Health Care Eligibility For Unauthorized Migrants - Moral & Practical Implications

Immigrants are often undocumented or have an uncertain legal status in the US. Many people mistakenly believe that unauthorized immigrants are not eligible for any form of health care coverage. This is false. Unauthorized immigrants are, in fact, eligible for coverage under the Affordable Care Act (ACA), and they can also purchase unsubsidized health insurance outside of the marketplace if they earn enough money.

This post discusses how to buy health care while being ineligible and why you should purchase a plan even if you have zero income by using pre-tax paychecks or other saving methods to fund your premiums.

Private health insurance for unauthorized immigrants is very different from the type of health insurance available to US citizens. Unauthorized immigrants (or "unauthorized workers") are not eligible for Medicaid or Medicare and do not receive subsidies or cost-sharing credits from the ACA. Unauthorized immigrants can choose between two plans through Covered California, which were created specifically for undocumented immigrants: medi‑Cal (California's Medicaid program) and Covered California Health Plan (the state's primary exchange). The proposed regulation requiring proof of citizenship before signing up for these plans was just proposed by CMS in October 2014 in response to a court order. The regulation has not yet been finalized and will be published in the Federal Register soon. The regulations, if they come into effect, will likely be challenged. However, they may also be a good idea for state and federal governments because it will enable them to collect data on the number of people who are ineligible for coverage.

People who do not have an immigration status that makes them eligible for health care coverage can still buy private health insurance through Covered California. There aren't any tax credits available for undocumented immigrants buying insurance outside the exchange, but self-employed workers are still allowed to deduct the premiums from their taxes if their individual income is below 400% of the poverty level (around $47k for a family of 4). They still have two options for tax-free coverage: the Medi‑Cal program or a Covered California Health Plan. Medi‑Cal can be achieved with a "broad access" policy that is purchased through Covered California but is less comprehensive than the plan sold to someone who has an immigration status that makes them eligible to buy insurance through Covered California. The second option, though, is preferred.

This post will describe how to identify yourself as an unauthorized immigrant buying health insurance in California and why you should choose to do so even if you cannot qualify for subsidies on another exchange. I will also discuss how these plans can help you pay for full medical costs out of pocket like some plans outside of insurance exchanges do.

Identifying yourself as an ineligible immigrant in Covered California

Covered California requires you to fill out a "declaration of immigration status form" and tell them if you are a US citizen or not. By completing this form, you will be able to buy insurance through the exchange even though you cannot qualify for subsidies. You can make your choice in a health care plan in the same way as someone who has an eligible immigration status and lives in California. For example, let's say that I am a Mexican citizen but have lived in the US for many years and buy health insurance on the exchange while being married. I earn $2,000 per month from selling croissants through my website. My husband also earns $2,000 per month as an Uber driver. We expect to file taxes jointly and have two kids under the age of 10. We need health care insurance because we get sick or injured and want a safety net in case we cannot pay for expensive medical expenses out of pocket.

If I try to buy insurance through Covered California, I will be asked whether or not I am a US citizen. If I am not a citizen, I answer the following question: "I am an immigrant authorized to work in the US for (INSERT EMPLOYER)". Then, when asked "Are you a US citizen?", my answer is "No".

Questions about citizenship are used by the federal government to enforce immigration laws. Nonetheless, they may also help the state and federal governments get a better picture of how many people are not eligible for coverage. It's important to note that it is legal for unauthorized immigrants to buy health insurance, but they won't qualify for any subsidies (e.g., premium tax credits or cost-sharing reductions). However, there are other ways to get financial assistance paying for health insurance.

Other solutions to undocumented immigrants' financial problems

People who are not U.S. citizens cannot receive tax breaks for health insurance. Nevertheless, there are other options that will reduce the burden on unauthorized immigrants from paying medical bills out of pocket. For example, there is a way to have full coverage without paying any premiums at all. Under "Qualified Individuals" we can list our dependents or low-income children in order to receive Medicaid or Medi‑Cal benefits for them instead of the parents (Medicaid eligibility is determined by age and income).

Ultimately, what I would like to see is a system where unauthorized immigrants who live in the US but work outside of it (e.g. Uber drivers, Uber Eats drivers, etc.) would be able to buy health insurance as individuals. The idea is that they could get a group plan with people who fulfill similar profiles to themselves. Their incomes would be combined in the group plan and then insurance companies could determine how much each person should pay for premiums and deductibles without having to ask for immigration status information or have employers file a form I-9.

I hope that this post helped you understand how Covered California plans can help unauthorized immigrants pay for medical expenses and more accurately reflect the number of people who are not eligible for coverage but still buy it. Please leave a comment if you have other questions or thoughts about this topic. I would love to hear from you.

Tweet

Follow @nathaliehugard

Note: As I mentioned in the post, it is true that unauthorized immigrants can buy health insurance in California through the exchange. However, they will not qualify for tax credits or cost-sharing reductions.

Conclusion

It is true that unauthorized immigrants can buy health insurance in California through the exchange. However, they will not qualify for tax credits or cost-sharing reductions. There are ways, however, to get insurance at a cheaper price without subsidies. This post will explain how this can be achieved and what other options there are for undocumented immigrants to avoid the high costs of medical bills each year.

Covered California plans can help you pay for full medical costs out of pocket like some plans outside of insurance exchanges do. Questions about citizenship are used by the federal government to enforce immigration laws. Nonetheless, they may also help the state and federal governments get a better picture of how many people are not eligible for coverage but still buy it.