Navigating Health Care and
Coverage as an Immigrant in
Massachusetts
Claire Valentin, Staff Attorney
Children’s Law Center of Massachusetts
 [email protected]
 1-888-KIDLAW8
 Facebook
About Children’s Law Center of Massachusetts
• Children’s Law Center provides legal representation
and resources to low-income children and youth in
education, special education, child welfare,
immigration, and mental health matters.
• Staff offer free trainings for providers on
education, special education, child welfare,
immigration, and mental health matters.
• Helpline for families, providers, and youth:
1-888-KIDLAW8
Navigating Health Care and Coverage
as an Immigrant in Massachusetts
1. Types of Immigration Status
2. Immigration Related Concerns under the
Trump Administration
Types of Immigration Status
Main Types of Immigration Status
U.S. Citizen
Legal
Permanent
Resident
(Green Card)
(U.S. Born
Acquired
Derived
Naturalized)
Employment
Family Reunification
Diversity Lottery
Humanitarian (Asylee,
Refugee, U & T visas,
VAWA, SIJ)
Temporary
NonImmigrants
Visitors (tourists &
business)
Temporary Workers
(farmworkers & skilled
labor)
Students (higher
education only)
Humanitarian (TPS,
Parolees)
In Process/
Deferred
Applying for Status
DACA or other
Deferred Status
Undocumented
or
Out of status
Health Insurance Meets
Immigration
U.S.
Citizen
Legal Permanent Resident
More than 5 years
=
Qualified Noncitizen
(Green Card)
=
Lawfully Present Noncitizen
Less than 5 years, but Humanitarian
Temporary Non-Immigrants
=
Nonqualified individuals lawfully
present
Less than 5 years, not Humanitarian
In Process/Deferred
=
Non-qualified PRUCOL
Undocumented or
Out of status
=
Qualified Noncitizen
=
Qualified Noncitizen Barred
Legal Permanent Resident/
Green Card Holder
A person with a green card is:
Allowed to live, work, and study. in the United States
 Allowed to travel outside the United States and back.
 Eligible to later apply to become a U.S. citizen.
 Eligible for certain types of public assistance.
 Still at risk of deportation!

Work Authorization
A person with a work
authorization card is:
Allowed to work in the United States.
 Eligible for a social security number.
 Eligible for a driver’s license in MA.
 Not necessarily allowed to live in the United States.
 Not necessarily allowed to travel.
 Not eligible for certain types of public assistance.
 Still at risk of deportation!

Work Authorization
Common examples of work
authorization cards:
Asylum: (a)(05)
 Asylum pending: (c)(08)
 DACA: (c)(33)
 Deferred Action: (c)(14)
 Pending Application for Residence: (c)(09)
 TPS: (a)(12) or (c)(19)
 T-Visa: (a)(16) or (c)(25)
 U-Visa: (a)(19) or (a)(20)

Immigration Related Concerns
under Trump Administration
“Sensitive Locations” Policy
 Previously,
ICE stated it would generally not conduct
enforcement actions at “sensitive
locations” such as schools, churches, and
medical facilities.
 Currently,
 This policy is still in place.
 However, ICE has increased enforcement
actions around locations not listed in their
policy such as courthouses.

“Public Charge” Concerns
• Laws and policies about immigrants and public
benefits have not changed; the “leaked” memo was
never finalized.
• Immigrants should not misrepresent information
when completing public benefits applications or
dealing with any government agency.
• Federal and state laws that protect the privacy of
people who apply for or use health programs remain
in place.
• People who need health care or other safety-net
benefits should use them!
Massachusetts A.G. Guidance
to Health Care Providers
• Do the President’s Executive Orders prevent any immigrant
patients from getting health care?
• No. To date, none of the Executive Orders signed by the President
directly impact any patient’s ability to receive health care or
apply for and receive health insurance coverage for which they
may be eligible (e.g., MassHealth Limited or Health Safety Net
programs)
• Are health care providers required to verify their patients’
immigration or citizenship status?
