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Immigration and Obamacare

February 1, 2013
By James R. Edwards Jr.

In this Backgrounder and Report, the author finds that in January 2013, the Centers for Medicare and Medicaid Services and the Department of Health and Human Services issued a proposed rule implementing health reform's Medicaid, Children's Health

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In this Backgrounder and Report, the author finds that in January 2013, the Centers for Medicare and Medicaid Services and the Department of Health and Human Services issued a proposed rule implementing health reform's Medicaid, Children's Health Insurance Program (CHIP), and Exchanges provisions. The proposal includes details of the statutory requirements for verifying the immigration or citizenship status of those applying for Medicaid and CHIP. 

Key aspects relating to immigration status include:

  • The definition of "lawfully present" does not include recipients of the DACA administrative amnesty.

  • Lacking verified immigration status may not hinder enrollment of those whose preliminary information indicates they are eligible for Medicaid or CHIP, under "presumptive eligibility" rules.

  • State residency is separate from citizenship or lawful presence verification.

  • Electronic documentation begins to overtake presentation of authentic identification documents. Similarly, a record of identity or status verification is regarded as more important than having authenticated copies of valid, legitimate documents on record.

  • Two, down from three, documents are to be required to establish one's status.

  • Attestation made about someone's citizenship status in a single affidavit counts as one of the accepted forms of identity. However, self-attestation is not allowed.

  • The SAVE system will verify eligibility by citizenship or immigration status through a single "federal data services hub", which will connect state agencies and exchanges with applicable government databases.

  • Individuals whose immigration or citizenship status verification "fails" or is delayed, including for those who cannot give a Social Security number or otherwise provide sufficient or adequate ID documents, have a 90-day "reasonable opportunity period" to settle the matter. The due process period may be extended.

  • Those whose immigration status check fails are enrolled in Medicaid or the health program for which they otherwise seem to qualify during the "reasonable opportunity period".

  • For Medicaid and CHIP, certain "lawfully present" aliens no longer face key welfare reform provisions, such as sufficient immigrant sponsor income or a five-year wait.
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Immigration Health Care