Apply over the phone Create account online and upload or mail

Health Insurance Marketplace Application Tips for Immigrant, Refugee, and Nonimmigrant Visa Holders Identity Verification Issues Identity proofing must be completed in order for a consumer to submit an online application. Because the online identity verification system relies on credit history, many individuals are not able to complete identity verification and cannot submit an application online. Options for Applying for People Who Can’t Verify Identity Online Apply over the phone Identity verification IS NOT REQUIRED with applications done through the Call Center. Consumers should be able to call the Marketplace Call Center (1-­‐800-­‐318-­‐2596) and complete an entire application and enrollment over the phone. There are Spanish speaking representatives available through the Call Center. Sometimes, individual Call Center Representatives may be hesitant to do an application over the phone for cases in which identity cannot be verified. If you run into this issue, you can ask to speak to a Call Center Supervisor. In addition, sometimes it is more effective to simply ask to do an application over the phone than to attempt to explain the identity verification issues. There is no reason that Call Center representatives cannot complete an application over the phone. If an application is done over the phone, the applicant will not be able to view the health plans through the usual online enrollment tool. Representatives read the plan information to the applicant over the phone. If a consumer is selecting a plan over the phone, you can use the Browse Coverage Options Tool (https://www.healthcare.gov/see-­‐plans/ or https://www.cuidadodesalud.gov/see-­‐plans/) to give the consumer a visual guide to their options and search provider directories or formularies before enrolling through the Call Center. Attempt the following work-­‐arounds for online applications When creating the new account online, try using the following work-­‐arounds: • Put consumer information in all CAPS • If the consumer recently moved, use their last permanent address • Leave Social Security number (optional field) blank These tips do not work in all cases, but have been successful for many consumers facing difficulty with identity verification on the website. Create account online and upload or mail documents to Marketplace for manual identity verification. Through this method, consumers would upload or mail their identity verification documents to the This document was prepared in December 2014 and tips are subject to change as changes are made to the application process. Please report updates to Alice Pollard (pollarda@ncchca.org) or Brendan Riley (rileyb@ncchca.org). Marketplace. After a few days or weeks (depending on method of submission), consumers can return and attempt to submit an application online. With this method, consumers cannot complete enrollment in one appointment and must return to see an assister or apply on their own once manual identity verification is complete. This method is not recommended due to the long delays involved. Immigration Status Verification People who are seeking health coverage must attest to being a U.S. Citizen or having an eligible immigration status. The application will ask applicants with eligible immigration status to list a document that proves their status. Consumers should fill in fields as completely as possible. The information is checked with the DHS SAVE system. When helping complete an application, it’s helpful to use all capital letters for first and last name of applicants and omit special characters or extra spaces. If verification of status does not work, then consumers can attest to having an eligible immigration status and proceed with the rest of the application without providing document type and numbers. If otherwise eligible, the applicant should be able to continue with enrollment. Applicants will need to upload or mail proof of status to the Marketplace within 90 days. It’s very important that this proof of status is mailed because coverage could be canceled if the Marketplace does not receive this information. If verification does not work, assisters should be very mindful of immigrants who do not qualify for Medicaid based on their immigration status (see note below). If the immigration verification does not work, the system will assume that the individual meets the immigration requirements for Medicaid. Therefore, it won’t recognize potential eligibility for tax credits below 100% FPL. Citizenship Status Verification Attestations of U.S. citizenship will be checked against Social Security Administration (SSA) data, using SSNs. Verification may not be successful for naturalized or derived citizens through SSA match. If so, they will be asked to provide: an A#, and either a naturalization certificate number or a certificate of citizenship number. If the documents are unavailable, they can upload or mail in other proof of citizenship, such as a copy of their U.S. passport. Tax Dependents with Foreign Address The HealthCare.gov application only accepts U.S. addresses. If a consumer has a tax dependent residing at a foreign address, the consumer’s domestic