The National Immigration Law Center advocates for equal treatment and opportunities for low-income immigrants. The document discusses upcoming immigration reform and the Affordable Care Act being implemented. It summarizes that lawfully present immigrants can access Medicaid/CHIP and marketplaces under the ACA, while undocumented immigrants only qualify for emergency Medicaid. The Senate bill proposes a 13-year path to citizenship including Registered Provisional Immigrant status. However, immigrants would still face barriers to health coverage even with reform, as RPI status holders would not qualify for ACA subsidies.

1. Immigration Reform
&
Health Care Access
Alvaro M. Huerta, Esq.
National Immigration Law Center
July 30, 2013

2. National Immigration Law Center
• Our mission is to defend & advance the rights & opportunities
of low-income immigrants and their family members.
• We envision a U.S. society in which all people — regardless of
their race, gender, immigration or economic status — are
treated equally, fairly, and humanely, have equal access to
justice, education, government resources and economic
opportunities, and are able to achieve their full potential as
human beings.
• Founded in 1979.
• Offices in Los Angeles, Oakland, and Washington, DC.

3. A Historic Moment
• Immigration Reform being debated in
Congress, including a pathway to citizenship for up to 11
million living in U.S.
• Health Reform (ACA) about to be implemented;
debates about coverage continue in the states.
• Even with the ACA and immigration reform, barriers to
health coverage will remain for many immigrants.
• Changing demographics make it imperative to
address the needs of immigrant families in both systems.

4. Immigrants and the ACA
Lawfully Present Immigrants
• Medicaid/CHIP
– “Qualified” immigrants
– 5-year bar
• Marketplace/Exchange
– “Lawfully present”*
– No 5-year bar
– Eligible for tax credits and
cost-sharing reductions
– Subject to individual
mandate
Undocumented
• Emergency Medicaid
• No Marketplace/Exchange
access
• No ACA subsidies
• Exempt from individual
mandate
• Remain eligible for FQHCs

5. Health Coverage of Immigrants
• More likely to be uninsured:
– 47% of non-citizens are uninsured, compared to 16% of U.S.
born citizens1
– 71% of undocumented adults are uninsured.
– But citizens make up the bulk of the uninsured (80%).2
• Children of Immigrants Lack Coverage:2
– 45-55% of low-income immigrant children in the U.S. are
uninsured.
– 17% of low-income citizen children lack coverage.
– 29% of undocumented children lack insurance
• Use Less Health Care:
– Immigrants use less health care,
– Per capita, immigrant use of health services costs less than half
the cost for average citizen.

6. Immigration Reform Bills
Senate
• Bipartisan “Gang of 8” Senators introduced “Border
Security, Economic Opportunity, and Immigration
Modernization Act” (S. 744) on April 16, 2013
• Senate Judiciary Committee markup of S. 744 - May 2013
(includes Senator Feinstein)
• Senate passed the amended bill on June 27, 2013, with a vote
of 68-32

7. Immigration Reform Bills
House
• Bipartisan “Task Force of 7”* still working on bill
(includes Reps. Becerra and Lofgren)
• Unclear if there will be a “road to citizenship”
• Piecemeal approach possible
• What was the hang up? – HEALTH CARE!
– *Rep. Labrador leaves the group

8. Key Provisions in S. 744
• Road to Citizenship
• 4 New Statuses:
1) Registered Provisional Immigrant (RPI)
2) Blue card
3) Family V visas
4) W non-immigrant visas
• Mandatory E-Verify
• Improves current paths:
– Fixes family backlog
• BUT eliminates sponsoring siblings (in future)
• Eliminates diversity visas
– Increases limits of U-Visas from 10,000 to 18,000
• Future flow – “guestworkers”

9. Registered Provisional
Immigrant Status (RPI)
ELIGIBILITY:
1. Be physically in the U.S. on or before December 31, 2011
2. Maintain continuous presence up until the date of application
3. Settle any unpaid taxes; AND
4. Not have certain offenses such as:
• Felony
• Aggravated Felony
• 3 or more misdemeanors (other than minor traffic violations)
• Gang activity
• Certain foreign offenses
• Unlawful voting
• Limited waiver available for some offenses

10. The S. 744 Road Map to Citizenship
RPI
application
• Year 1
• $500 fine
+ fees
RPI
renewal
• Year 6
• $500 fine
+ fees
Green card
application
• Year 10
• $1000 fine
• $1070 fees
U.S. citizen
• Year 13
• $680 fees
Total:
• 13 years
• $3750 +
fees

11. Rights with RPI Status
• Authorized to work while in RPI status (will be issued
SSN and RPI card)
• Considered admitted and lawfully present while in RPI
status (BUT not eligible for ACA subsidies)
• Authorized to travel outside of the U.S. for up to 180
days

12. DREAM Timeline
• May apply for RPI status
• At the end of 5 years in RPI status:
– DREAMers can apply for LPR status
– AND immediately apply for citizenship (time
in RPI status counts toward naturalization)

13. Access to Health Care
After Immigration Reform
RPIs/Blue Card/V Visas
• Medicaid/CHIP
– Not eligible during status
– 5-year wait after LPR
• Marketplace/Exchange
– Not eligible for ACA
subsidies
• Excluded even though
“lawfully present”
– Eligible after LPR (with no
waiting period)
• Exempt from individual
mandate
During Status
• Emergency Medicaid
• Can buy full price insurance
in Marketplace/Exchange
• Remain eligible for FQHCs
• Corker-Hoeven Amendment
– Excludes B and F Visa holders
from ACA subsidies
– Social Security and Medicare

14. National Immigration Law Center: www.nilc.org
National Council of La Raza: www.nclr.org
National Health Law Program: www.healthlaw.org
Center on Budget and Policy Priorities: www.cbpp.org
California Immigrant Policy Center: www.caimmigrant.org
Resources on
Immigrants and Benefits

15. Alvaro M. Huerta
Skadden Fellow & Staff Attorney
National Immigration Law Center
huerta@nilc.org
(213) 674-2829