Minnesota cuts back medical care for immigrants

When Minnesota’s new, leaner, meaner medical assistance law goes into effect on January 1, 2012, many legal immigrants will lose eligibility for medical assistance. The changes in the law affect both medical assistance for low-income legal immigrants, and the already-limited emergency medical assistance available to everyone.

Legal permanent residents — those who have a right to live and work in the United States indefinitely, and who are on a path to citizenship — already have limited eligibility for state and federal programs, such as food stamps or medical assistance, under complicated eligibility rules. Their current eligibility for medical assistance will be cut under the new Minnesota law that takes effect on January 1.

Medical assistance for low-income Minnesotans is complicated for everyone. There’s a federally-funded medical assistance program, commonly called Medicaid or MA in Minnesota. Then there’s a Minnesota-funded program called state-funded Medical Assistance or Minnesota MA. Just to confuse matters even further, there’s Emergency Medical Assistance, which is available to anyone — citizen, legal permanent resident, even unauthorized immigrant — who has two things: “categorical” eligibility and a medical emergency. (See sidebar for explanation of “categorical” eligibility” and medical emergency.)

In Minnesota, immigrants make up about 6.8 percent of the state’s population or about 358,000 people. (For statistical purposes, “immigrant” means someone who was born outside the United States.) About 44 percent of Minnesota’s immigrants are U.S. citizens. Legal permanent residents make up the next largest group.  Then there are unauthorized immigrants, and a whole lot of small groups classified as “otherwise lawfully residing” immigrants.

Emergency Medical Assistance
Laura Melnick of Southern Minnesota Regional Legal Services provides this explanation of EMA:EMA is a basic health care safety net program. It has been available to everyone “categorically” eligible for MA who requires “Emergency Medical Services.” (“Categorical” eligibility extends to pregnant women, adults without minor children with income at or below 75% of federal poverty level, and people under 22 or over 64, living in a household with minor children, or certified disabled by Social Security or the State Medical Review Team [SMRT]).

The law change has to do with how Minnesota interprets the definition of “Emergency Medical Services.” The federal law defines such services as those required after the sudden onset of a medical condition manifesting itself by acute symptoms of such severity that the absence of immediate medical attention could reasonably be expected to result in: (a) placement of the patient’s health in serious jeopardy; (b) serious impairment of bodily functions; OR (c) serious dysfunction of any bodily organ or part. Minnesota has interpreted the definition very loosely to cover chronic conditions. …

CHRONIC CONDITIONS WILL NO LONGER BE COVERED BY EMA. Effective 1/1/12, EMA will no longer pay for chemotherapy, insulin, kidney dialysis, physical or occupational therapy, psychotherapy, or mental health medications. Under the new law, EMA will be available only for services: (i) delivered in an emergency room or ambulance and “directly related” to the treatment of an emergency medical condition; (ii) delivered on an in-patient basis in a hospital following admission from the emergency room for an acute emergency condition; or (iii) for follow-up and “directly related” to the original services provided to treat the emergency medical condition.

Examples of these “otherwise lawfully residing” immigrants include refugees, asylum applicants, and people with U or VAWA visa status, as well as people on Deferred Enforced Departure (many Liberians in Minnesota), and other statuses.

Under the current law, some lawful permanent residents qualify for federally-funded Medicaid, but most do not. A few categories of “otherwise lawfully residing” immigrants qualify for federally-funded Medicaid, but most do not. Right now, Minnesota uses state-funded medical assistance for permanent residents and “otherwise lawfully residing” immigrants in need. That changes on January 1. After January 1, legal permanent residents who have been admitted to the United States for less than five years (except for refugees and asylees) will no longer be eligible for medical assistance. Neither will most “otherwise lawfully residing” immigrants.

State-funded medical assistance will remain available to pregnant women, children, and people receiving care and rehabilitation services from the Center for Victims of Torture.

The Daily Planet asked John Keller of the Immigrant Law Center of Minnesota to explain more about the impact of the new law:

TCDP: Can you give an example of a group affected by the new law?

Keller: It’s basically the restriction of access or qualifying for persons on Temporary Protected Status. Liberians and Salvadorans are the two biggest groups, plus some Haitians, Somalis and Sudanese. Temporary Protected Status is a humanitarian legal status that we grant to people from countries that are suffering severe civil or natural disasters. [e.g., Haitian earthquake, Liberian civil war]

Because it’s a humanitarian status, it comes with immigration status protection at the federal level. For the state to make the decision that they are going to save money by cutting off health care to folks like that does two things. It ignores the reality of TPS, which is that some people have been forced to remain in the United States since the early 1990s, Liberians particularly.

TCDP: In the case of an immigrant who is a crime victim, what happens under the new Minnesota law?

Keller: Congress, in creating the U visa and VAWA, specifically said: We want to create an incentive for crime victims to trust the local police. Why? To stop crime. To prevent criminals from preying on vulnerable individuals. To encourage community policing in cities where there is a diverse immigrant population. To get at the root of crime.

One of the barriers for crime victims to come forward is a fear that talking to police will get you deported. The multiple value of U visa is it gives local police ability to say “Trust us. We’re in this together. We want to stop crime from hurting you and your children.” To obtain a U visa, the local police department has to certify that the victim assisted in the investigation of the crime that happened. The police and prosecutors make the decision if a victim has been helpful and then decide whether to sign the certification. From there, the federal government (USCIS) reviews the application and if it is approved will grant a U-visa to the victim and your immediate family, usually children. The U-visa provides a person with legal, non-immigrant status including work authorization and puts you on a path to permanent residency in three years, and U.S. citizenship five years after that. The cap nationally is 10,000 principal applicants, which we ran into for the first time last fall.

So that federal and local cooperation on fighting crime and protecting vulnerable immigrants has been extremely successful for both of those purposes. And suddenly you have people trying to get control of their lives for the first tine, to break the whole cycle of … domestic violence ….

And now we’ve taken away access to care for probably the 3-4 years it’s going to take to get a green card.

One of the things that constantly comes up in comments “Illegal immigrants get Medicaid.” Can you clarify?

It is impossible for undocumented immigrants to qualify for any public subsidized benefits like Medicaid. 99.9 percent do not qualify for them. The exceptions have been that we still won’t turn away people in emergency conditions, and that is being redefined in the state, what is an emergency condition. And for basic prenatal and delivery care – that still will qualify. Outside of those two exceptions – there’s no way anybody can walk into a county office who does not have documents and sign up for government care of any kind.

A lot of people will allege that folks are doing it fraudulently. In our experience, that is a completely inconsistent behavior for a marginalized, increasingly frightened population. They want as little contact with government of any size or shape as possible.

Are there restrictions on medical assistance eligibility for legal permanent residents?

Absolutely.

Legal permanent residents are restricted from using means-tested benefits [i.e., any benefit programs for low-income persons] for the first five years of their permanent residency. These are green card holders. If you or I bring in a spouse or a child, they also will be turned away at the county office. Those are folks on a path to citizenship.

That’s been a change since welfare reform in 1996. That’s been the law. We long ago restricted access to public benefits, even for people with green cards.

We end up having to counsel our clients who are legally entitled to bring over a family member … to tell them that the family member will not be eligible for any kind of public assistance for the first five years. If you have a mother or father coming in, they will have no access to public health care coverage. Some people have made the decision not to bring over that family member even though they are legally entitled to enter as a permanent resident. The lack of access to health care is preventing working class families for reuniting.

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