Movement on Health Coverage for Immigrants

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Guest blog by Max Hadler, Health Advocacy Specialist at The New York Immigration Coalition

Despite the major health care coverage gains achieved under the Affordable Care Act, more than 450,000 New Yorkers remain uninsured because their immigration status makes them ineligible for affordable coverage. As a result of the continued failure to approve federal immigration reform or lift health coverage restrictions on many groups of immigrants, it continues to fall to state and local governments to pick up the slack. Health Care For All New York has responded to the dire lack of coverage options for immigrants by launching the Coverage 4 All campaign under the leadership of two of the coalition’s member organizations, Make the Road New York and the New York Immigration Coalition.

The campaign’s mission is to obtain affordable coverage options for all New Yorkers, regardless of immigration status. A shorter-term goal is to expand coverage to a smaller group of immigrants who are “permanently residing under color of law” (PRUCOL). These are people whose presence in the U.S. is known and may be unauthorized, and who have received confirmation from the federal government that it has no intention of deporting them. In New York, immigrants who are PRUCOL are eligible for state-funded Medicaid when they meet the income requirements (less than $16,242 annual income for a single person). However, the same people are not currently eligible for the Essential Plan, New York’s low-cost, comprehensive coverage program for low-income residents whose incomes are too high for Medicaid (up to $23,540 annually for a single person). This restriction runs counter to New York’s history of providing coverage to many immigrants who are excluded from federally-funded programs.

Most immigrants who are PRUCOL are young adults who grew up in the U.S. and have Deferred Action for Childhood Arrivals (DACA) as a result of President Obama’s 2012 executive order providing them two-year work authorizations and a reprieve from deportation. These young people are encouraged to work as a result of their DACA status but are then faced with a dearth of affordable coverage options when their incomes increase beyond the Medicaid threshold because they are ineligible for the Essential Plan and prohibited from accessing tax credits through the New York State of Health insurance marketplace.

To begin to remedy these coverage gaps, the New York State Assembly is working to expand Essential Plan eligibility to include immigrants who are PRUCOL. The Assembly included $10.3 million in its 2016-17 budget to provide this coverage, but the funding was ultimately cut in budget negotiations. Assemblymembers Richard Gottfried and Marcos Crespo have since introduced legislation that would expand Essential Plan eligibility to include immigrants who are PRUCOL. Bill A10054 was successfully voted out of the Assembly Health Committee on May 17 and is now awaiting a vote by the Ways and Means Committee. HCFANY has submitted a memorandum of support for the bill. Others are encouraged to submit their own memorandums and to borrow language from the HCFANY memo as needed. Please contact me at the New York Immigration Coalition if interested in registering your support (mhadler@nyic.org).

By: Ali Harris, LGBT Program Coordinator, Raising Women’s Voices – New York

Today the U.S. Department of Health and Human Services (HHS) released the final rule on Section 1557 of the Affordable Care Act, which prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in certain health programs. One of the most significant components is related to discrimination based on sex, which it defines more clearly to include discrimination against people based on gender identity and sex stereotypes.  This means a lot of great things for transgender people – if your health insurance provider receives any HHS funding:

  • It cannot categorically deny care based on transgender status (New York along with 15 other states and the District of Columbia already require coverage for the treatment of gender dysphoria).
  • It cannot deny someone a health service that is normally covered for one gender just because the person in need of care identifies or is documented as a different gender (for example, someone who identifies as male may still need preventive services like pap smears).

Additionally, in facilities that receive HHS funding (which includes any provider, facility, or hospital contracted with Medicaid or Medicare), individuals may use the gender-specific facilities appropriate to their respective gender identities.

There are also some important issues left unresolved. One is whether discrimination based on an individual’s sexual orientation alone is legal discrimination under Section 1557. HHS qualified the rule’s ban on discrimination based on sex stereotyping as an appropriate venue to file sexual orientation discrimination complaints, but did not offer explicit protections.  HHS also suggested that collecting data about LGBT people is a good method to monitor compliance with the new regulation; however, the agency did not offer recommendations or mandates to collect this demographic information in health care settings. There are also some questions about how much the final rule applies to health programs with oversight from other agencies, such as self-insured employer-sponsored plans, ERISA plans, and plans administered through third parties (this analysis by the National Health Law Program provides some discussion about how the rule’s applicability as well as commentary on other parts of the rule).

Find HHS’s final rule here and press release here. HHS also released a set of fact sheets summarizing major issues addressed in the rules: sex discrimination, access for individuals with limited English language proficiency, accessibility for individuals with disabilities, and implications for marketplaces plans.

Guest Blog by Ciara Johnson, RWV-NY Intern and MSW Student at Columbia University

The rate of uninsured people in the United States has dropped to 11 percent, according to a Gallup poll released earlier this month. That’s the lowest uninsured rate since Gallup began tracking it eight years ago. Still, that is a lot of people facing potential penalties as this year’s tax deadline approaches. What do you need to know if you are one of these uninsured people, or you are someone working with uninsured people? Here are a few tips.

pay taxesThe penalty for not having health insurance has gone up again this year. April 18 (yes, the IRS has changed the deadline for this year!) is the third tax deadline for which the Affordable Care Act (ACA) penalties for not having health insurance will apply. According to the healthcare.gov, this year’s penalty went up from 2 percent to 2.5 percent of your yearly household income. With the increase, you will have to pay roughly $695 per adult and $347.50 per child under 18. The maximum penalty, which is equal to the cost of the yearly premium for a bronze plan, is $2,085.

