Term Care: wide range of services provided to elderly individuals and people with disabilities who need ongoing care due to chronic conditions. Immigrants seeking legal status who become a public charge are subject to: Rejection of Legal Permanent Resident status or visa adjustment Admission to US denied Deportation 1 US Citizenship and Immigration Services (USCIS) Public Charge:

15 PRUCOL: Permanently Residing Under Color of Law A benefit eligibility category for federal public benefits, including Medi-Cal. Not an immigration status or eligibility for US citizenship. PRUCOL: individuals who are in the U.S. with the knowledge of US Citizenship & Immigration Services (USCIS) and are not likely to be deported. In California, immigrants who are PRUCOL are eligible for Medi-Cal: DACA Recipients Temporary Protected Status (TPS) People with pending applications for green card, permanent residency, immigration status readjustment Notice, letter, or proof from USCIS stating paperwork has been received or is in process will be needed during enrollment.

16 AFFORDABLE CARE ACT

17 Affordable Care Act It was signed into law on March 23, 2010 Upheld by the Supreme Court on June 28, A federal law also known as ObamaCare The official name is the Patient Protection and Affordable Care Act Commonly referred to as the Affordable Care Act or ACA Also: Medi-Cal (Medicaid), Covered California (The Exchange) Affordable Care Act Health Care Reform ObamaCare

18 Affordable Care Act Creates a Health Benefit Exchange ( The Exchange ) Known as Covered California in California Expands Medicaid eligibility from 100%FPL to 133%FPL Known as Medi-Cal in California Eligibility was expanded to 138% FPL in California Ten Essential Health Benefits ensures Medi-Cal and Covered CA health plans offer comprehensive package of services. Individual Mandate for citizens and lawfully present individuals to have health coverage or pay a penalty if uninsured more than 3 months. People with pre-existing conditions can no longer be denied or dropped from health coverage. Federal Poverty Level (FPL): A measure of income level issued annually by the U.S. Department of Health and Human Services used to determine eligibility for certain state and federal benefits.

19 Affordable Care Act: Two Major Systems in California Covered California California s health benefit exchange Online marketplace where individuals, families, and employers can purchase health plans and enroll in Medi-Cal. Medi-Cal California s Medicaid program. Public health program for low-income Californians run by federal and state funds.

20 20 Affordable Care Act Ten Essential Health Benefits

21 Affordable Care Act: Exemptions to Individual Mandate Undocumented residents and DACA Recipients Financial Hardship Cost of coverage is greater than 8% of household income If household income is below tax filing threshold ($10,000 for individuals; $20,000 for families) Incarcerated People Religious Objection Members of a Federally Recognized Tribe Hardship Exemption Homelessness, eviction, domestic violence, utility shut off, natural disaster, etc.

22 Affordable Care Act: Rights and Protections 22 Information about immigration status may be used ONLY to determine an applicant s eligibility for health care. Mixed status families must include all members of the family in their application for health insurance, including undocumented family members not eligible for health coverage. Undocumented family members have the option to use an ITIN or state this person does not qualify for an SSN. ICE released a notice stating that information provided in health insurance application process will not be used for civil immigration enforcement. Clarification of Existing Practices Memo (Oct 15, 2013):

23 23 COVERED CALIFORNIA

24 What is Covered CA? Online, private health insurance marketplace 4 Metal Tiers: Bronze, Silver, Gold, Platinum Available health plans vary by region Financial Assistance for middle and low income households that qualify to help them afford health insurance: Premium Subsidies: Incomes between % FPL (All Plans) Cost Sharing Subsidies: Incomes between % FPL (Silver Plans) Enroll at

25 Covered California THE EXCHANGE Online Insurance Marketplace Metal Tiers Metal Tiers PLATINUM GOLD SILVER BRONZE Health Care Plans LA Care Kaiser Permanente Anthem Blue Cross Blue Shield Health Net Molina 25 Copyright 2012 UMMA Community Clinic. All rights reserve

26 Covered California Eligibility and Enrollment Individuals and families with household incomes over 138% FPL can enroll in a Covered CA health plan: California Residents U.S. Citizens, Nationals, or Lawfully Present immigrants Cannot be currently incarcerated DACA recipients are not eligible to buy health plans Household incomes below 138% FPL can still enroll in a Covered CA health plan, but will not be eligible for premium tax subsidies. Open Enrollment CLOSED on March 31, 2014 Special Enrollment after April 15, 2014 Only by contacting Covered CA within 60 days after a Qualifying Life Event: any event that would change your family size or income.

