What does the requirement to get Health Insurance Subsidies of being
“Lawfully Present
45 CFR 152.2  mean?

immigration status - getting health insurance

Covered CA – Accepted Documents to prove lawful status

You must be Lawfully present – check this entire page for information and details of what “lawful presence” means, in the USA  to get tax credits– Subsidies  in Covered CA. 

If you want coverage without subsidies, you  can purchase direct from an Insurance Company, no extra charge for us to help you with that, with the only requirement being that you  reside in CA, even if you don’t have legal status.

There is no charge for our help, when you appoint us as your agent by using the enrollment links in this website or using “find local help” in the upper right hand portion of the Covered CA Online Application.

We are not immigration attorney’s and can’t help you with that.  If you have the documents, proving lawful status, we can help you get health insurance.

Learn More ===>

Immigration Status Law Center explanation

Covered CA Application page 27

How to find receipt # on green card

CA Mandate Penalty?

Public Charge?
Can't get Medi-Cal or subsidies, but must have health insurance

VIDEO

Medi-Cal Qualification

The complete list of “qualified” immigrants includes those listed at

8 U.S.C. § 1641 Definitions

and Trafficking Victims as a result of) the Victims of Trafficking and Violence Protection Act of 2000, Pub. L. No. 106–386, § 107 (Oct. 28, 2000) and the

Trafficking Victims Protection Reauthorization Act of 2003, Pub. L. No. 108–193, § 4(a)(2) (Dec. 19, 2003).

See also “Table: A Quick Guide to Immigrant Eligibility for Affordable Care Act (ACA) and Key Federal Means-tested Programs,” National Immigration Law Center, September 2015, available at: https://www.nilc.org/document.html?id=844.

Consumer Resources

Citizenship & Immigration Services uscis.gov

Verify work eligibility

Publication 519 US Tax Guide 1040 for Aliens

Exemption from Obama Care Mandate Penalty?

Publication 8965 Page 3

Our Webpage on Exemptions

What you need to know – Covered CA 1 page pdf

Fax # and Cover Letter

nilc.org/lawfullypresent/  National Immigration Law Center

Western Poverty Law Center – Guide for Low Income CA to get coverage

Resources Tool Kit  Rev 1.2015 includes Immigration Status, FAQ’s, Lawfully Present FAQ’s, Acceptable Documentation Rev 11.2015

Here are samples of acceptable documents that Covered CA will accept as proof ♦ November 2015 ListinFAQ’s2015 Verification

If you do NOT qualify, you can try an International Policy Under the Health Reform Law, you must be lawfully present to get coverage outside of Covered CA too. page 25 Specimen Evidence of Coverage or excerpt below from agents manual.

Covered CA Application 7 Page Worksheet to complete ONLINE Application

The National Immigration Law Center has written an excellent 7 page pdf on what are the eligible categories, as defined under 45 CFR 152.2 “Lawfully Present.” Covered CA Summary – “Legally Present”?

Steve Shorr - Covered CA Certified Agent

Steve Shorr - Covered CA Certified Agent -
Appoint Us - Instructions 
No Charge for Complementary Year Around Service -
Same price as Covered CA or Direct with Insurance Company

instant proposal including APTC Subsidy Calculation

Covered CA – Countable Income 

Set a phone, Skype or Face to Face  meeting to review the proposal

Video on how great agents are

Report aspe immigration
ASPE 16 Page Brief – Immigration & Affordable Care Act
Government Immigration Website
Federal Immigration Website
lawfully.present.nilc
NILC.org 7 page treatise on Lawfully Present

Comparison Chart Qualification RulesComparison of Eligibility Rules - Covered CA - Medi-Cal

Attorney Guide Determine Citzenship in Criminal Cases
Attorney Guide Determine Citzenship in Criminal Case

Child & Related Pages

Medi-Cal

Can an illegal immigrant buy health insurance in Covered CA?

Outside of Covered CA?

Can they get subsidies?

