MEDICAID & AFFORDABLE CARE ACT (ACA) ELIGIBILITY FOR NON-CITIZEN PERSONAL INJURY PLAINTIFFS

by Thomas D. Begley, Jr., Esquire, CELA and Emily Schurr

Medicaid

General Rule

            As a general rule, Medicaid provides medical insurance for individuals.  To be eligible for most programs, the applicant must be a resident of New Jersey, be a U.S. citizen or qualified alien, and meet specific standards for financial income and resources pertaining to that Medicaid program.  A naturalized citizen is considered the same as a U.S. born citizen.  A qualified alien is a legal permanent resident (“green card” holder), an asylee, a refugee, an alien whose deportation is being withheld, or other individual listed below.  For most aliens, the date they entered the U.S. and became a “qualified alien” is on their I-95 card or Customs and Border Protection (CBP) stamp on their passport, on a Refugee Transportation Letter as a “Date of Entry,” and on their Permanent Resident card as a “Resident Since” date.  Most immigrants who arrived after August 22, 1996 are barred from Medicaid for five years.

Exceptions

            There are certain exceptions for New Jersey FamilyCare.  Children age 18 or younger and pregnant women who are lawfully admitted are able to apply for New Jersey FamilyCare regardless of the date they entered the U.S.  They do not have the five-year waiting period to be eligible.  Adults who are legal permanent residents of the U.S. must have had that status for at least five years to be eligible for New Jersey FamilyCare.  Qualified status includes:

• A lawful permanent resident
• A refugee
• An asylee
• An undocumented resident whose deportation is being withheld by U.S. Citizenship and Immigration Services (USCIS)
• Certain aliens granted conditional entry
• An immigrant paroled for over one year
• A Cuban/Haitian entrant
• An Amerasian immigrant
• An alien who is honorably discharged or who is on active duty in the United States Armed Forces, and his or her spouse and unmarried dependent children
• Certain American Indians born in Canada
• Certain members of Indian tribes
• An applicant under the Violence Against Women Act.

The individual must be a resident of New Jersey and meet specific standards for financial income and resources.

Special Programs

• Medical Emergency Payment Program for Aliens. There is a special program known as the “Medical Emergency Payment Program for Aliens.”  This program is available to immigrants who have experienced a medical emergency and meet the requirements of Medicaid, except for their immigration status.  This includes individuals who have no documentation from the USCIS or are non-immigrants (students, temporary workers, or children of a worker or visitor on business) or are a qualified alien subject to the five-year bar on Medicaid.

There is no resource test for this program, but there are income limits.  The income limits are dependent on family size.  For pregnant women or individuals applying for a child under age one, the family income ranges from $2,117 for a family of one to $5,831 for a family of six.  For a child over age one but under age 19, the income limits range from $1,564 for a family of one to $4,308 for a family of six.  For a single adult, childless couple, or a parent, the income limit is $1,468 for a family of one to a maximum of $4,044 for a family of six.  For individuals under the Aged, Blind, and Disabled program, there is a resource limit of $4,000 for a single person and $6,000 for a married couple, and a monthly income limit of $1,064 for a single person and $1,437 for a married couple.  The Medical Emergency Payment Program for Aliens pays for hospital emergency services, including inpatient, outpatient, emergency room, and ambulance services.

• Pregnant Women. New Jersey FamilyCare provides coverage for pregnant women who are residents of New Jersey.  The women must be U.S. citizens or immigrants whose documentation allows them to reside permanently in the U.S.  A child born to an eligible New Jersey FamilyCare mother is eligible for New Jersey FamilyCare for one year.  There is no asset test, but the family income must be at or below 205% of the Federal Poverty Level.

Affordable Care Act (ACA)

Naturalized Citizens

            Naturalized citizens have the same access and requirements for affordable coverage as U.S.-born citizens.

Lawfully Present Immigrants

            Lawfully present immigrants have limited federal coverage under the ACA.  However, they generally may enroll in a “Qualified Health Plan (QHP)”.

Documentation

            Federal immigrant eligibility restrictions, including the five-year or more waiting period outlined above, apply.  However, states may elect to provide Medicaid and Children’s Health Insurance Program (CHIP) benefits to lawfully residing children and pregnant women without a waiting period.

            Undocumented immigrants are not entitled to coverage under the ACA.  However, they are eligible for emergency care under federal law.  They are also eligible for emergency Medicaid if low-income under the Medical Emergency Payment Program for Aliens.  Children of undocumented parents are eligible under the ACA, if the children are citizens who are lawfully present.