address should be entered for that dependent. This guidance comes directly from CMS. Additionally, the address must be entered identically for each person on the application who lives at the same address. For example, do not enter “Street” for one person’s address and “St.” for another. Notes about PTC Eligibility for Certain Immigrants with Income below the Federal Poverty Level Immigrant Eligibility for Medicaid and Marketplace Medicaid has much stricter eligibility requirements for immigrants than the Marketplace. Medicaid Eligibility • Must have a “qualified” immigration status. Qualified immigrants include lawful permanent resident, refugees, asylees, persons granted withholding of deportation, certain victims of domestic This document was prepared in December 2014 and tips are subject to change as changes are made to the application process. Please report updates to Alice Pollard (pollarda@ncchca.org) or Brendan Riley (rileyb@ncchca.org). violence and trafficking in humans, certain Cuban and Haitian entrants, and persons paroled into the U.S. for one year or more. •
Many qualified immigrants are subject to a five-­‐year waiting period for Medicaid and CHIP coverage. o After the 5-­‐year disqualification period expires, qualified immigrants must meet other Medicaid eligibility rules (income and category) to qualify. o The following immigrants are exempt from the five-­‐year bar on federal means-­‐tested public benefits, and may start collecting benefits as soon as they receive legal status. • Children under age 19 and pregnant women who are otherwise eligible • “Qualified” immigrants who entered the US before August 22, 1996 • Refugees, asylees, Cuban and Haitian entrants, Amerasian immigrants, persons granted withholding of deportation, victims of trafficking, veterans and active duty military personnel and their spouses and children, as well as certain Native Americans. Marketplace Eligibility • Any “lawful” immigration status-­‐ Full list available at http://www.nilc.org/lawfullypresent.html. • Examples: o Lawful Permanent Resident o Anyone with work authorization (LPR/Green Card holder) who: is a registry applicant, has an o Asylee order of supervision, has applied for o Refugee cancellation of removal, or is an o Worker visas (including H-­‐2A, H-­‐2B, applicant for legalization under H-­‐1B, etc.) IRCA or the LIFE Act o Student Visas o Anyone with work authorization o U visas who: is a registry applicant, has an o Temporary protected status (TPS) order of supervision, has applied for o Deferred Enforced Departure (DED) cancellation of removal, or is an o Deferred Action Status (But not applicant for legalization under DACA holders). IRCA or the LIFE Act • If ineligible for Medicaid based on immigration status, Lawfully present immigrants with household incomes of less than 100% FPL may qualify for financial assistance in the marketplace. Why are some immigrants below the poverty line eligible for tax credits when US citizens are not? The architects of the ACA designed the law this way with the assumption that all states would have expanded Medicaid eligibility from 0% FPL to 138% FPL; however, that alone would have shut out some immigrants from affordable coverage, as Medicaid is only available for certain types of immigrants and may require a waiting period. Lawfully present immigrants who are not barred from Medicaid due to their immigration status are treated like US citizens and aren’t eligible for premium tax credits if their incomes are below 100% of poverty. (This is because under the law’s original intent, these individuals would’ve been eligible for expanded Medicaid.) This document was prepared in December 2014 and tips are subject to change as changes are made to the application process. Please report updates to Alice Pollard (pollarda@ncchca.org) or Brendan Riley (rileyb@ncchca.org). Examples: •
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Raul is a HH of 1, earning $5,000 per year. Raul has been a lawful permanent resident for 3 years. o Not eligible for Medicaid (due to 5 year bar) o Eligible for premium tax credits (because ineligible for Medicaid due to 5 year bar) Raul is a HH of 1, earning $5,000 per year. Raul has been a lawful permanent resident for 6 years. o Not eligible for Medicaid (because not disabled and no children) o Not eligible for premium tax credits (because not barred from Medicaid due to immigration status) Lupe lives with her 4 year old daughter Ana. Ana is a US Citizen and Lupe recently obtained a U visa. Their income is $10,000 per year. o Ana is eligible for Medicaid. o Lupe is eligible for PTCs in the Marketplace because she is ineligible for Medicaid as an adult U visa holder. Marketplace Application System Issues with Recognizing PTC Eligibility Below 100% FPL During the first open enrollment period (2013-­‐2014), the system did not do a good job of recognizing eligibility for immigrants who were eligible for tax credits below 100% FPL. Assisters should double-­‐