Bill pending for CA Covered CA to request permission from the Federal Government.  This still won’t give APTC – subsidies to illegal immigrants. CA HealthLine 6.10.2016    SB 10  Covered CA         SB 4  Medi-Cal See below – illegal immigrants can buy coverage now through an agent or direct from the Insurance Company.

 
Covered California & The Health Law

California Inches Closer To Offering Coverage Under Health Law To Those In U.S. Illegally

Gov. Jerry Brown signed legislation that would require the state to seek a waiver from the federal government to allow immigrants in the country illegally to buy insurance from Covered California exchanges. They would not be eligible for subsidies.

The Associated Press: California Moves To Open Health Care Exchange To Undocumented People California Gov. Jerry Brown has approved a path to open the state’s health care exchange to people who cannot prove they are legally in the country. Brown signed a law Friday that would allow undocumeted immigrants to buy insurance through the state marketplace but not receive government-subsidized health care. (6/10)

Reuters: California Governor Signs Bill Letting Undocumented Immigrants Buy Insurance California Governor Jerry Brown signed a bill into law allowing unauthorized immigrants to buy health insurance on a state exchange created under the U.S. Affordable Care Act, making the state the first in the country to offer that kind of coverage. The law lets the state request a waiver from the federal government that will be needed to allow unauthorized immigrants to purchase unsubsidized insurance through Covered California, the state’s healthcare exchange. (O’Brien, 6/11)

Los Angeles Times: Gov. Brown Signs Bill That Could Help Immigrants Get Access To Health Insurance The new law is the latest immigrant-friendly policy recently passed in California. Over the last few years, immigrants here illegally have gained the ability to apply for professional licenses, such as for practicing law or medicine, and also for drivers licenses. Opponents of these policies say they encourage illegal immigration and take away resources from those here legally. But immigrant advocates have praised California’s efforts, especially those around expanding healthcare. (Karlamangla, 6/10)

The Sacramento Bee: Gov. Jerry Brown Agrees To Seek Health Insurance For Undocumented Immigrants “Today we ask the federal government to remove barriers to health insurance access that discriminates against some of our residents on the basis of their documentation status,” Sen. Ricardo Lara, D-Bell Gardens, said in a statement. “The current policy disallowing immigrants from purchasing care with their own money is both discriminatory and outdated.” (White, 6/10)

California Healthline: Gov. Brown Signs Bill Seeking OK For Exchange To Sell To Immigrants Without Documents Under the terms of California’s request to the federal government, immigrants without legal standing would not qualify for government assistance to help pay for the coverage — unlike the vast majority of Covered California enrollees. Many experts and advocates concede that this makes the measure a largely symbolic gesture, since few would be able to afford policies on their own. They are allowed to buy coverage in the private market, but many decline to do so for financial reasons, insurance industry experts say. (Ibarra, 6/10)

What happens if you have a severe chronic condition or major accident, you can’t qualify for Medi-Cal as you are not lawfully present, must a hospital treat you if you show up in the ER Emergency Room?

 

You could get deported!

 

In an emergency, hospitals, by law –  EMTALA – must treat any patient in the U.S. until he or she is stabilized , regardless of the patient’s immigration status or ability to pay.

Yet, when it comes time for the hospitals to discharge these patients, the same standard doesn’t apply. Though hospitals are legally obligated to find suitable places to discharge patients (for example, to their homes, rehabilitation facilities or nursing homes), their insurance status makes all the difference. After reaching the patient’s family in Mexico, and discussing issues with the Mexican consulate, the case manager began making travel arrangements to a rehabilitation hospital in Mexico. Medical air transport to another country is an expensive proposition — roughly $50,000, depending on the equipment needed and the distance to the receiving facility in the patient’s home nation. From the hospital’s point of view, it was easy to see that this large one-time expense would be worthwhile. The transfer to Mexico would put a stop to the indefinite, uncompensated costs of continued hospitalization. Further, the transfer would open up the patient’s bed to a new (and presumably insured) patient.    NPR 4.9.2016  *

Some hospitals have been deporting illegal immigrants even though the U.S. government is the only authority that can perform this action.  Medical repatriation is considered a human rights violation mainly because many of these hospitals act as “unauthorized immigration officers.”    Medical news today 4.23.2014 * Forbes 2.26.2018 *

Public Charge USCIS * Some places where undocumented can go   US News 11.2.2016 *

Links & Resources

Our page on ER’s having to treat you till your stabilized.

