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In this explainer video, Shelby Gonzales, Senior Policy Analyst, provides a detailed explanation of how to assist lawfully present individuals who are not eligible for Medicaid due to their immigration status and may be eligible for premium tax credits even if their income is below the poverty line.

Presentation Slides

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Overview: Special Subsidy Eligibility

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• Marketplace subsidy eligibility for lawfully present individuals who do not qualify for Medicaid based on immigration status
• Extra steps to get to correct eligibility determination

 

Medicaid Eligibility Based on Status

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• Statuses eligible for Medicaid
• Five-year bar
• State flexibility

 

Eligibility for Marketplace Enrollment

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• Statuses considered lawfully present for the purposes of Marketplace enrollment

 

Example: Application incorrectly determines individual eligible for Medicaid

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• Step 1: Identify Medicaid eligibility based on status
• Step 2: Identify eligibility for Marketplace enrollment
• Step 3: Help consumer complete the application
• Step 4: Help complete extra steps to get correct eligibility

 

Example: Application incorrectly determines individual not eligible for Medicaid or premium tax credits

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• Step 1 and 2: Identifying eligibility for Medicaid and Marketplace enrollment
• Step 3: Help consumer complete the application
• Step 4: Help complete extra steps to get correct eligibility

 

Tips and Notes

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• Tips to prevent extra work for eligible individuals
• In states with more restrictive Medicaid eligibility

 

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Additional Resources

Webinar: Immigrant Eligibility for Health Coverage Programs | View webinar

NILC | Tips for Addressing Immigrant Families’ Concerns When Applying for Health Coverage Programs | View resource

Reference Guide: Documents Used to Verify Immigration Status | View resource

Key Facts: Immigrant Eligibility for Health Insurance Affordability Programs | View key facts

Key Facts: Application Process for Families that Include Immigrants | View key facts

Beyond the Basics Webinar Series | View all webinars

Key Facts About Health Reform | View all key facts