What does the requirement to get Health Insurance Subsidies of being
“Lawfully Present” 45 CFR 152.2 mean?
Covered CA – Accepted Documents to prove lawful status
Proof of Citizenship or US National Status
You must be Lawfully present – check this entire page for information and details of what “lawful presence” means, in the USA to get tax credits– Subsidies in Covered CA.
If you want coverage without subsidies, you can purchase direct from an Insurance Company, no extra charge for us to help you with that, with the only requirement being that you reside in CA, even if you don’t have legal status.
There is no charge for our help, when you appoint us as your agent by using the enrollment links in this website or using “find local help” in the upper right hand portion of the Covered CA Online Application.
We are not immigration attorney’s and can’t help you with that. If you have the documents, proving lawful status, we can help you get health insurance.
Learn More ===>
Covered CA Application page 27
How to find receipt # on green card
#Public Charge?
Can't get Medi-Cal or subsidies, but must have health insurance
- Covered California Fact Sheet and Talking Points
- CA Health & Human Services Public Charge Guide 2.2020 2 pages
- HealthCare.Gov: Health Coverage for Immigrants
- National Immigration Law Center: Top 5 Things to Know About Public Charge
- Public Charge Resource Sheet
- Proposed Changes Public Charge Determination Quick Guide
- Final Rule Inadmissibility on Public Charge Grounds 8 CFR Parts 103, 212, 213, 214, 245 and 248
- Ways to get around this rule or mitigate it?
- Organizations that can help assist you
- individuals seeking an immigrant visa must prove that they will obtain health insurance coverage within 30 days of entry in the United States or be able to pay for ‘reasonably foreseeable medical costs.’ Health Affairs.org *
- Special Enrollment when it's not Open Enrollment
VIDEO
Medi-Cal Qualification
The complete list of “qualified” immigrants includes those listed at
and Trafficking Victims as a result of) the Victims of Trafficking and Violence Protection Act of 2000, Pub. L. No. 106–386, § 107 (Oct. 28, 2000) and the
Trafficking Victims Protection Reauthorization Act of 2003, Pub. L. No. 108–193, § 4(a)(2) (Dec. 19, 2003).
See also “Table: A Quick Guide to Immigrant Eligibility for Affordable Care Act (ACA) and Key Federal Means-tested Programs,” National Immigration Law Center, September 2015, available at: https://www.nilc.org/document.html?id=844.
CA Residency Guidelines #FTB1031 2019
See our webpage on lawful presence & public charge
Residency for Medicare & Under 65
- A California resident is one who is in California for other than a temporary or transitory purpose; or Domiciled in California, but outside California for a temporary or transitory purpose. (ftb.ca.gov).
- Amount of time you spend in California versus amount of time you spend outside California;
- Location of your spouse and children;
- Location of your principal residence;
- Where your driver's license was issued;
- Where your vehicles are registered;
- Where you maintain your professional licenses;
- Where you are registered to vote;
- Location of the banks where you maintain accounts;
- Location of your doctors, dentists, accountants, and attorneys;
- Location of the church, temple or mosque, professional associations, or social and country clubs of which you are a member;
- Location of your real property and investments;
- Permanence of your work assignments in California; and
- Location of your social ties.
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In using these factors, it is the strength of your ties and closest connections not just the number of ties, that determines your residency (ftb.ca.gov/)
http://sanjivcpa.com to learn about various tax rules in California. Sanjiv Gupta CPA reviews rules related to residency in California.
Covered CA Certified Agent
No extra charge for complementary assistance
- Appoint us as your broker
- VIDEO on ARPA Stimulus and more Covered CA Subsidies
- Set Consultation Meeting via Phone, Skype or Zoom
- Instant Health Quotes, Subsidy Calculation & Enroll
Videos on how great agents are
Enrolling in health plans has helped people focus on their families and careers, and feel protected against unexpected medical issues.
Can an illegal immigrant buy health insurance in Covered CA?