News report of hospital sending uninsured patient back to his country  * Wikipedia  *

 

Technical and Research Resources

 

Covered CA Q & A on Immigration Status

Immigrants 

Health Care.gov on immigrants

Immigration Document Types

Coverage and Issues for Immigrant Families – aspe.hhs.gov (pdf)

Attorney Guide to determine Citizen Status in Criminal Cases

Covered CA Webinar on verification of residency Proposed Regulations 5.2013 Covered CA Q & A Residency Medi-Cal Handbook

immigration policy.org

What if you are not lawfully present and you try to apply for coverage? Will it be reported to INS?

 

FAQ’s Kaiser Foundation kff.org/immigrants

New Obama Immigration may allow those to get Medi-Cal californiahealthline.org/2014/11/21

4 page – Immigration Status and Covered Ca hbex.coveredca.com

 

§ 152.2 Definitions.

For purposes of this part the following definitions apply:

Creditable coverage means coverage of an individual as defined in section 2701(c)(1) of the Public Health Service Act as of March 23, 2010 and 45 CFR 146.113(a)(1).

Enrollee means an individual receiving coverage from a PCIP established under this section.

Lawfully present means

(1) A qualified alien as defined in section 431 of the Personal Responsibility and Work Opportunity Act (PRWORA) ( 8 U.S.C. 1641);

(2) An alien in nonimmigrant status who has not violated the terms of the status under which he or she was admitted or to which he or she has changed after admission;

(3) An alien who has been paroled into the United States pursuant to section 212(d)(5) of the Immigration and Nationality Act (INA) ( 8 U.S.C. 1182(d)(5)) for less than 1 year, except for an alien paroled for prosecution, for deferred inspection or pending removal proceedings;

(4) An alien who belongs to one of the following classes:

(i) Aliens currently in temporary resident status pursuant to section 210 or 245A of the INA ( 8 U.S.C. 1160 or 1255a, respectively);

(ii) Aliens currently under Temporary Protected Status (TPS) pursuant to section 244 of the INA ( 8 U.S.C. 1254a), and pending applicants for TPS who have been granted employment authorization;

(iii) Aliens who have been granted employment authorization under 8 CFR 274a.12(c)(9), (10), (16), (18), (20), (22), or (24);

(iv) Family Unity beneficiaries pursuant to section 301 of Public Law 101-649 as amended;

(v) Aliens currently under Deferred Enforced Departure (DED) pursuant to a decision made by the President;

(vi) Aliens currently in deferred action status;

(vii) Aliens whose visa petitions have been approved and who have a pending application for adjustment of status;

(5) A pending applicant for asylum under section 208(a) of the INA ( 8 U.S.C. 1158) or for withholding of removal under section 241(b)(3) of the INA ( 8 U.S.C. 1231) or under the Convention Against Torture who has been granted employment authorization, and such an applicant under the age of 14 who has had an application pending for at least 180 days;

(6) An alien who has been granted withholding of removal under the Convention Against Torture; or

(7) A child who has a pending application for Special Immigrant Juvenile status as described in section 101(a)(27)(J) of the INA ( 8 U.S.C. 1101(a)(27)(J)).

(8)Exception. An individual with deferred action under the Department of Homeland Security’s deferred action for childhood arrivals process, as described in the Secretary of Homeland Security’s June 15, 2012, memorandum, shall not be considered to be lawfully present with respect to any of the above categories in paragraphs (1) through (7) of this definition.