27 MEDI-CAL 27

28 What is Medi-Cal? Public health insurance in California for low income individuals and households. Medi-Cal Expansion now covers up individuals with household incomes up to or below 138% FPL. Now Eligible: Parents who would lose coverage under old rules Single adults without children, ages Annual incomes at or below 138% FPL

29 Full Scope vs. Restricted Medi-Cal Full Scope Medi-Cal Covers Essential Health Benefits ensured by the Affordable Care Act. Includes dental benefits for adults 21 and over Emergency / Restricted Medi-Cal Emergency services Pregnancy-related services Breast & cervical cancer treatment Long-term care (subject to public charge )

30 Medi-Cal Eligibility and Enrollment There is no deadline to apply for Medi-Cal When you are determined eligible for Medi-Cal, you are eligible for the entire month which you are determined eligible. Full Scope Medi-Cal: Ages 0-64 Must be living in California Citizen, Legal Permanent Resident, or lawfully present PRUCOL Immigrants Eligible (Includes DACA Recipients) Household income at or below 138% Federal Poverty Level Emergency/Restricted Medi-Cal For individuals who are not eligible for full scope due to immigration status.

31 Federal Poverty Level Medi-Cal Eligibility by Monthly Income

32 How to Apply for Health Insurance Medi-Cal & Covered California Plans Online Application You can create an on-line profile through the Covered California website, which allows you to view health plan prices and updates on your application status. You can enroll through In Person Assistance Certified Enrollment Counselors and Agents are qualified by Covered CA to offer assistance at no cost to you. You can search for an Enrollment Counselor near you at: Recommended for understanding your eligibility and completing the online application. Medi-Cal applications can also be completed at a local office with the Department of Public Social Services (DPSS). Office Locations:

33 CALIFORNIA STATE HEALTH PROGRAMS

34 Band Aid Care Safety Net Programs Safety-net programs exist in California to provide services to low-income, uninsured residents. Funding for programs open to people regardless of immigration status are constantly at risk of being cut by state and county stakeholders. Programs vary by state and by county.

35 California Health Programs Minor Consent Medi-Cal Confidential services for people under 21 years of age without parental consent or notification. Eligibility depends on income and resources. Pregnancy and pregnancy-related services; Mental health treatment and counseling; Drug and substance abuse treatment and counseling; Family planning; STD screening and treatment; sexual assault and rape treatment. Children under 12 years old only eligible for pregnancy-related care, family planning, and sexual assault services. Family PACT (Planning, Access, Care, and Treatment) Comprehensive family planning services for women under 55 and men under 50 with incomes at or below 200% FPL. Contraceptive education and counseling; Family planning services; Pregnancy testing and limited infertility services; STD/STI screening and treatment; mammogram screenings (women over 40)

36 California Health Programs Pregnancy Only Medi-Cal Immediate, temporary Medi-Cal coverage for ambulatory prenatal care and prescription drugs for conditions related to pregnancy for women or teens who think are pregnant. Must have incomes at or below 200% FPL. Includes pregnancy test, ambulatory prenatal care, prescription drugs for conditions related to pregnancy, out-patient abortion procedures, and limited preventive dental services. AIM: Access for Infants and Mothers Health program for pregnant women no more than 30 weeks pregnant who don t qualify for Medi-Cal and their newborns (up to 2 years old). Must have income between % FPL. Coverage for women includes prenatal care and delivery, maternity care, hospitalization, and all medically necessary medical services until 60 days postpartum. Coverage for newborns include infant care checkups, sick child care, hospitalization up to 60 days postpartum. Eligible for Medi-Cal.

37 California Health Programs Every Woman Counts provides screening and diagnostic services for breast and cervical cancer to uninsured California residents with incomes at or below 200% FPL, regardless of immigration status. Coverage includes clinical breast exams, mammograms, pelvic exams, pap tests, annual screenings and diagnostic services. Breast Cancer: at least 40 years old for 18 months of treatment (women over 40 can receive mammograms through Family PACT) Cervical Cancer: at least 21 years old for 24 months of treatment AIDS Drug Assistance Program Medication coverage for people living with HIV/AIDS over the age of 18, without insurance that covers medications or who don t qualify for no-cost Medi-Cal. Annual income must be at or less than $50,000.