Outside of Covered CA?
Can they get subsidies?
Bill pending for CA Covered CA to request permission from the Federal Government. This still won’t give APTC – subsidies to illegal immigrants. CA HealthLine 6.10.2016 SB 10 Covered CA SB 4 Medi-Cal See below – illegal immigrants can buy coverage now through an agent or direct from the Insurance Company.
Consumer Resources
Citizenship & Immigration Services uscis.gov
Verify work eligibility
Publication 519 US Tax Guide 1040 for Aliens
What you need to know – Covered CA 1 page pdf
nilc.org/lawfullypresent/ National Immigration Law Center
Western Poverty Law Center – Guide for Low Income CA to get coverage
Resources Tool Kit Rev 1.2015 includes Immigration Status, FAQ’s, Lawfully Present FAQ’s,
Here are samples of acceptable documents that Covered CA will accept as proof ♦
FAQ’s ♦
If you do NOT qualify, you can try an International Policy Under the Health Reform Law, you must be lawfully present to get coverage outside of Covered CA too. page 25 Specimen Evidence of Coverage or excerpt below from agents manual.
Covered CA Application ♦ 7 Page Worksheet to complete ONLINE Application
What happens if you have a severe chronic condition or major accident, you can’t qualify for Medi-Cal as you are not lawfully present, must a hospital treat you if you show up in the ER Emergency Room?
You could get deported!
In an emergency, hospitals, by law – EMTALA – must treat any patient in the U.S. until he or she is stabilized , regardless of the patient’s immigration status or ability to pay.
Yet, when it comes time for the hospitals to discharge these patients, the same standard doesn’t apply. Though hospitals are legally obligated to find suitable places to discharge patients (for example, to their homes, rehabilitation facilities or nursing homes), their insurance status makes all the difference. After reaching the patient’s family in Mexico, and discussing issues with the Mexican consulate, the case manager began making travel arrangements to a rehabilitation hospital in Mexico. Medical air transport to another country is an expensive proposition — roughly $50,000, depending on the equipment needed and the distance to the receiving facility in the patient’s home nation. From the hospital’s point of view, it was easy to see that this large one-time expense would be worthwhile. The transfer to Mexico would put a stop to the indefinite, uncompensated costs of continued hospitalization. Further, the transfer would open up the patient’s bed to a new (and presumably insured) patient. NPR 4.9.2016 *
Some hospitals have been deporting illegal immigrants even though the U.S. government is the only authority that can perform this action. Medical repatriation is considered a human rights violation mainly because many of these hospitals act as “unauthorized immigration officers.” Medical news today 4.23.2014 * Forbes 2.26.2018 *
Public Charge USCIS * Some places where undocumented can go US News 11.2.2016 *
Links & Resources
Our page on ER’s having to treat you till your stabilized.
News report of hospital sending uninsured patient back to his country * Wikipedia *
[youtube https://www.youtube.com/watch?v=QuwQFId1mag]
Technical and Research Resources
Covered CA Q & A on Immigration Status
Coverage and Issues for Immigrant Families – aspe.hhs.gov (pdf)
Attorney Guide to determine Citizen Status in Criminal Cases
Covered CA Webinar on verification of residency Proposed Regulations 5.2013 Covered CA Q & A Residency Medi-Cal Handbook
What if you are not lawfully present and you try to apply for coverage? Will it be reported to INS?
FAQ’s Kaiser Foundation kff.org/immigrants
New Obama Immigration may allow those to get Medi-Cal californiahealthline.org/2014/11/21
4 page – Immigration Status and Covered Ca hbex.coveredca.com
For purposes of this part the following definitions apply:
Creditable coverage means coverage of an individual as defined in section 2701(c)(1) of the Public Health Service Act as of March 23, 2010 and 45 CFR 146.113(a)(1).
Enrollee means an individual receiving coverage from a PCIP established under this section.