Out-of-pocket costs means the sum of the annual deductible and the other annual out-of-pocket expenses, other than for premiums, required to be paid under the program.

Pre-Existing condition exclusion has the meaning given such term in 45 CFR 144.103.

Pre-Existing Condition Insurance Plan (PCIP) means the temporary high risk health insurance pool plan (sometimes referred to as a “qualified high risk pool”) that provides coverage in a State, or combination of States, in accordance with the requirements of section 1101 of the Affordable Care Act and this part. The term “PCIP program” is generally used to describe the national program the Secretary is charged with carrying out, under which States or non-profit entities operate individual PCIPs.

Resident means an individual who has been legally domiciled in a State.

Service Area refers to the geographic area encompassing an entire State or States in which PCIP furnishes benefits.

State refers each of the 50 States and the District of Columbia.

[ 75 FR 45029, July 30, 2010, as amended at 77 FR 52616, Aug. 30, 2012]
 

8 US Code §1641 Definitions

 
(a) In general 

 

Except as otherwise provided in this chapter, the terms used in this chapter have the same meaning given such terms in section 101(a) of the Immigration and Nationality Act [8 U.S.C. 1101(a)].
(b) Qualified alienFor purposes of this chapter, the term “qualified alien” means an alien who, at the time the alien applies for, receives, or attempts to receive a Federal public benefit, is— 

 

(1) 

 

an alien who is lawfully admitted for permanent residence under the Immigration and Nationality Act [8 U.S.C. 1101 et seq.],
(2) 

 

an alien who is granted asylum under section 208 of such Act [8 U.S.C. 1158],
(3) 

 

a refugee who is admitted to the United States under section 207 of such Act [8 U.S.C. 1157],
(4)an alien who is paroled into the United States under section 212(d)(5) of such Act [8 U.S.C. 1182(d)(5)] for a period of at least 1 year,
(5)an alien whose deportation is being withheld under section 243(h) of such Act [8 U.S.C. 1253] (as in effect immediately before the effective date of section 307 of division C of Public Law 104–208) or section 241(b)(3) of such Act [8 U.S.C. 1231(b)(3)] (as amended by section 305(a) of division C of Public Law 104–208),
(6)an alien who is granted conditional entry pursuant to section 203(a)(7) of such Act [8 U.S.C. 1153(a)(7)] as in effect prior to April 1, 1980; [1] or
(7)an alien who is a Cuban and Haitian entrant (as defined in section 501(e) of the Refugee Education Assistance Act of 1980).
(c) Treatment of certain battered aliens as qualified aliensFor purposes of this chapter, the term “qualified alien” includes— 

 

(1) an alien who— 

 

(A)has been battered or subjected to extreme cruelty in the United States by a spouse or a parent, or by a member of the spouse or parent’s family residing in the same household as the alien and the spouse or parent consented to, or acquiesced in, such battery or cruelty, but only if (in the opinion of the agency providing such benefits) there is a substantial connection between such battery or cruelty and the need for the benefits to be provided; and
(B) has been approved or has a petition pending which sets forth a prima facie case for— 

 

(i)status as a spouse or a child of a United States citizen pursuant to clause (ii), (iii), or (iv) of section 204(a)(1)(A) of the Immigration and Nationality Act [8 U.S.C. 1154(a)(1)(A)(ii), (iii), (iv)],
(ii)classification pursuant to clause (ii) or (iii) of section 204(a)(1)(B) of the Act [8 U.S.C. 1154(a)(1)(B)(ii), (iii)],
(iii)suspension of deportation under section 244(a)(3) of the Immigration and Nationality Act [8 U.S.C. 1254(a)(3)] (as in effect before the title III–A effective date in section 309 of the Illegal Immigration Reform and Immigrant Responsibility Act of 1996).[2]
(iv)status as a spouse or child of a United States citizen pursuant to clause (i) of section 204(a)(1)(A) of such Act [8 U.S.C. 1154(a)(1)(A)(i)], or classification pursuant to clause (i) of section 204(a)(1)(B) of such Act [8 U.S.C. 1154(a)(1)(B)(i)]; [3]
(v)cancellation of removal pursuant to section 240A(b)(2) of such Act [8 U.S.C. 1229b(b)(2)];
(2) an alien— 