Anyone who can afford health insurance as determined by your yearly income, but chooses not to buy it, will have to pay a penalty.

Who is exempt from the tax penalty? Generally, whether you qualify for an exemption from the tax penalty depends on your household income. If the lowest priced bronze-level health plan available to you through the health insurance marketplace in your state costs more than 8.05% of your household income, then your coverage is considered to be unaffordable. In this case, you can claim an exemption by filling out and submitting IRS Form 8965 with your 2015 tax return. You can also mail in an exemption application.

An exemption can also be granted based on a number of circumstances. Many are “hardship” exemptions for people who have suffered bankruptcy, the death of a close family member, eviction, homelessness, caring for an ill family member or other disruptive life events. Other exemptions are for categories of people, such as Native Americans and people who have religious objections to medical care. For more information on the exemptions process, visit healthcare.gov.

Couldn’t afford the expensive coverage your employer offered? You moneywill qualify for an exemption from the tax penalty if you can show that the cost of the coverage would have been more than 8.05 percent of your income.

What if you had health insurance for part of the year? If you only lacked coverage for one or two months during 2015, then you will qualify for the “short gap exemption” from paying the penalty. If you were uninsured for a longer period, you will pay a fee that is a pro-rated fraction of the annual penalty. So, for example, if you were uninsured for six months, you would pay half the annual penalty.

If you are facing a penalty, can you sign up for coverage now and avoid paying it? No. In previous years, there was a special enrollment period that allowed still uninsured people to apply for affordable private health insurance through the ACA marketplaces at tax time. However, there is no special enrollment period this year for those facing penalties for being uninsured in 2015.

The next open enrollment period for marketplace coverage starts November 1. It would be a good idea to mark this date on your calendar if you are still uninsured and facing a tax penalty this month. However, be aware there are some circumstances in which you can apply for coverage before then. For example, if you experience a “qualifying life event,” such as getting married or having a child (and in New York, becoming pregnant or suffering from domestic violence or spoumagnifying glasssal abandonment), you may apply for coverage right away during a Special Enrollment Period. In addition, people can apply for Medicaid and Children’s Health Insurance year round. Examine whether you might qualify for one of these options by contacting a Navigator, or going to New York’s Marketplace, NY State of Health.

If you do have health insurance coverage, how must you prove this when filing your tax return? You are not required to submit proof of health care coverage when filing your tax return, but you should keep these records on hand to verify coverage if necessary. Acceptable forms of proof of insurance include: 1095 information forms sent to you by your insurer or employer, insurance cards, explanation of benefits statements from your insurer, W-2 or payroll statements reflecting health insurance deductions, records of advance payments of the premium tax credit and other statements indicating that you, or a member of your family, had health care coverage.

 

Welcome to National LGBT Week of Action for Enrollment! The U.S. Department of Health and Human Services (HHS), the White House, Out2Enroll and partners across the country and New York State are collaborating this week to reach uninsured LGBT people and get them enrolled in health insurance for 2016. The deadline to apply for coverage that starts January 1 is next week, December 15.out to enroll

Members of the Health Care For All New York (HCFANY) LGBT Task Force are providing culturally competent enrollment assistance for LGBT New Yorkers, helping them apply for coverage through the NY State of Health Marketplace. These Task Force members include the Community Service Society, Callen Lorde Community Health Center, the LGBT Community Center in Manhattan and its partner in Queens, Voces Latinas, GMHC and Make the Road New York.

The National LGBT Week of Action for Enrollment celebrate the immense progress for LGBT health policy over the last few years since passage of the Affordable Care Act (ACA). HHS LGBT Issues Coordinating Committee Co-Chairs Kathy Greenlee and Wanda Jones took the opportunity this week to launch the 2015 HHS LGBT Annual Report and described new potential efforts to require electronic medical records systems to collect information on gender identity, sex assigned at birth and sexual orientation by 2018. Other exciting advancements include (1) proposed regulations implementing section 1557 of the ACA will bar discrimination against LGBT people in health care coverage and access, (2) a proposed Center for Medicare and Medicaid Services (CMS) National Coverage Determination Criteria Guideline for transgender medical care services, and (3) efforts to institute data collection on the basis of sexual orientation and gender identity.

HCFANY’s LGBT Task Force is working hard on many of these same issues at the state level. The Task Force has provided LGBT cultural competency training to more than 150 Navigators across the state so they can better serve LGBT people who want to apply for coverage. The Task Force also advocated for issuance of state policies requiring coverage of medically-necessary care that transgender people need by both private insurance and Medicaid. Listening sessions have been helping the Task Force and state officials identify needed follow up action to ensure compliance with these transgender coverage policies.

Want to learn more about coverage for yourself or an LGBT loved one? Contact the Community Health Advocates hotline at 888-614-5400, or visit the NY State of Health website to learn about your coverage options, which include the new very low-cost Essential Plan.