Lawfully present means
(1) A qualified alien as defined in section 431 of the Personal Responsibility and Work Opportunity Act (PRWORA) ( 8 U.S.C. 1641);
(2) An alien in nonimmigrant status who has not violated the terms of the status under which he or she was admitted or to which he or she has changed after admission;
(3) An alien who has been paroled into the United States pursuant to section 212(d)(5) of the Immigration and Nationality Act (INA) ( 8 U.S.C. 1182(d)(5)) for less than 1 year, except for an alien paroled for prosecution, for deferred inspection or pending removal proceedings;
(4) An alien who belongs to one of the following classes:
(i) Aliens currently in temporary resident status pursuant to section 210 or 245A of the INA ( 8 U.S.C. 1160 or 1255a, respectively);
(ii) Aliens currently under Temporary Protected Status (TPS) pursuant to section 244 of the INA ( 8 U.S.C. 1254a), and pending applicants for TPS who have been granted employment authorization;
(iii) Aliens who have been granted employment authorization under 8 CFR 274a.12(c)(9), (10), (16), (18), (20), (22), or (24);
(iv) Family Unity beneficiaries pursuant to section 301 of Public Law 101-649 as amended;
(v) Aliens currently under Deferred Enforced Departure (DED) pursuant to a decision made by the President;
(vi) Aliens currently in deferred action status;
(vii) Aliens whose visa petitions have been approved and who have a pending application for adjustment of status;
(5) A pending applicant for asylum under section 208(a) of the INA ( 8 U.S.C. 1158) or for withholding of removal under section 241(b)(3) of the INA ( 8 U.S.C. 1231) or under the Convention Against Torture who has been granted employment authorization, and such an applicant under the age of 14 who has had an application pending for at least 180 days;
(6) An alien who has been granted withholding of removal under the Convention Against Torture; or
(7) A child who has a pending application for Special Immigrant Juvenile status as described in section 101(a)(27)(J) of the INA ( 8 U.S.C. 1101(a)(27)(J)).
(8)Exception. An individual with deferred action under the Department of Homeland Security’s deferred action for childhood arrivals process, as described in the Secretary of Homeland Security’s June 15, 2012, memorandum, shall not be considered to be lawfully present with respect to any of the above categories in paragraphs (1) through (7) of this definition.
Out-of-pocket costs means the sum of the annual deductible and the other annual out-of-pocket expenses, other than for premiums, required to be paid under the program.
Pre-Existing condition exclusion has the meaning given such term in 45 CFR 144.103.
Pre-Existing Condition Insurance Plan (PCIP) means the temporary high risk health insurance pool plan (sometimes referred to as a “qualified high risk pool”) that provides coverage in a State, or combination of States, in accordance with the requirements of section 1101 of the Affordable Care Act and this part. The term “PCIP program” is generally used to describe the national program the Secretary is charged with carrying out, under which States or non-profit entities operate individual PCIPs.
Resident means an individual who has been legally domiciled in a State.
Service Area refers to the geographic area encompassing an entire State or States in which PCIP furnishes benefits.
State refers each of the 50 States and the District of Columbia.
8 US Code §1641 Definitions
(A)resides in the same household as a parent who has been battered or subjected to extreme cruelty in the United States by that parent’s spouse or by a member of the spouse’s family residing in the same household as the parent and the spouse consented or acquiesced to such battery or cruelty, but only if (in the opinion of the agency providing such benefits) there is a substantial connection between such battery or cruelty and the need for the benefits to be provided; and
[1] So in original. The semicolon probably should be a comma.
[2] So in original. The period probably should be a comma.[3] So in original. The semicolon probably should be “, or”.
Child & Related Pages
judge blocks Trump’s immigration rule on public benefits
https://www.latimes.com/world-nation/story/2020-11-03/judge-blocks-trump-immigration-public-charge-rule
FAQ’s from updated webpages
However, the Blue Cross Application doesn’t ask the question. Maybe the rules have become less stringent since 2014? I will grant that the Confidential Agent Manual for 2016 page 16 uses the term “resident” not lawfully present. The 2016 Blue Cross Direct Page 29 EOC uses the term Reside and not lawfully present. 45 CFR 147.104 (a) Guaranteed availability of coverage in the individual and group market.
