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Health Care Reform: Immigrant Eligibility

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5712EN - The Affordable Care Act includes several provisions that may help you get coverage for your medical bills if you are an immigrant.

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What is the Affordable Care Act?

The Affordable Care Act (ACA) is a federal law that changes

  • how health insurance companies operate

  • how people can get medical coverage

You may hear it called "Obamacare" after President Obama. Our publication called Health Care Reform: General Information has more information about the ACA, including how to apply.

I am an immigrant. I need medical coverage.  Can the ACA help me?

Yes.  The ACA includes several provisions that may help you get coverage for your medical bills.

The ACA expanded eligibility for the Medicaid program, which provides medical coverage for low-income people.  Medicaid coverage is now available to people with higher incomes than before, and to non-disabled adults under age 65 who do not have children. The ACA did not change existing restrictions on immigrant eligibility for Medicaid.  Our publication called Health Care Reform – Medicaid Expansion has more information.

The ACA also provided for the establishment of health care exchanges where people can buy insurance, called Qualified Health Plans, and apply for tax credits and subsidies to help with the costs of those plans.  Washington State's health care exchange is called Healthplanfinder.  Our publication called Health Care Reform – Qualified Health Plans has more information.

Am I eligible for Medicaid?

It depends. You may be eligible for non-emergency Medicaid if, in addition to meeting other requirements (such as being low-income), you either

  • are a citizen OR
  • have "qualified" immigration status

The following are considered "qualified" immigrants:

  • Lawful Permanent Residents (LPRs/"green card" holders)
  • Asylees
  • Refugees
  • Persons granted withholding of deportation/removal
  • Cuban/Haitian Entrants
  • Persons who have been paroled into the U.S. for at least one year
  • Conditional Entrants
  • Certain battered immigrant spouses and children (and their children/parents)
  • Certain victims of trafficking (and certain relatives)

Some qualified immigrants, including those who got their green card through a visa petition filed by a relative, cannot get non-emergency Medicaid until they have been in lawful permanent resident (LPR) status for five years. This bar does not apply to refugees, asylees, and other humanitarian entrants. There are other special exceptions for active duty military, veterans, and their families. 

The five-year bar only applies to non-emergency Medicaid. It does NOT affect eligibility for:

  • emergency Medicaid for immigrants
  • health insurance through the health insurance exchanges
  • medical coverage for low-income children and pregnant women

*Washington State has a program called Medical Care Services (MCS) for lawfully present immigrants who are age 65 or older, blind, or disabled, who are ineligible for non-emergency Medicaid.

Can I buy insurance and apply for subsidies through Healthplanfinder?

Maybe, if you

  • are a lawfully present immigrant AND
  • meet other eligibility requirements

The Appendix at the end of this publication lists immigration statuses considered lawfully present under the ACA.  The list includes

  • people with immigration applications pending AND
  • people who have been granted some type of immigration status

I am undocumented. I do not have any immigration application pending. Am I eligible for any programs?

Not eligible: You are not eligible for non-emergency Medicaid. You cannot buy health insurance through Healthplanfinder.

Eligible: Some programs are available to all immigrants, regardless of status, including:

  • emergency Medicaid for treatment of certain emergency conditions
  • dialysis, cancer treatment, and treatment for benign life-threatening tumors  
  • medical coverage for low-income children
  • medical coverage for low-income pregnant women

You may also be able to get treatment for a reduced fee at a community clinic, regardless of your immigration status.  You can also still buy health insurance on your own, although you cannot buy it through Healthplanfinder and you cannot get federal subsidies to help pay for it. 

*Our publication called Help with Medical Bills for Immigrants without Legal Status has more information.

I was granted deferred action under DACA (Deferred Action for Childhood Arrivals). Am I eligible for any programs under the ACA?

No. The ACA does not consider persons granted deferred action under DACA lawfully present.  You cannot buy insurance through Healthplanfinder or get subsidies to help pay the costs of insurance.  You are not eligible for non-emergency Medicaid. 

If you are over 65, blind, or disabled, you may be eligible for the state Medical Care Services program.  You may also be eligible for programs that are available regardless of immigration status, including emergency Medicaid, cancer treatment, dialysis, treatment of benign life-threatening tumors, and coverage for low income children and pregnant women. 

I do not have legal status. If I apply for medical coverage, will I be reported to immigration officials?

No. The state can only use the information you provide on your application to determine your eligibility for benefits. No one can use it for immigration enforcement.

You must be truthful on your application. If you lie or provide fake documents or social security numbers, you could face accusations of fraud. This could have consequences for your immigration status or ability to get status in the future.

You can use Healthplanfinder even if you are not lawfully present and it does not appear you are eligible for non-emergency Medicaid or to buy insurance on the exchange. There may be other programs open to you (including emergency Medicaid and coverage for low-income children and pregnant women).

Will I have to provide a social security number?