 

(A)whose child has been battered or subjected to extreme cruelty in the United States by a spouse or a parent of the alien (without the active participation of the alien in the battery or cruelty), or by a member of the spouse or parent’s family residing in the same household as the alien and the spouse or parent consented or acquiesced to such battery or cruelty, and the alien did not actively participate in such battery or cruelty, but only if (in the opinion of the agency providing such benefits) there is a substantial connection between such battery or cruelty and the need for the benefits to be provided; and
(B)who meets the requirement of subparagraph (B) of paragraph (1);
(3) an alien child who— 

 

(A)resides in the same household as a parent who has been battered or subjected to extreme cruelty in the United States by that parent’s spouse or by a member of the spouse’s family residing in the same household as the parent and the spouse consented or acquiesced to such battery or cruelty, but only if (in the opinion of the agency providing such benefits) there is a substantial connection between such battery or cruelty and the need for the benefits to be provided; and

(B)who meets the requirement of subparagraph (B) of paragraph (1); or

(4)an alien who has been granted nonimmigrant status under section 101(a)(15)(T) of the Immigration and Nationality Act (8 U.S.C. 1101(a)(15)(T)) or who has a pending application that sets forth a prima facie case for eligibility for such nonimmigrant status.
This subsection shall not apply to an alien during any period in which the individual responsible for such battery or cruelty resides in the same household or family eligibility unit as the individual subjected to such battery or cruelty.
After consultation with the Secretaries of Health and Human Services, Agriculture, and Housing and Urban Development, the Commissioner of Social Security, and with the heads of such Federal agencies administering benefits as the Attorney General considers appropriate, the Attorney General shall issue guidance (in the Attorney General’s sole and unreviewable discretion) for purposes of this subsection and section 1631(f) of this title, concerning the meaning of the terms “battery” and “extreme cruelty”, and the standards and methods to be used for determining whether a substantial connection exists between battery or cruelty suffered and an individual’s need for benefits under a specific Federal, State, or local program.
(Pub. L. 104–193, title IV, § 431, Aug. 22, 1996, 110 Stat. 2274; Pub. L. 104–208, div. C, title III, § 308(g)(8)(E), title V, § 501, Sept. 30, 1996, 110 Stat. 3009–624, 3009–670; Pub. L. 105–33, title V, §§ 5302(c)(3), 5562, 5571(a)–(c), 5581(b)(6), (7), Aug. 5, 1997, 111 Stat. 599, 638, 640, 643; Pub. L. 106–386, div. B, title V, § 1508, Oct. 28, 2000, 114 Stat. 1530; Pub. L. 110–457, title II, § 211(a), Dec. 23, 2008, 122 Stat. 5063.)

[1]  So in original. The semicolon probably should be a comma.

[2]  So in original. The period probably should be a comma.[3]  So in original. The semicolon probably should be “, or”.

 
 