38 California Health Programs Long Term Care Medi-Cal Nursing home and convalescent care, as well as comprehensive preventive care services, primary and specialty care for persons in long term care facilities. Covers medical office visits, vision care, dental care, mental health services, hospitalization and prescription medicines. May affect person s immigration status adjustment/application.

39 Episodic Programs Kaiser Child Health Program Currently closed. Next Open Enrollment Period: TBA. Community Benefit program for children up to19 years old who don t have health insurance and don t qualify for Medi-Cal. Depending on your family size and income, monthly payments can be $0 or $10 or $20 per child, for up to three children. Additional children are covered at no additional cost. Covers only certain counties in California

40 Other Public Health Programs Immunizations for children and adolescents HIV/AIDS related care and treatment including primary care, housing, and mental health Tuberculosis screening, diagnosis, and treatment STI/STD screening, diagnosis, and treatment Testing and treatment of symptoms of other communicable diseases even if communicable disease is not the cause of symptoms.

41 LOS ANGELES COUNTY HEALTH PROGRAMS 41

42 Los Angeles County Programs My Health LA (formerly Health Way LA Unmatched) 42 HWLA Matched Low Income Health Program (LIHP) ended on December 2013 for LA County residents who are now eligible for Medi-Cal. HWLA Unmatched My Health LA Public health care program for uninsured LA County residents with incomes up to or below 138% FPL who do not qualify for full scope Medi-cal. Legal Permanent Residents of up to 5 years also eligible. Not Eligible: people with temporary work permits, DACA Recipients. Coverage good for one year, renewals. Funded by County Board of Supervisors who agreed to use county funds to reimburse community clinics for care.

43 Los Angeles County Programs My Health LA (formerly Health Way LA Unmatched) My Health LA Benefits Assigned to a medical home (participating clinics & health centers) Receive primary and preventive care services Mental health counseling and services Free to low cost medications Benefits Do Not Include Hospital / ambulatory services Specialty care Can receive specialty care treatment in LA County through Ability To Pay (ATP) program.

44 Los Angeles County Programs Ability to Pay (ATP, formerly known as ORSA) All Ages Ability to Pay (ATP): medical care at low or no cost for residents of LA County who meet the income requirement, regardless of immigration status. All ages eligible. Emergency Medi-Cal OK. Covers outpatient, inpatient services, emergency room visits, certain surgeries, prenatal, maternity, and prescribed medicines. Not Eligible: Unexpired work, student, or tourist visas. LA County clinics and hospitals No cost for individuals at or below the listed income limits. Low cost for individuals over the listed income limits For screening locations: Los Angeles Department of Public Social Services Ability to Pay:

45 Los Angeles County Programs Pre-Payment Plan All Ages Pre-Payment Plan: flat fee for LA County residents for each medical visit if paid within 7 days of choosing the plan. No age requirement, regardless of immigration status or income level. Covers doctor visits, outpatient hospital care, lab tests, emergency room visits, and some surgeries. $60 prenatal vists for first 7 vists, the restare at no cost $60 for clinic visits at Comprehensive Health Centers (CHC) and Health Centers (HC) $80 for clinic visits at county hospital clinics and Multi-service Ambulatory Care Centers $80 for urgent care visits at all locations $140 at county hospital emergency rooms $500 at outpatient surgery clinics Does not cover medicines. Not Eligible: Unexpired work, student, or tourist visas. Eligible to apply at LA County clinics and hospitals. Los Angeles County Department of Health Services:

46 Presentation Sources National Immigration Law Center (NILC) California Immigrant Policy Center (CIPC) Maternal & Child Health Access National Health Law Program California Health Care Almanac U.S. Department of Health & Human Services LA County Department of Health Services LA County Department of Public Health California Department of Health Care Services

47 QUESTIONS? 47

48 48 Thank You! Gracias! Carlos Juárez Certified Enrollment Counselor Nidia De Leon Certified Enrollment Counselor