Not necessarily.

Both the on-line and paper application will ask you for your social security number if you have one.  However, even if you do not have a social security number, you can still fill out the application. Some programs do not require a social security number. You will have the chance to provide other documents to show you are eligible.

You may need to provide other evidence of income (such as paystubs) for relatives who do not have a valid social security number, so the state can determine what benefits you or other relatives may be eligible for.

*If you are eligible for a social security number but do not have one, you can get help applying for one.

I do not want to apply for myself. Can I use Healthplanfinder to apply for my children?

Yes.  You can choose to apply for certain relatives and not for yourself. 

It is okay to apply for all your family members to see who may be eligible.  All information you provide on the application is confidential.

Do I have to get health insurance coverage?

Probably.  The ACA requires most U.S. citizens and lawfully present immigrants to have a minimum level of medical coverage for themselves and their dependents.  Some people are exempt from this requirement, including those whose income is below the tax filing threshold.  If you are required to have medical coverage and do not, you may have to pay a penalty to the Internal Revenue Service (IRS). Our publication called Health Care Reform: Requirement to get Health Care Coverage has more information. 

If you are undocumented or the law does not consider you lawfully present (including persons granted deferred action under DACA), you do not need to have health insurance for yourself.  You still must have medical coverage for any lawfully present dependents, including children.   This is not a problem for most families. Children from low- and moderate-income families are eligible for free or low-cost coverage.

I get health insurance or medical coverage through the government. Will that affect my immigration status?

Most medical benefits provided by the government will not affect your immigration status.

If you are in the process of becoming a lawful permanent resident (getting your green card) through a visa petition submitted by a family member, you must show that you will not become a "public charge." This means you will not rely on government benefits for your financial support. In deciding whether you are likely to become a public charge, the government primarily considers any cash assistance you have received. The government does not consider medical benefits or insurance. The only exception to this is if you get long-term care benefits in an institutional setting, such as a nursing home.

There is no public charge consideration or bar for persons applying for naturalization. Getting public benefits will not keep you from becoming a naturalized U.S. citizen.

What if I need legal help?

CLEAR is Washington's toll-free, centralized intake, advice and referral service for low-income people seeking free legal assistance with civil legal problems. 

  • Outside King County: Call 1-888-201-1014 weekdays from 9:15 a.m. until 12:15 p.m. 

  • King County: Call 211 for information and referral to an appropriate legal services provider Monday through Friday from 8:00 am – 6:00 pm. You may also call (206) 461-3200, or the toll-free number, 1-877-211-WASH (9274). You can also get information on legal service providers in King County through 211's website at www.resourcehouse.com/win211/.

  • Persons 60 and Over: Persons 60 or over may call CLEAR*Sr at 1-888-387-7111, regardless of income.

Callers who are deaf and hard of hearing can call 1-800-833-6384 or 711 to get a free relay operator. They will then connect you with 211 or CLEAR.


 

APPENDIX
Immigration statuses considered "lawfully present" under the ACA:

  • Lawful Permanent Residents (LPRs/"greencard" holders)

  • Asylees

  • Refugees

  • Granted Withholding of Deportation/Removal, under the immigration laws or the Convention Against Torture (CAT)

  • Cuban/Haitian Entrants

  • Paroled into the U.S.

  • Conditional Entrants

  • Certain battered immigrant spouses and children (and their children/parents)

  • Certain victims of Trafficking (and certain family members)

  • Granted Temporary Protected Status

  • Granted Deferred Action (except for persons granted Deferred Action under DACA for childhood arrivals)

  • Granted Deferred Enforced Departure

  • Granted Family Unity

  • Citizens of the Marshall Islands, Micronesia, and Palau

  • Individuals in current non-immigrant status who have not violated the terms of their status, including persons with student visas, U visas and V visas

  • Applicants for Adjustment with approved visa petitions

  • Applicants for Adjustment who have been granted employment authorization

  • Applicants for Asylum and/or Withholding of Deportation/Removal who have been granted employment authorization (or applicants under the age 14 who have had an application pending for at least 180 days)

  • Applicants for TPS who have been granted employment authorization

  • Applicants for Suspension of Deportation or Cancellation of Removal who have been granted employment authorization

  • Lawful Temporary Residents under IRCA

  • Applicants for Legalization under IRCA or the LIFE Act who have been granted employment authorization

  • Applicants for Registry who have been granted employment authorization

  • Individuals on an Order of Supervision who have been granted employment authorization

  • Children with a pending application for Special Immigrant Juvenile status

 

5712EN 

This publication provides general information concerning your rights and responsibilities. It is not intended as a substitute for specific legal advice.
This information is current as of October 2015.

© 2015 Northwest Justice Project — 1-888-201-1014

(Permission for copying and distribution granted to the Alliance for Equal Justice and to individuals for non-commercial use only.)

Last Review and Update: Oct 14, 2015