ObamaCare and Immigrants

Let’s look at how ObamaCare affects immigrants and how immigration status affects Marketplace coverage, cost assistance, Medicaid, and coverage requirements.

Most immigration statuses qualify people to use the Marketplace, but only lawfully present immigrants have access to cost assistance and are required to obtain coverage. Limitations apply to specific groups in regards to Marketplace coverage, Medicaid, and CHIP.

For detailed information see HealthCare.Gov. We used the official HealthCare.Gov section on immigration to create this page. For further information see “ten things immigrant families need to know about the Marketplace.” Due to complexities involved, it is important to note that HealthCare.Gov provides 24/7 assistance and your information cannot and will not be used for enforcement purposes. If you have questions, we strongly suggest contacting HealthCare.Gov for help. 1-800-318-2596 / TTY: 1-855-889-4325

Who is Eligible for the Marketplace?

Most people in the following groups are eligible for coverage through the Health Insurance Marketplace:

  • U.S. citizens
  • U.S. nationals
  • Lawfully present immigrants

Who isn’t Eligible for the Marketplace?

The following groups aren’t eligible to use the marketplace, get cost assistance, or use Medicaid or CHIP:

  • Undocumented immigrants
  • Those who are currently incarcerated.

Your Information is Protected and Won’t be Used for Enforcement Purposes

Your information will never be used for enforcement purposes when you apply to HealthCare.Gov or a state Marketplace.  Immigration status is only used to determine eligibility.

  • Family members won’t be asked for immigration status.
  • It won’t impact your chances, or your loved one’s chances, of getting a green card.

Who is Required to Get Covered or Pay the Fee?

If you are an undocumented immigrant; you are not legally a U.S. citizen, a U.S. national, or an alien lawfully present in the U.S. you are exempt from the fee and are not required to be covered. If you aren’t “legally present” you are exempt from the fee.

Key Aspects of Immigration and ObamaCare

Keep in mind the following aspects in regards to immigrants and ObamaCare from CIS.Org.

  • The definition of “lawfully present” does not include recipients of the DACA administrative amnesty. Learn more on our page on Key Facts Regarding DACA Recipients and the Affordable Care Act.
  • 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.

How is “Live in the United States” Defined?

If you’re considered a “resident” of the United States for tax purposes, you’re eligible to use the Marketplace.

What Does Lawfully Present Mean?

The term “lawfully present” includes immigrants who have:

  • “Qualified non-citizen” immigration status without a waiting period (see details below)
  • Humanitarian statuses or circumstances (including Temporary Protected Status, Special Juvenile Status, asylum applicants, Convention Against Torture, victims of trafficking)
  • Valid non-immigrant visas
  • Legal status conferred by other laws (temporary resident status, LIFE Act, Family Unity individuals) See a full list of eligible immigration statuses eligible for Marketplace coverage.

Does ObamaCare Apply to Lawfully Present Immigrants?

Lawfully Present immigrants can use the Marketplace, get cost assistance, and get Medicaid and CHIP.

There is a five year waiting period (“5-year ban”) for Medicaid and CHIP coverage.

Getting Medicaid or CHIP doesn’t make someone a “public charge.” This means it won’t affect their chances of becoming a Lawful Permanent Resident or U.S. citizen. There’s one exception. People receiving long-term care in an institution at government expense may face barriers to getting a green card.

TIP: In general, getting assistance through the ACA (Medicaid/CHIP or cost assistance like tax credits) won’t negatively impact your chances of becoming a resident or citizen. However, not needing as much assistance (being over 250% of the Federal Poverty Level or having coverage through work instead of the ACA) can have a positive impact. Learn more about the current “public charge” rules as of Jan 2021 (this could change in the future).

What does “Qualified Non-Citizen Mean?

The term “qualified non-citizen” includes:

  • Lawful Permanent Residents (LPR/Green Card Holder)
  • Asylees
  • Refugees
  • Cuban/Haitian entrants
  • Paroled into the U.S. for at least one year
  • Conditional entrant granted before 1980
  • Battered non-citizens, spouses, children, or parents
  • Victims of trafficking and his or her spouse, child, sibling, or parent or individuals with a pending application for a victim of trafficking visa
  • Granted withholding of deportation
  • Member of a federally recognized Indian tribe or American Indian born in Canada

Who is  Considered a U.S. Citizen?

A U.S. citizen is someone who’s born in the United States (including U.S. territories, except for American Samoa) or who was born outside the U.S. and who either:

  • Was naturalized as a U.S. citizen
  • Derived citizenship through the naturalization of his or her parent(s)
  • Derived citizenship through adoption by U.S. citizen parents, provided certain conditions are met
  • Acquired citizenship at birth because he or she was born to U.S. citizen parent(s)
  • Became a U.S. citizen by operation of law

Who is Considered a U.S. National?

A U.S. national is someone who’s a U.S. citizen or a person who isn’t a U.S. citizen, but owes permanent allegiance to the U.S. With extremely limited exception by which he or she is entitled to be protected, all non-citizen U.S. nationals are people born in American Samoa or abroad with one or more American Samoan parents under certain conditions.

What if I’m a Resident of a U.S. territory?

U.S. territories can decide whether to create their own Health Insurance Marketplace or expand Medicaid coverage. Residents of a U.S. territory aren’t eligible to apply for health coverage using the federal or state Marketplace unless they also qualify as a resident within the service area of a Marketplace.
Residents of U.S. territories are not required to have health coverage under the health care law.