• No. Health care providers are not required to ask about
immigration or citizenship status and may treat anyone
regardless of immigration or citizenship status.
• Who can a health care provider contact at the AGO with
questions or to report an incident?
• If you have questions or need further assistance, you may contact
the Health Care Division of the Attorney General at (888) 8306277 or the Civil Rights Division of the Office of the Attorney
General at (617) 963-2917
Health Care for Immigrants
in Massachusetts:
2017 and Beyond
Andrew P. Cohen
Staff Attorney
Health Law Advocates
Youth At Risk Conference
June 9, 2017
Health Law Advocates
Non-profit, public interest law firm
Pro bono legal services for lowincome Mass. residents (< 300% FPL)
Core issues:
•
•
•
•
Legal barriers to care and coverage
Appeals of coverage or service denials
Medical debt/collections assistance
Immigrant Healthcare Access Initiative
HLA’s Finch cases
2009: Budget pressures caused Mass.
legislature to pass law cutting ~40K legal
immigrants from Commonwealth Care
2010: HLA filed class action lawsuit
2011: SJC held legal immigrants are a
“suspect class” that get strict scrutiny
2012: SJC held that state law was
unconstitutional; coverage restored!
HLA’s Immigrant
Healthcare Access Initiative
Free legal services for low-income
immigrant clients, regardless of status
Trainings about immigrants’ access to
coverage under Mass. public programs
Policy advocacy through the Immigrant
Healthcare Access Coalition (“IHAC”)
Immigrant Healthcare
Access Coalition (IHAC)
Next Meeting
• TBD July, 2017
• One Federal Street, 5th Floor (HLA’s office)
Policy issues
• Ensuring providers and public programs are
welcoming to immigrant patients
• Language access
• Access to MassHealth programs
“Culture of Fear”
Federal administration is sowing fear
States, cities, organizations, and
medical providers can help!
Proposed federal policies
would hurt access to care
CHIP reauthorization?
Proposed Executive Order on public
benefits?
• i.e. redefining “public charge” to include
all federally means-tested benefits
Repeal of Affordable Care Act?
Medicaid cuts?
ACA Repeal, Medicaid cuts
House passed AHCA bill
• Per-capita caps, Health Savings Accounts,
age-based tax credits, continuous
coverage penalty, High Risk Pools, limits
on abortion coverage
Likely effect in MA:
• Less federal $ to support coverage,
undercut state protections
Privacy Protections
Medicaid and the ACA contain
privacy protections:
• Applicant information may be used
ONLY for purposes of determining
eligibility for programs
SAVE System (federal data hub) does
NOT save individual info in a database
Resistance!
MASSHEALTH PROGRAMS
Overview of MassHealth eligibility and
programs
MassHealth: Overview
MassHealth = Medicaid + CHIP
• State/Federal program
• Managed care (as primary coverage)
Eligibility, generally
• Adults <138% FPL, Kids <300% FPL
• BUT: lots of different eligibility categories
based on disability, immigration status,
age, etc.
MassHealth Programs
MassHealth Standard
• Comprehensive benefit package
• Preventive care, outpatient medical services, nursing home
and PCA services, prescription drugs, hospitalization.
MassHealth Common Health
• Same as Standard; only for disabled people
MassHealth Family Assistance
• Rich benefits, but does not cover nursing home or personal
care attendant services
• OR Premium Assistance to help pay for private insurance
MassHealth Care Plus
• Childless, low-income, able-bodied adults age 21-64
• Same as Family Assistance
MassHealth Limited – Emergency services ONLY
IMMIGRANT ELIGIBILITY
Eligibility for MassHealth coverage for
immigrants with various statuses
Health care coverage for
immigrants: Overview
Type/robustness of coverage is
dependent on immigration status
• However, Mass. residents with low
incomes will almost always be eligible
for some program, even people without
documents
Categories of legal status I
“Lawfully present” non-citizens
• “Qualified noncitizens”
o Lawful permanent residents (LPRs, i.e. green card
holders) >5yrs
o Refugees/Asylees, Cuban/Haitian entrant, victims of
trafficking
• “Qualified noncitizens barred” = LPRs <5 yrs
• “Nonqualified individuals lawfully present”
oVisa holders/authorized employment
oTemporary protected status, parolees, etc.
