Programs and Resources

for Maine Immigrants and Refugees

November 14, 2013

2013 Advocacy Conference

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What We Plan to Cover Today

�Eligibility for Public Benefit Programs

�Access to Health Care under the ACA

�Overcoming Issues and Barriers

�Outreach and Education Efforts

�Public Policy Changes Needed

TANFTANFTANFTANFTANF stands for Temporary Assistance for Needy Families. TANF provides cash help to families with children living at home. TANF can help some legal immigrants pay for basic needs.

Lawfully present immigrants in one of the following groups may only qualify for TANF if they have a hardship.

1. Lawful Permanent Resident (LPR) in their first 5 years with that legal status (who are not pregnant, under age 21, a Refugee or an Asylee);

2. Those who have filed an application for permanent status and are still waiting for a decision;

3. Asylum applicants; and

4. Some other less common immigrant statuses (like Temporary Protected Status).

If someone is in one of these groups, they may be able to get help from TANF if they are:

– A Lawfully Present AND you are pregnant OR under age 21;

– Elderly or Disabled;

– A domestic violence survivor; or

– An asylum applicant and you are not yet employed

Food Supplement Program

The Food Supplement program, also called Food Stamps, helps people pay for food. You get a card you can use to buy food at grocery stores.

Lawfully present immigrants in one of the following groups may only qualify for TANF if they have a hardship.

1. Lawful Permanent Resident (LPR) in their first 5 years with that legal status (who are not pregnant, under age 21, a Refugee or an Asylee);

2. Those who have filed an application for permanent status and are still waiting for a decision;

3. Asylum applicants; and

4. Some other less common immigrant statuses (like Temporary Protected Status).

If someone is in one of these groups, they may be able to get help from Food Supplements if they are:

– A Lawful Permanent Resident (green card) under age 18;

– Elderly or Disabled;

– A domestic violence survivor; or

– An asylum applicant and you are not yet employed 4

Supplemental Security Income (SSI)

Supplemental Security Income, called SSI, gives you cash to pay for basic needs like food, clothing, and shelter. Sometimes people call this program Social Security or Super Supp.

Lawfully present immigrants may be able to get SSI if they have low income AND they:

– are 65 years old or older;

– are blind; or

– have a disability. (Having a “disability” means you have a serious physical or mental health problem and cannot work full-time for at least 12 months)

General Assistance

General Assistance, called GA, comes from towns and cities. GA helps to pay for housing costs and other basic needs.

Immigrants may be able to get General Assistance if they do not have enough money to meet their basic needs and they meet the program rules.

There exist no citizenship or residency criteria in order to be eligible for General Assistance.

The Maine Human Rights Act (MHRA) has non-discrimination requirements that require that public entities cannot deny an individual services or benefits because of race, color, or national origin. As a result, all persons, including those not from Maine and those who are not U S citizens must be provided the opportunity to apply and must be assisted if otherwise eligible.

Since proof of citizenship is not a requirement for receiving General Assistance, the question should not be asked in order to determine general assistance eligibility.

The Affordable

Care Act Access to Health Care

for Immigrants and Refugees

NEW Health Insurance Marketplace where you can

shop for health insurance

If you cannot get health insurance through your

job you can go to

where you can apply for:

� Public Health Insurance (MaineCare) – OR

� Private Health Insurance (with subsidies)

Medicaid (MaineCare)

Members: low income families and individuals

Eligibility: Candidates are means-tested. Strict criteria

that vary some state to state. Income restrictions vary.

Coverage: Covers a wider range of services: including hospitalization, x-rays, lab services, clinic treatment, pediatrics care, family planning, nursing services and in-home nursing facilities for 21+

years, medical and surgical dental care.

Funding: In Maine the federal contribution is 67% and the state

pays 33%.

Medicare

Members: over the age of 65, end stage renal disease,

and disabled (2 year wait period after determination)

Eligibility: Available to all U.S citizens above the age of 65

irrespective of income, providing that he or she paid taxes into the

Social Security fund.

Coverage: More limited - Divided in to Part A which covers hospital care, Part B which covers medical insurance and

Part D which covers prescription drugs.

Funding: federal funding and beneficiary premiums

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Category Benefit Level Income Limit Asset Limit

Children age 0-18 Full-benefit MaineCare 200% FPL None

19- and 20-year olds Full-benefit MaineCare 150% FPL $2,000 (many are excluded)

Parents or guardians Full-benefit MaineCare 133% FPL (100% as of 2014) $2,000 (many are excluded)

Pregnant Women Full-benefit MaineCare 200% FPL None

Adults with disabilities and seniors

age 65 and olderFull-benefit MaineCare 100% FPL

$2,000

($3,000/couple)

(many are excluded)

Adults with disabilities and seniors

age 65 and older who have

Medicare

Limited-benefit MaineCare (Medicare

Savings Program)175% FPL None

“Non-Cats”: adults who do not fit

into one of the “categories” for full-

benefit MaineCare: Wait list open

but new enrollments CLOSED;

coverage group ends January 2014

Partial-benefit MaineCare 100% FPL

$2,000

($3,000/couple)

(many are excluded)