Naturalization Numbers

To qualify for a government subsidy, you must be a U.S. citizen or a legal immigrant (examples are if you’re a naturalized citizen or otherwise legally present in the United States). To apply for Obamacare subsidy, have the documents that prove your legal immigration status or your citizenship with you. These include (but are not limited to) your naturalization papers, green card, or work visa. In particular, have your naturalization numbers available. – eHealth.

Immigration Statuses and the Marketplace

People with the following immigration statuses qualify for Marketplace coverage.

Get details about what document numbers and other information you’ll need to fill out a Marketplace application.

Immigrants with the following statuses qualify to use the Marketplace:

  • Lawful Permanent Resident (LPR/Green Card holder)
  • Asylee
  • Refugee
  • Cuban/Haitian Entrant
  • Paroled into the U.S.
  • Conditional Entrant Granted before 1980
  • Battered Spouse, Child, and Parent
  • Victim of Trafficking and his/her Spouse, Child, Sibling or Parent
  • Granted Withholding of Deportation or Withholding of Removal, under the immigration laws or under the Convention against Torture (CAT)
  • Individual with Non-immigrant Status (includes worker visas, student visas, and citizens of Micronesia, the Marshall Islands, and Palau)
  • Temporary Protected Status (TPS)
  • Deferred Enforced Departure (DED)
  • Deferred Action Status (Deferred Action for Childhood Arrivals (DACA) is not an eligible immigration status for applying for health insurance)
  • Lawful Temporary Resident
  • Administrative order staying removal issued by the Department of Homeland Security
  • Member of a federally-recognized Indian tribe or American Indian Born in Canada
  • Resident of American Samoa

Applicants for any of these statuses qualify to use the Marketplace:

  • Temporary Protected Status with Employment Authorization
  • Special Immigrant Juvenile Status
  • Victim of Trafficking Visa
  • Adjustment of LPR Status
  • Asylum (see note below)
  • Withholding of Deportation, or Withholding of Removal, under the immigration laws or the Convention against Torture (CAT) (see note below)

Applicants for asylum are eligible for Marketplace coverage only if they’ve been granted employment authorization or are under the age of 14 and have had an application pending for at least 180 days.

People with the following statuses and who have employment authorization qualify for the Marketplace:

  • Registry Applicants
  • Order of Supervision
  • Applicant for Cancellation of Removal or Suspension of Deportation
  • Applicant for Legalization under Immigration Reform and Control Act (IRCA)
  • Legalization under the LIFE Act

Immigration Documentation Type

You may need to have one or more of the following documents when you apply for and enroll in Marketplace coverage. The documents you need depend on your immigration status.

  • Permanent Resident Card, “Green Card” (I-551)
  • Reentry Permit (I-327)
  • Refugee Travel Document (I-571)
  • Employment Authorization Card (I-766)
  • Machine Readable Immigrant Visa (with temporary I-551 language)
  • Temporary I-551 Stamp (on passport or I-94/I-94A)
  • Arrival/Departure Record (I-94/I-94A)
  • Arrival/Departure Record in foreign passport (I-94)
  • Foreign Passport
  • Certificate of Eligibility for Nonimmigrant Student Status (I-20)
  • Certificate of Eligibility for Exchange Visitor Status (DS2019)
  • Notice of Action (I-797)
  • Document indicating membership in a federally recognized Indian tribe or American Indian born in Canada
  • Certification from U.S. Department of Health and Human Services (HHS) Office of Refugee Resettlement (ORR)
  • Office of Refugee Resettlement (ORR) eligibility letter (if under 18)
  • Document indicating withholding of removal
  • Administrative order staying removal issued by the Department of Homeland Security
  • Alien number (also called alien registration number or USCIS number) or 1-94 number

See a complete list of the documents (including pictures of what they look like) that can be used to verify your immigration status.

Mixed-Status Immigrant Families

Many immigrant families are of “mixed-status,” with members having different immigration and citizenship statuses. For example:

  • Some families may have taxpaying members who can’t buy health insurance through the Marketplace, alongside other family members who are eligible to use the Marketplace as citizens or lawfully present immigrants.
  • In another “mixed-status” family, some members may not be eligible for full Medicaid coverage, while other members are eligible for Medicaid or CHIP.

“Mixed-status” families can apply for premium tax credits or lower out-of-pocket costs for private insurance for their dependent family members who are eligible for coverage in the Marketplace. They can also apply for Medicaid and CHIP coverage for their dependent family members.

Family members who aren’t applying for health coverage for themselves won’t be asked if they have eligible immigration status.

Disclosure of Immigration Status

Federal and state Marketplaces and state Medicaid and CHIP agencies can’t require applicants to provide information about the citizenship or immigration status of any family or household members who aren’t applying for coverage.

States also can’t deny benefits to an applicant because a family or household member who isn’t applying hasn’t disclosed his or her citizenship or immigration status.

Information provided by applicants or beneficiaries won’t be used for immigration enforcement purposes.

Author: Thomas DeMichele

Thomas DeMichele is the head writer and founder of ObamaCareFacts.com, FactsOnMedicare.com, and other websites. He has been in the health insurance and healthcare information field since 2012. ObamaCareFacts.com is a...

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