Overcoming Barriers to Access to Health Care by Immigrant Families Sonal Ambegaokar, Health Project Manager National Immigration Law Center March 4, 2013.

Overcoming Barriers to Access to Health Care by

Immigrant Families

Sonal Ambegaokar, Health Project ManagerNational Immigration Law Center

March 4, 2013

What Barriers or Concerns do Immigrant Families Have?

Helping with the Application – Whose Info is Needed?

Goal: To make the application process put immigrant and mixed-status families at ease and be sensitive to their concerns.

From the start, application should make clear that an individual can apply on behalf of someone else in the family.Request sensitive info only of applicantMake clear that non-applicants will not have to provide their SSN or citizenship/immigration status in order to complete the application.

Helping with the Application – Social Security Numbers and Individual Taxpayer

Identification Numbers (ITINs)SSNs will be primary gateway to the electronic verification system (the federal hub), including IRS data.

Applicants must provide SSN, IF they have one

Eligibility determination and enrollment should proceed pending issuance of SSN or if only eligible for non-work SSN

Request for SSN of non-applicants must:Make clear it is optional/voluntaryNot be required to proceed in electronic applicationExplain how the SSN will be used and shared to determine eligibility for those seeking coverage

Helping with the Application – Immigration Status Requirements

Exchange and Medicaid/CHIP have different immigrant eligibility rules; eligibility varies from state to state

Date of Entry: N/A for Exchange – no 5-year bar for eligible immigrants in Exchange; N/A for certain immigrants for Medicaid/CHIP

Screen first for income, then get into details about immigration status

Have cheat sheets and info on eligible immigration statuses handy

Provide multiple notices and reassuring messages about privacy, confidentiality, and public charge

Helping with the Application – Verifying Citizenship or Immigration Status

Citizenship- electronic database match via SSN - SSA, Vital Statistics, other databases, SAVE

Ensure opportunity to provide alternative proof of citizenship if unable to match via electronic match or do not have SSN

Naturalized citizens have higher error rates in SSA database match

Immigration status - Federal data services hub will use SAVE

Provide clear notice that immigration status will be verified only to determine eligibility and not for immigration enforcement or other purposes

Ensure applicants who are otherwise eligible and provide proof of status to be aided pending verification without delay

Helping with the Application – Documentation of Income

Variety of workers whose income not recorded by IRS or state wage databases will need to provide additional info.

Electronic data matching preferred – could be done using data fields other than SSN

What happens when the hub can’t verify income?

Self-attestation of income should be allowed when documentation does not exist or is not reasonably available

Privacy, Security & ConfidentialityNeed to address concerns about what info is collected, how it is shared, and unintended consequences.Info can be collected, used or disclosed ONLY if necessary to carry out Exchange functions (eligibility determination and enrollment in health insurance)

Info can only be used by/disclosed to those authorized to receive or view itExchange will require the same or more stringent privacy and security standards as a condition of contract or agreement with individuals or entities (Navigators, agents, and brokers).Exchange must ensure workforce compliance; training

No immigration consequencesDepartment of Homeland Security does NOT engage in enforcement activities based on a SAVE inquiryNo “public charge”

Language Barriers

Medi-Cal and Covered California or other entities that receive federal funding)

MUST provide free oral interpretation services and translate key documents into top languages.

Strategies to Enroll Immigrant Families

Provide a safe environment in which immigrants, LEP persons, and other vulnerable populations can seek services and information

Include reassuring language on application, instructions, notices, outreach & education materials

Strategies to Enroll Immigrant FamiliesProvide free interpretation and translation services

All settings – call center, website, in-person, Navigators, consumer assistance programsInclude tag lines on written materials and websiteBudget for appropriate language assistance services

Strategies to Enroll Immigrant Families

Eligibility workers, call center personnel, Navigators, consumer assistance programs

Include training on immigrant eligibility, immigrants’ concerns, language access policies, privacy & confidentiality procedures

Recruit culturally & linguistically appropriate workforce, including organizations trusted by immigrant communities