Subject to paragraphs (b) through (d) of this section, [Open and Special Enrollment] a health insurance issuer that offers health insurance coverage in the individual, small group, or large group market in a State must offer to any individual or employer in the State all products that are approved for sale in the applicable market, and must accept any individual or employer that applies for any of those products. (e) Marketing. A health insurance issuer and its officials, employees, agents and representatives must comply with any applicable state laws and regulations regarding marketing by health insurance issuers and cannot employ marketing practices or benefit designs that will have the effect of discouraging the enrollment of individuals with significant health needs in health insurance coverage or discriminate based on an individual’s race, color, national origin, present or predicted disability, age, sex, gender identity, sexual orientation, expected length of life, degree of medical dependency, quality of life, or other health conditions.
One not lawfully present has an exemption from the mandat>e.
I’m 65 now and have worked and paid taxes into Medicare for 50 years. I’m not lawfully present. Can I still enroll and not risk getting deported?
See this page for the Answer
Hello sir,
can you please advise me with this question and what I have to do.
I am applying for medical and I am a married man ,but my wife and kids are not here at this time
do I have to fill as married filling jointly or separately for my household and is there any difference between both?
Thank you so much.
1st off, we only get compensated when you choose us as your broker, no extra charge. Are you willing to do that?
2nd – Are you talking about Medi-Cal for low income – see chart or Covered CA with Subsidies?
Get Covered CA Quote & subsidy calculation, no extra charge for our service, help and expertise.
Here’s our webpage on the mandate for Covered CA subsidies to file jointly.
Where are your wife & kids?
Is there a concern about the public charge rule?
When you file taxes, will you be showing your family as dependents?
Here’s the tax guide for aliens # 519
So, if you want Covered CA Subsidies, you must file jointly.
There are some exceptions…. Why isn’t your family here?
Here’s the definition for Medi-Cal
At the end of the year, when you file taxes, how will your family show up?
What is your MAGI Income? Foreign Income?
Get the quote, answer the questions and if we can be your agent, we’ll do the rest of the research.
You’ve come to the right site, if you want research backed up with a citation to the actual law or rule. Over the phone, you’re likely to get just a wild guess.
After you get the quotes and respond on your tax filing, MAGI income, etc. If you want to do a Zoom or Skype meeting with screen sharing, you can set a time here
https://steveshorr.com/intro/set-a-meeting/
See the commentary here, about how confusing these questions can get and my own CPA along with Covered CA say to ask your own tax professional.
https://taxcredits.healthreformquotes.com/magi/magi-faqs/capital-gains-line-13/#comment-13580
See our webpage on reporting foreign income
https://taxcredits.healthreformquotes.com/magi/magi-faqs/foreign-income-irc-911/
65 paid into Medicare, not lawfully present. What happens? https://medicare.healthreformquotes.com/sign-medicare/rules-get-part-hospital-medicare-no-charge/#comment-25168
https://www.uscis.gov/greencard/public-charge
I have a Mexican Passport and USA Permanent Residency Green Card. Do I need a visa to visit Peru and return to USA?
Do I need a Tourist Visa for Peru?
In general citizens of the countries in the listing below do NOT have to apply for a visa at an embassy or consulate before entering Peru.
Below listed countries can get a tourist visa at airport immigrations or any other Peruvian border without applying for it at an embassy or consulate
North America: Citizens of the United States, Canada and Mexico
Travelers need a passport valid at least half a year with at least 2 free pages in the visa section when entering Peru.
The maximum stay in Peru on a tourist visa is 183 days (per year)!
