Public Payers News

CMS Releases Guidelines for Sponsored Immigrants’ Public Benefits

At a time when immigrant healthcare has national attention, CMS is revising the guidelines for sponsored immigrants to receive public benefits, reimbursed by the sponsor.

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Source: Getty

By Kelsey Waddill

- CMS released a letter detailing the agency’s strategy for determining a sponsored immigrant’s eligibility for public benefits such as Medicaid and CHIP coverage. The letter came in response to President Trump’s “Memorandum on Enforcing the Legal Responsibilities of Sponsors of Aliens,” issued on May 2019.

“Today’s guidance reminds states of their obligation to comply with the sponsor deeming requirements, along with information on the repayment and recovery of costs requirements,” the press release explained.

Legal immigrants experience a high rate of uninsurance. However, they can receive healthcare through a sponsor who reimburses the government for their care under a Form I-864 Affidavit of Support or a Form I-864A Contract.

The letter revolved around the sponsor’s financial condition and obligations, as these are attributed to the immigrant.

Throughout the text, CMS emphasized the freedom of states when setting procedures. As long as the letter’s guidelines are met, states have the freedom to apply their state plans. CMS also recognized the challenge of implementing this plan and set the deadline for practicable implementation with that in mind.

READ MORE: Noncitizens, Lawful Immigrants Much More Likely to Be Uninsured

After stating the four possible exemptions, such as victims of battery and those who are incapable of obtaining food and shelter outside of federal assistance, the letter listed potential approaches to the sponsor deeming process which the agency found appropriate.

CMS supported states’ use of Modified Adjusted Gross Income (MAGI) and Supplemental Security Income (SSI) to determine a potential sponsor’s fiscal eligibility, as used for Medicaid and CHIP beneficiaries.

To determine what income or resources qualify an individual to be a sponsor, states can apply Medicaid and CHIP financial eligibility requirements using MAGI or SSI. The approaches can also be used to analyze how much of a sponsor’s income or resources can be applied to the immigrant by identifying the sponsor’s needs and those of the sponsor’s dependents. Lastly, they are also useful when a parent or spouse is the immigrant’s sponsor.

Alternatively or in addition to this approach, if the state plan disregards certain income or resources, the state can use this disregard to determine how much of a sponsor’s income may be available for the immigrant’s use.

When states seek reimbursement for payments made on behalf of the immigrant, the letter affirmed every state’s right to seek reimbursement from the immigrant’s sponsors but not from the immigrant.

READ MORE: Trump Budget Proposes Medicaid Block Grants, Big Medicare Cuts

CMS then clarified the process for acquiring a reimbursement, which starts with the state sending a written request for reimbursement directly to the sponsor. The request must encompass a breakdown of the cost. If there is no reply or compliance within 45 days, the state may sue the sponsor.

Sponsors are not responsible for reimbursement if the sponsored immigrant is eligible for CHIP or is a pregnant woman who is eligible for Medicaid, if the treatment was for emergency care that can be covered under Medicaid, or if the Affidavit of Support which identifies the immigrant’s sponsor is not in effect.

The sponsor, however, is held liable for the reimbursement in other cases of exemption, such as a victim of battery or an indigent immigrant.

CMS offered a number of ways to identify eligible individuals, including using the Systematic Alien Verification for Entitlements (SAVE) program and the Social Security Administration (SSA). The immigrants must ensure that their states receive the sponsor’s income and resource data.

If a state has to change any part of their process in order to comply with these guidelines, they must clearly inform sponsored immigrants and their sponsors.

READ MORE: CMS Adds Star Ratings System to Show Plan Quality on ACA Exchanges

States may receive federal funding to smooth this transition. Enhanced Federal Financial Participation (FFP) at a 90 percent federal matching rate is available to cover new Medicaid eligibility determination systems and states can secure 75 percent federal funding for maintenance and operations of those systems.

CMS asked states to take steps to prevent discrimination based on national origin due to these changes. The federal agencies also asked that beneficiaries and the public recognize that these changes are solely applicable to sponsored immigrants whose sponsors signed either a Form I-864 Affidavit of Support or a Form I-864A Contract.

CMS will also release Medicaid and CHIP State Plan Amendment pages in response to the president’s memorandum.

All these changes seek to rectify the out-of-date and unenforced policies laid out in the president’s memorandum.

“Several major means-tested public benefits programs — including the Supplemental Nutrition Assistance Program (SNAP), Medicaid, and Temporary Assistance for Needy Families (TANF) — require updated procedures and guidance to ensure that the requirements of existing law are enforced,” the president’s memorandum stated. “The purpose of this memorandum is to direct relevant agencies to update or issue procedures, guidance, and regulations, as needed, to ensure that ineligible non-citizens do not receive means-tested public benefits, in better compliance with the law.”

The guidelines come at a time when immigrant healthcare is at the center of political debate. A little over a month after President Trump signed the “Memorandum on Enforcing the Legal Responsibilities of Sponsors of Aliens,” ten Democratic candidates behind their debate podiums unanimously raised their hands in support of undocumented immigrants receiving public healthcare benefits. Additionally, the Department of Homeland Security released a rule this month that some say hinders immigrants’ access to care.

As CMS responds to the memorandum and the states react to comply, the changes could ensure that the subject of immigrant healthcare — sponsored, undocumented, or otherwise — remains key to the election campaign.