Categories of legal status II
“Non-qualified PRUCOL”
• “Permanent Resident Under the Color of Law”
Including:
• Pending application for legal status
• DACA
• Non-citizen living in U.S. with
knowledge/consent of DHS whose departure
won’t be enforced
• Indef. stay of deport. or indef. voluntary departure
• Suspension of deportation
Access to Coverage - I
MassHealth Standard
• Infants <1yr, lawfully present, <200% FPL
• Kids ages 1-20, lawfully present, <150% FPL
• Adults ages 21-64, qualified lawfully present,
<138% FPL - (or MH Care Plus if childless)
• Elderly adults ages 65+, qualified lawfully
present, <100% FPL
• Pregnant women, any status(!), 200% FPL
Access to Coverage - II
MassHealth Family Assistance
• Kids 1-20, lawfully present, 151-300% FPL
• Infants to elderly, PRUCOL, <300% FPL
• Disabled adults, non-qualified or barred
lawfully present, <100% FPL
MassHealth Common Health
• Disabled children 1-18, PRUCOL, no $ limit
• Disabled young adults 19-20, PRUCOL,
<150% FPL
Access to Coverage - III
Connector Care (i.e. public subsidies
for private coverage, “ObamaCare”)
• Adults ages 21+, lawfully present, 0300% FPL
Advance Premium Tax Credits (APTCs)
• Infants to elderly adults, lawfully
present, 301-400% FPL
Special groups: Pregnant
women, DACA
Pregnant Women
• MassHealth Standard: <200% FPL
oRegardless of immigration status
• Connector Care/Tax credits: 200-400% FPL
DACA
• Not “Lawfully Present” under ACA
• DACA = eligible for Family Assistance
Coverage for undocumented
immigrants
Terms
• “Undocumented” = people without statesanctioned immigration or visa status
Coverage
• MassHealth Limited
• Children’s Medical Security Plan
• Health Safety Net
MassHealth Limited
Background: MA version of Emergency
Medicaid
Coverage: Emergency services for acute
medical problems, or prevention of a serious
health problem
Eligibility: Mostly undocumented immigrants
• Adults: < 138% FPL
• Kids 1-20: < 150% FPL
Children’s Medical Security Plan
(CMSP)
Background: Created by statute in the 1990s
• Inspiration for CHIP (esp. tobacco tax)
Coverage: Primary care and preventive
services (no premiums if <200% FPL)
• Limitations: Caps on Rx ($200/yr), DME, dental
($750), and mental health visits (20)
Eligibility: Uninsured children ages 0-18 (i.e.
ineligible for MassHealth);
• Mostly undocumented kids
Health Safety Net (HSN)
Background: “Uncompensated Care Pool”
created in 1985; became the “HSN” in 2006
Coverage: Pays for care delivered at acute
care hospitals and Community Health Centers
• Wraps private insurance as secondary coverage;
• Pays deductibles and co-insurance
Limitations: Not insurance
• Doctors NOT covered except at Boston Medical
Center and Cambridge Health Alliance
• Does not pay for private insurance copayments
Gov. Baker cut coverage
for immigrants in 2016
Health Safety Net (HSN) cuts:
Eliminated 6 month retroactive period
Introduced $500+ deductibles for
people earning 150-200% FPL
Decreased eligibility from 400% FPL
to 300% FPL
Questions?
Andrew P. Cohen, Staff Attorney
 617-275-2891
 [email protected]
Health Law Advocates:
 Toll-free: 888-211-6168