You can’t extent your tourist visa once you entered Peru!
foreign visitors must have a return or onward ticket /passage when entering the country. While this law isn’t enforced by Peruvian immigrations, airlines often demand to see a return or onward ticket when checking in for a flight to Peru. https://www.limaeasy.com/peru-info/peruvian-visa#tourist-visa-peru
https://cibtvisas.com/requirements
https://cdn.www.gob.pe/uploads/document/file/337769/Requerimientos_de_visa_para_ciudadanos_extranjeros.pdf
embassyofperu.org/los-angeles
Mr. Ricardo Romero Talledo
[email protected]
The embassy website refers one to this website https://www.peru.travel/en-us/
[youtube https://www.youtube.com/watch?v=-ahnJtRIv4w&w=560&h=315%5D
New proposed rule Mike penalize immigrants for Using Medi cal
https://www.npr.org/2018/08/20/640262463/trump-administration-moves-to-penalize-immigrants-for-using-government-benefits
It’s a REAL rule now! https://www.latimes.com/politics/story/2019-08-12/immigrants-green-cards-medicaid-food-stamps
me and my wife are only visitors with tourist visa,
she is currently pregnant in last months,
my income in another country is about 70 thousand US dollar per year.
she is not working, family size 4.
so can we apply for any option for maternity services,
because it is very expensive in California,
$70k when looking at the Covered CA Income Chart appears to qualify your wife for the MCAP Medi-Cal Access Program – Pregnant Women
However, all the programs, private direct coverage, Covered CA and Medi-Cal require permanent residency, which it doesn’t appear you have under a USA Visitor Visa’s nor does it meet Federal or State Requirements 45 CFR 155.305 intends to reside or seeking employment Our webpage on Residency – CA Franchise Tax Board # 1031
You might try International Travel Policies – but be careful of Pre X existing condition clauses
How about going back to your home country? I hope it’s safe and not war-torn.
I’m not an immigration attorney, nor salaried Medi-Cal eligibility worker, you might want to follow the links above to double check.
I appreciate your comprehensive and conclusive answer, still I am searching for travel or international insurance with maternity coverage for current pregnancy, because we have twins and I preferred to receive care here in USA.
Did you click on the link and review what we have with Insubuy?
I’m checking, but I doubt I’ll find anything.
What kind of a premium would you be willing to pay, being as there is such a short time till delivery, the estimated cost for twins is $105K per CBSNews.com citing the American Journal of Obstetrics & Gynecology.
While the ACA – Obamacare is mandated to cover maternity, there is still the Medical Loss Ratio which means the Insurance Company keeps 20% of the premium and pays out 80%.
Thank you sir for detailed explanation. Appreciate your compassion.
I will arrange for self payment.
Thanks again
LA Times article on Chinese come in and have their babies
But it didn’t really mention anything about how they’re paying for the maternity cost
http://www.latimes.com/local/lanow/la-me-ln-birth-tourism-persists-20161220-story.html
More on birth tourism
http://www.medicaltourismmag.com/
Here’s the answer on insbuys website
They say that basically no coverage is available
https://www.insubuy.com/us-visitor-insurance-for-pregnancy-coverage/
Wikipedia on birth tourism
https://en.wikipedia.org/wiki/Birth_tourism
Off exchange plans may not require lawfully present documentation on the part of the prospective health plan member. Any plan sold through the exchange and eligible for APTC can only be sold to lawfully present individuals that can provide proof. Eligibilty conditions for enrollment in a specific health plan can usually be found in the carrier’s Evidence of Coverage.
Thanks. We appreciate comments and clarification from other knowledegable brokers.
I have my lady I’ve been with for 25 years that has a social security number …but her immigration status wasn’t fixed…….I am getting the adjustment of lpr [lawful presence?] filed this week….we got married on the dec 31….she’s been here for 35 years. ..
I need to get her real coverage….I was stuck overseas and just came back yesterday!!!
What can I do? Help…. she has a cancer…..
If you want subsidies in Covered CA, send us proof of her lawful presence. If you can pay full pop – we can do it outside of Covered CA at open enrollment. Click here for quotes.