This is another installment of "Ask Emily," a biweekly column by Emily Bazar, senior writer with the California HealthCare Foundation's Center for Health Reporting. It is a Q&A exploring the practical questions that consumers have about the Affordable Care Act. You can submit questions for "Ask Emily" at AskEmily@usc.edu.
California has more immigrants than any other state. At least one in four Californians – more than 10 million people – were born in another country.
And they’re a diverse bunch: Some immigrants, like my parents, are naturalized U.S. citizens. Others are green card holders. Some live here illegally. In addition, there are many thousands of people who have temporary status here on work or student visas.
Lots of you have asked how the Affordable Care Act affects immigrants. How I’d love to hand you a one-size-fits-all response! But this is Obamacare, after all, and the law treats categories of immigrants differently.
Q: What types of immigration status will be covered under Obamacare?
A: Let’s start with one important little detail: All naturalized citizens and legal immigrants must have health insurance as of Jan. 1 or pay a tax penalty. (That is, unless they fit into a category of people who are exempt, including those who cannot find “affordable” coverage, as defined by the law.)
The insurance requirement isn’t as ironclad for people with temporary visas. Some will have to abide and some won’t. (Thanks Obamacare!) If you’re not sure where you fall, check with an immigration attorney.
Whether you’re eligible for zero, some or all Obamacare programs depends on your legal status:
- Naturalized U.S. citizens are eligible for all Obamacare benefits, including the expansion of California’s Medicaid program for low-income residents, which is called Medi-Cal. They also can receive tax credits for plans purchased through the state’s health insurance exchange, Covered California (as long as they meet the income guidelines and other qualifications).
- Lawful permanent residents (also known as green card holders); people with temporary work and student visas (such as H-1B, J and F visas); refugees and asylees; Cuban/Haitian entrants; and others can all buy from the exchange and apply for tax credits. Click here to see the full list. People in most of those categories also will be eligible for expanded Medi-Cal if their incomes qualify. Some states – but not California – require a five-year waiting period before allowing certain immigrants to enroll.
- People who are here illegally cannot participate in any of these programs, but can receive emergency or prenatal treatment, as they do now. They also don’t have to comply with the Obamacare requirement.
Q: I’m a legal immigrant who has been in the U.S. for less than two years. I already have private health insurance from my country (Mexico), which covers me internationally. I can't afford to get another health plan. Am I obliged to buy another health plan here? Will I have to pay the penalty if I don’t?
A: Remember that important little detail I mentioned above, Laura? If you’re a legal immigrant you have to have health insurance starting Jan. 1.
Does health insurance from another country qualify? Probably not. Coverage from a foreign insurer does not meet the Obamacare requirement unless the insurer has received approval from the federal government, says Jenny Rejeske, health policy analyst for the National Immigration Law Center.
Check with your insurer to find out whether it has sought and received approval. If not, you’ll need to find coverage that meets Obamacare’s standards, qualify for one of the law’s exemptions or pay the tax penalty. On the bright side, you may be eligible for tax credits or other financial help.
Q: I recently read that all illegal immigrants’ children will be covered under the Affordable Care Act. Can this be true?
A: As I mentioned earlier, people in the country illegally cannot qualify for the Medi-Cal expansion or buy from Covered California.
But just because a parent (or parents) are in the country illegally doesn’t mean their children are, too. Many such children were born here and are citizens, and are eligible for health care benefits. (Note: Parents who apply for their children but not for themselves will not be asked for their immigration status.)
“Most immigrants live in mixed-status families,” Rejeske says. “You may have an undocumented parent who’s not eligible for anything. There may be a citizen child who’s eligible for Medi-Cal. You may have a lawfully present parent who is eligible for the exchanges.”
She ends with my favorite Obamacare truism: “It can get very complicated.”
Q: I am a Deferred Action for Childhood Arrivals recipient. Where do we fall into the whole Affordable Care Act?
A: This question is related to the DREAM Act. That’s the bill – as of yet unapproved – that would permit some immigrant youth who were brought to the United States illegally by their parents to apply for temporary legal status. That status could lead to U.S. citizenship if they went to college or served in the military.
In the absence of legislative action, President Obama announced the creation of the Deferred Action for Childhood Arrivals (DACA) program for those young people in 2012.
DACA provides them temporary status for two years and work authorization, and may be renewed. Luis, who wrote in from Modesto, is among them.
First, Luis, as a DACA recipient, you are not required to have insurance under Obamacare.
If you actually want insurance, however, you can’t buy it from Covered California. DACA recipients are barred from the health insurance exchange.
But you may be eligible for Medi-Cal, depending on your income. Unlike some other states, California law allows DACA recipients to sign up for Medi-Cal if they qualify.
Questions for Emily: AskEmily@usc.edu
The CHCF Center for Health Reporting partners with news organizations to cover California health policy. Located at the USC Annenberg School for Communication and Journalism, it is funded by the nonpartisan California HealthCare Foundation.