Carly Burton

1
Health Reform and Immigrants

• Carly Burton
• MIRA Coalition
• Thursday, January 29th, 2009
• Families USA

2
Health Reform and Immigrants

• Language codifying MassHealth Essential benefits
  for elderly and disabled legal immigrants
• Language preventing sponsor deeming for these
  individuals
• Commonwealth Care Health Insurance Program- All
  legally residing immigrants will be eligible
  including PRUCOLs (people with TPS, applicants
  for asylum, etc)
• 10 member Connector Board to oversee
  implementation of this law
• Undocumented immigrants not included in reform

3
Commonwealth Care Eligibility for Non-Citizens

• Individuals who have an eligible immigration
  status. Examples of those statuses are
• With deferred action status
• With approved immediate relative petitions
• With indefinite stays of deportations
• With indefinite voluntary departures
• Under an order of supervision
• Who meet the registry date
• Who have temporary protected status

4
Other Ways Health Reform Affects Immigrants

• Individual Mandate Required all residents to
  have health insurance December 31st, 2007
• Penalty accrues each month a person does not have
  health insurance (starting 1/2008)
• Employer assessment Requires employers with 11
  or more full-time employees who do not offer
  health insurance to pay a 295 assessment per
  employee
• Uncompensated Care Pool- Now called Health Safety
  Net Trust Fund

5
Changes to Free Care/Health Safety Net Trust Fund

• Undocumented immigrants still eligible need to
  prove MA residency, need to prove income
• Those with access to subsidized insurance are no
  longer eligible
• Those who fail to pay MassHealth or Commonwealth
  Care premiums are not eligible
• New drug co-payments started 12/1/07 1/3 for
  all adults AND additional hospital co-pays for
  adults over FPL (Copay being increased for
  generics in 2/09)

6
Individual Mandate

• The individual mandate is the law in
  Massachusetts. It says that most Massachusetts
  residents age 18 and older must have health
  insurance. By January 1, 2009, the health
  insurance must have certain basic benefits.

7
How does the mandate work?

• As of January 1, 2008, you will be penalized for
  each month that you stay uninsured. The monthly
  penalties are based on ½ of the cost of the
  lowest-priced Health Connector plan available to
  you.
• 63-day grace period when people can be uninsured
  without incurring penalties. The penalties are
  set and enforced by the Massachusetts Department
  of Revenue.
• Persons whose incomes were below 150 of the
  federal poverty level do not have to pay a
  penalty even if they were not insured in 2008.

8
How much do I have to pay?

• 2008 tax penalties for adults who dont qualify
  for a government-subsidized plan
• 56 each month or 672 for an entire year for
  people age 26 or younger.
• 76 each month or 912 for the year for people
  age 27 or older.
• 2008 tax penalties for adults who qualify for a
  government-subsidized plan
• 0 for individuals earning up to 15,324.
• 17.50 each month or 210 for the year for those
  who earning between 15,325 and 20,424.
• 35 each month or 420 for the year for those
  earning between 20,425 and 25,536.
• 52.50 each month or 630 for the year for those
  earning between 25,537 and 30,636

9
Minimum Creditable Coverage

• Cover prescription drugs (Rx)
• Cover 3 regular doctor visits and check-ups for
  an individual or 6 for a family before any
  deductible
• Cap the deductible at 2,000 for an individual or
  4,000 for a family each year
• Cap out-of-pocket spending for non-Rx health
  services at 5,000 for an individual or 10,000
  for a family each year if you have a deductible
  or co-insurance
• Not cap total benefits for a sickness or for each
  year and more.

10
Certificate of Exemption

• The certificate of exemption allows you to
  preemptively be waived from the responsibility of
  the individual mandate if you
• Are homeless
• Are the victim of a natural disaster
• Incurred sudden expenses as a result of domestic
  violence or taking care of a disabled household
  member
• Or have other extenuating circumstances

11
Challenges of Health Reform

• Codification of MassHealth Essential for Elderly
  and Disabled
• Undocumented immigrants structurally left out-not
  universal coverage, disincentive to use HSN
• Retention of coverage funding for consistent
  outreach, community health workers
• Cost
• Makes a larger, more substantial change more
  difficult (ie. Single payer)