check eligibility determinations to be sure that the system is working properly. If the system is not able to verify an applicant’s immigration status or if the consumer does not include their immigration document numbers, the system will assume that the individual meets the immigration requirements for Medicaid. Therefore, it won’t recognize potential eligibility for tax credits below 100% FPL. If the consumer has applied for Medicaid since 11/15/2014 and been denied based on immigration status, you can indicate that on the application. This is the third checkbox on the page of the application which asks about disability. Checking this box will generally help to flag the application and obtain correct eligibility results. If the consumer has not received a Medicaid denial since 11/15/2014, thinks they are ineligible for Medicaid due to their immigration status, and is having trouble getting a correct eligibility result through the Marketplace, you can help them apply for Medicaid again. Once they receive the new denial, they can update the Marketplace application and check this box. The new Medicaid denial is often a faster way to get correct results than waiting on an appeal. However, requesting an appeal is still important because it protects the initial date of application for retroactive coverage if needed. Incorrect Eligibility Determinations In the case of incorrect eligibility determinations, assisters can help a consumer with a few options: 1) Call the Marketplace Call Center to see whether the issue can be solved informally. 2) Re-­‐apply and be sure to provide all necessary documentation. Go back to the application and click on “report life change” review all information in the application, to make sure that nothing was checked which may be triggering an incorrect eligibility result. Common examples of questions which result in no APTC include: a. Married but filing taxes separately This document was prepared in December 2014 and tips are subject to change as changes are made to the application process. Please report updates to Alice Pollard (pollarda@ncchca.org) or Brendan Riley (rileyb@ncchca.org). b. Not planning to file taxes c. Has an offer of affordable employer based coverage or clicked "I don't know" d. Income just over the poverty line and indicated a disability 3) File an appeal and refer to legal services. Appeal forms for NC can be found at this link: https://www.healthcare.gov/downloads/marketplace-­‐appeal-­‐request-­‐form-­‐a.pdf. It’s strongly advised that a consumer seek assistance from legal services with an appeal. To facilitate a referral, assiters can fill out this appeal referral form with some brief information about the situation and have the consumer sign the form to authorize sharing of their information. The assisters can fax the form to the appropriate contact listed at the bottom of the sheet. The form does not guarantee representation but it will help a legal services agency make the connection to the consumer. If the assister does not fill out the appeal referral form, they can help consumers access legal services by calling the following phone numbers: • Pisgah Legal Services: 828-­‐253-­‐0406 (Buncombe, Henderson, Madison, Polk, Rutherford, and Transylvania Counties) • Legal Services of Southern Piedmont: 704-­‐376-­‐1600 (Mecklenburg County) • Legal Aid of NC: 866-­‐219-­‐5262 (All 100 Counties) Frequently Asked Questions About Mixed Status Families The National Immigration Law Center (NILC) has developed this helpful document with answers to frequently asked questions about mixed–immigration status families’ access to ACA programs. This 7-­‐
page FAQ explains, for example, who is eligible for coverage in the health insurance marketplaces created by the ACA, and who in a mixed-­‐status family is an “applicant” and who a “nonapplicant.” And it lists six “Key points to remember about mixed-­‐status families.” http://www.nilc.org/aca_mixedstatusfams.html Report Enrollment Barriers NILC has developed a Google form (http://nilc.org/acaproblems.html) that in-­‐person assisters should fill out anytime immigrant consumers that they assist encounter problems with the application process. NILC is using this information to continue its efforts to monitor the application and enrollment barriers to immigrant consumers and advocate for a less burdensome application process for the immigrant population. References and Resources • National Immigration Law Center, http://www.nilc.org/health.html • Health Reform Beyond the Basics, Application Process for Families that Include Immigrants http://www.healthreformbeyondthebasics.org/assister-­‐training-­‐webinar-­‐application-­‐process-­‐
for-­‐health-­‐coverage-­‐for-­‐families-­‐that-­‐include-­‐immigrants/ • Maine Equal Justice Partners & Portland Community Health Centers, “Tips for Immigrant/Refugee applications in the Health Insurance Marketplace” • In the Loop Assister Community • North Carolina Justice Center • HealthCare.gov Resources on Immigration: https://www.healthcare.gov/immigrants/immigration-­‐status/
This document was prepared in December 2014 and tips are subject to change as changes are made to the application process. Please report updates to Alice Pollard (pollarda@ncchca.org) or Brendan Riley (rileyb@ncchca.org). Common Immigration Documents (From 2015 Marketplace Assister Training) Prepared by NC Community Health Center Association Prepared by NC Community Health Center Association