Kevin Knausssays:
Off exchange plans may not require lawfully present documentation on the part of the prospective health plan member. Any plan sold through the exchange and eligible for APTC can only be sold to lawfully present individuals that can provide proof. Eligibilty conditions for enrollment in a specific health plan can usually be found in the carrier’s Evidence of Coverage.
Reply
  • Here’s a specimen platinum policy off exchange – see page 25 – which does state that one must be a lawful resident. However, the Blue Cross Application doesn’t ask the question. Maybe the rules have become less stringent since 2014? I will grant that the Confidential Agent Manual for 2016 page 16 uses the term “resident” not lawfully present. The 2016 Blue Cross Direct Page 29 EOC uses the term Reside and not lawfully present. 45 CFR 147.104 (a) Guaranteed availability of coverage in the individual and group market. Subject to paragraphs (b) through (d) of this section, [Open and Special Enrollment] a health insurance issuer that offers health insurance coverage in the individual, small group, or large group market in a State must offer to any individual or employer in the State all products that are approved for sale in the applicable market, and must accept any individual or employer that applies for any of those products. (e) Marketing. A health insurance issuer and its officials, employees, agents and representatives must comply with any applicable state laws and regulations regarding marketing by health insurance issuers and cannot employ marketing practices or benefit designs that will have the effect of discouraging the enrollment of individuals with significant health needs in health insurance coverage or discriminate based on an individual’s race, color, national origin, present or predicted disability, age, sex, gender identity, sexual orientation, expected length of life, degree of medical dependency, quality of life, or other health conditions. One not lawfully present has an exemption from the mandate.
    Reply
    • I checked with Blue Cross and here is their reply. Can an illegal resident purchase an off Covered CA policy? No. We follow the same rules as CoveredCa, since they are one of the regulators for Individual. I am surprise their producer manual does not state ‘lawfully present’, my understanding is that you must be here legally to qualify for a subsidy. Either its Covered Cal plan(On Exchange) or direct(Off Exchange), not both.
      Reply
      • Updated Reply from BC As long as the applicant can provide proof of residency not so much legal residency they may apply. Once the information is submitted the applicant will be contacted to get a hold of a SSN or a reason for a lack of SSN. The documentation that states this information as required proof of residency is in your agent contract.
        Reply
      •  Max H says:
        They are full of shit. [Technical Insurance Term – Max is referring to the 1st reply from Blue Cross] Of course, to get APTCs one must be a legal resident — but I know of no legal entanglement an insurance company would find itself in if it sold an off-exchange iFP to an illegal immigrant. If CA had its way, every illegal immigrant would get Medi-Cal. Also — look at the footnote on the CoveredCA group application that specifically states no proof of residency (or maybe it says lawful presence) is required. They are trusting the feds to enforce immigration law when it comes to hiring illegal immigrants, which we know is not currently happening. And won’t be in the future if Bernie Sanders is elected POTUS — another 4-8 years of “democratic socialism” will completely derail America as we know it. Forget health insurance companies — we’ll have “free” health insurance for everyone in America, paid for by the handful of people who choose to continue working instead of sitting on their asses and collecting the government dole. Exactly what caused the collapse of the Soviet Union — a 50-year failed experiment with socialism. And look at the trouble China is having trying to remain communist in the face of expanding capitalism — the only weapon they have is monetary policy which has come back to bite them on the butt. MAX Webmaster’s Note – Max is on the CA Dept. of Insurance Curriculum Board – amongst other accomplishments Learn more http://maxherrinsuranceservices.com/about/
        Reply

24 comments on “Lawfully Present – Public Charge – Immigration Status

  1. Hello sir,

    can you please advise me with this question and what I have to do.

    I am applying for medical and I am a married man ,but my wife and kids are not here at this time

    do I have to fill as married filling jointly or separately for my household and is there any difference between both?

    Thank you so much.

  2. me and my wife are only visitors with tourist visa,

    she is currently pregnant in last months,

    my income in another country is about 70 thousand US dollar per year.

    she is not working, family size 4.

    so can we apply for any option for maternity services,

    because it is very expensive in California,

  3. Off exchange plans may not require lawfully present documentation on the part of the prospective health plan member. Any plan sold through the exchange and eligible for APTC can only be sold to lawfully present individuals that can provide proof. Eligibilty conditions for enrollment in a specific health plan can usually be found in the carrier’s Evidence of Coverage.

  4. I have my lady I’ve been with for 25 years that has a social security number …but her immigration status wasn’t fixed…….I am getting the adjustment of lpr [lawful presence?] filed this week….we got married on the dec 31….she’s been here for 35 years. ..

    I need to get her real coverage….I was stuck overseas and just came back yesterday!!!

    What can I do? Help…. she has a cancer…..

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