Adults medically eligible for nursing

careFull-benefit MaineCare 300% of SSI benefit level

$2,000

($3,000/couple)

(many are excluded)

Adults living in residential care

facilities other than nursing facilitiesFull-benefit MaineCare

Income must be below the

private pay rate for the

residential care facility

$2,000

($3,000/couple)

(many are excluded)

Women who have breast or cervical

cancer (or pre-cancerous condition)Full-benefit MaineCare 250% FPL None

HIV-positive adultsMaineCare drug coverage and other

limited benefits250% FPL None

“Medically Needy” or “spend

down”: persons whose income is

too high for full-benefit MaineCare

Full-benefit MaineCare, after a large

deductible is metNone

$2,000

($3,000/couple)

(many are excluded – see Asset Rules)

Adults with disabilities and seniors

age 62 and older

Low Cost Drugs for Elderly and

Disabled (DEL)

175% FPL (income limit is

increased by 25% if drug

costs are high)

None

Persons who do not qualify for full-

benefit MaineCareMaine Rx Plus 350% FPL None

MaineCare Coverage Categories

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Eligibility for MaineCare for Immigrants

Answer YES to these 2 questions and you may be eligible for MaineCare:

1. Do you qualify for MaineCare based on your circumstances and income?

Depending on income, you may qualify for MaineCare if you are in one of the following groups:(1) children (under age 21); (2) pregnant women; (3) parents; (4) adults with disabilities; and (6) seniors age 65 and older.

2. Do you qualify for MaineCare based on your immigration status?

You probably do qualify based on your immigration status if you are in one of these groups:

– Under age 21 and lawfully present in the U.S.;

– Pregnant and lawfully present in the U.S.;

– Came to United States as a Refugee;

– Granted Asylum (if you have an application pending for asylum you only qualify if you are under age 21 or pregnant); OR

– Lawful Permanent Resident (with a green card) for at least 5 years.

Eligibility for Lawfully Present Immigrants

“Lawfully Present” immigrants who are not eligible for

MaineCare will be able to buy private health insurance through

the Marketplace and may qualify for subsidies.

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The following groups of immigrants are “Lawfully Present” and may qualify for help buying

health insurance through the Marketplace:

Refugees

Asylees

Lawful Permanent Residents (green card)

Asylum applicants waiting for a decision

(with work authorization)

Immigrants paroled to the United States

Immigrants with U Visas who were victims of serious crimes

Cuban and Haitian Entrants

Workers on temporary and seasonal H-2A and H-2B visas

Battered Spouses and Children

Temporary Protected Status (TPS)

Immigrants with Deferred Action (Except for DACA) Other groups lawfully permitted to be in the U.S.

Subsidies for Lawfully Present Immigrants

As a general rule, the ACA does not provide subsidies in the Marketplace to people

under 100% FPL because Congress intended that very low-income people would be

insured through Medicaid. The ACA does, however, carve out an exception to this

general rule, because Congress acknowledged that some lawful immigrants cannot

get Medicaid because of their immigration status.

This means that “lawfully present” immigrants who cannot get Medicaid because of

their immigration status can qualify for subsidies in the Marketplace even if their

income is below 100% FPL.

– Lawfully present immigrants below 100% FPL will pay 2% of their income for their premiums

with the tax credit. If an individual has no income, then they will not have to pay anything for

their premium.

– Lawfully present immigrants with income below 100% of the poverty level will have the same

cost sharing obligations as people at 100% of the poverty level.

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Estimated Cost of Health Insurance in the Marketplace

Source: http://www.cbpp.org/files/premium-credit-webinar.pdf

Eligibility based on Immigrant Status

� U.S. born Citizens and naturalized citizens

� Refugees and Asylees

� Lawfully Permanent Residents (sponsored with that status for more

than 5 years)

• If you are low income and fit into a coverage category, you may

qualify for MaineCare

• If you are 65 or older or have a disability, you may qualify for

Medicare

• If you make between 100%-400% FPL, you will be eligible for

subsidies to help you buy insurance in the marketplace

Eligibility based on Immigrant Status

� People waiting for an Asylum decision

� Lawfully Permanent Residents with sponsors with their green card

for less than 5 years

� People with Temporary Protective Status

� Guest workers with an H2A or H2B visa

You will NOT be eligible for MaineCare (unless you are under age 21 or

pregnant) or Medicare

You will be eligible for subsidies in the marketplace if you have income

below 400% FPL. Asylum applicants are eligible for subsidies once they get

their work authorization.

Eligibility based on Immigrant Status

�People without documentation

�People with “Deferred Action for Childhood Arrivals” or DACA

You are not eligible for MaineCare, Medicare or for health insurance through the

marketplace.

The new law does NOT require you to have health insurance.

You are allowed to buy a private plan purchased outside of the Marketplace or

your employer could offer you health insurance.

You do qualify for Emergency MaineCare but that only pays for health care needed

to stabilize an emergency medical condition.

It is important to think of each family member separately

when determining eligibility. Some people in a family may

be eligible for MaineCare or subsidies in the marketplace

while others will not.

It’s safe for an ineligible

family member to apply

for those who are

eligible.

Information provided will not

be used to enforce

immigration laws or for

deportation.

For more information:

Health Insurance Marketplace Call Center

1-800-318-2596 The Call Center can connect you to language lines for immediate interpretation into 150 languages

Apply online at http://www.healthcare.gov

Visit enroll207.com to find out who can help you in your local area

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Some concerns for immigrants

�  Confusion about eligibility

�     Privacy and confidentiality

�     Verification and documentation

�         Language Access

�     Hostility and discrimination

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Confusion about eligibility for immigrants

• Emphasize that a citizen or lawfully-present child or adult will still be eligible even when other family members are not. It’s safe for an ineligible family member to apply for those who are eligible.

•  Have immigrant-specific resource materials handy, in English and in multiple languages for consumers.

• Share information in multiple ways: social media, video, audio, written materials, face-to-face interaction

•  Identify advocates in the community and Marketplace with knowledge of immigrant eligibility.

•  Keep a record of immigration-related problems to share with state and federal officials.

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Privacy and Confidentiality

• The ACA provides strong privacy protections.

• Agencies must not ask about citizenship or immigration status of anyone in the family except those applying for coverage.

• Agencies can collect, use, or disclose personally identifiable information ONLY for eligibility and enrollment purposes.

Verification and Documentation

Agencies verify immigration status through the Systematic Alien Verification for Entitlements (SAVE) program of U.S. Department of Homeland Security (DHS)

• used only to verify the status of applicant family members (not ineligible immigrants)

• used only to verify status for benefits eligibility purposes (not to enforce immigration laws)

At times, SAVE cannot verify status quickly. Agencies cannot delay health insurance once immigrant presents satisfactory documentation of status.

Verification of Social Security Number

Applicants must provide SSN … if they have one

Non-applicants must provide SSN … if they have one, are a taxfiler, AND are applying for help with costs

Agencies must provide assistance in obtaining SSN if needed/requested

“Non-work SSN” may be issued if needed solely for health care/other benefits

Language services

• Agencies must provide meaningful access to limited

English proficient individuals to all programs receiving

federal assistance

• Agencies must provide free oral interpretations and

translate key documents into top languages

• Assistors should learn which languages predominate

• Call Center (1-800-318-2596) can connect to language

lines for immediate interpretation into 150 languages 28

Discrimination

Discrimination based on race, ethnicity, and

national origin, including language spoken, is

prohibited by Title VI of the Civil Rights Act and ACA Section 1557

Applies to all entities receiving federal financial assistance: consumer assisters, clinics, hospitals, insurers, Marketplace agencies, Medicaid and CHIP agencies, contractors, HMOs, others

Applications, processes and procedures that have a chilling effect -- deterring eligible immigrants from applying -- may violate Title VI and Sec. 1557

TIPS: Immigration Status Questions

Avoid question that could result in an admission; avoid words like “undocumented”

Use words like “eligible” and “ineligible”

Screen first for income, before asking about status

Have credible fact sheets available about eligibility

Provide multiple reassurances about privacy and confidentiality

Removing Barriers

• Provide a welcoming and trusted environment for seeking services

• Provide free, competent interpretation services

• Provide translated docs and tag lines in all settings

• Train all employees, contractors and volunteers who provide consumer assistance to immigrant families

• Include organizations trusted by immigrant communities

• Identify appropriate referrals in the community, if needed, or other experts

Outreach Efforts

• Somali Culture and Development Association

(SCDA), Maine Migrant Health (MMH) and

Maine Equal Justice Partners (MEJP) have been

working together to help spread the word.

• SCDA plans to expand these efforts to do more

outreach and enrollment with immigrant

communities in Portland and Lewiston.

What we have learned

• You need to be flexible and willing to adapt all the time

• Face-to-face is the best with some people

• It may take more time with some people – figure out where people are coming from and then start from there

• It is so important to have trusted community members to go to with sensitive questions

Advocacy Efforts

The Maine Immigrant Rights Coalition (MIRC) advocates to improves the legal, social, and economic conditions for Maine’s immigrants --enhancing their lives and strengthening Maine --through advocacy, information sharing, and building capacity of member organizations.

For example, MIRC helped stop the proposal to eliminate the State SSI Program for immigrants last year.

Policy Changes Needed to improve the

lives of immigrants in Maine

• Repeal cuts in the 2012-2013 State Budget• MaineCare cuts

• TANF and Food Supplement Cuts

At least, continue funding for hardship for asylum seekers who are

not yet employed

• Bolster Employment Supports – the Welcome

Center

• Federal Immigration Reform

Basic Health ProgramThe ACA gives states the option to implement a Basic Health Program (BHP) as an alternative to the new health insurance Marketplace for low income consumers. The program looks especially promising for lawfully present immigrants who face high barriers to health care.

A BHP would allow Maine to offer coverage for lawfully present immigrants with incomes below 133% FPL that are barred from MaineCare because of their immigration status.

Additionally, the BHP would cover people with incomes between 133% and 200% (annual incomes up to $21,780 for individuals and$44,700 for a household of four).

The Maine Health Exchange Advisory Council is exploring this option for Maine.

Thank You!

Questions or

Comments?