Dreamers in search of affordable health care (Part 2)

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Huntington Park resident Stephanie Martinez was just five years old when her parents brought her illegally to live in the United States. Now 23, she’s one of an estimated 853,000 people in the country who have temporary, quasi-legal status through President Obama’s Deferred Action for Childhood Arrivals (DACA) program enacted in 2012.

Today she has health insurance, but like so many in her situation the road to coverage was filled with obstacles, complicated by her family’s mixed-immigration status and a combined household income slightly too high to qualify for health subsidies but too low to pay for private insurance.

Under DACA, young people between the ages of 16 and 31 who were brought to the country illegally as children can temporarily avoid deportation and work legally in the U.S., provided they meet certain eligibility requirements, such as attending or completing high school and passing a criminal background check.

For many who have qualified there’s a sense of normalcy, of no longer living in society’s shadow, that is unless like Stephanie you live in a “mixed-status” home, where some members of your family are citizens, legal residents, or DACA recipients, but others are undocumented.

When enacted in 2014, the Affordable Care Act (ACA)—also known as Obamacare—explicitly excluded DACA recipients – often referred to as “dreamers” – and undocumented immigrants from buying health insurance from state or federally sponsored health insurance marketplaces and the premium tax credits, subsidies and other savings on marketplace plans.

“It’s political,” Gabrielle Lessard, a health policy attorney with the National Immigration Law Center told EGP, explaining that the Obama Administration knew it would face a backlash if the undocumented and DACA recipients were allowed to take part in the program, even though they pay into the tax pool that subsides the coverage.

In her early twenties, Stephanie wasn’t worried about not having health insurance; after all, she’s young and healthy. The same couldn’t be said for her father Alvaro Martinez who suffers from diabetes and needs ongoing medical attention, but struggles to get care because he is undocumented.

So last year, when Stephanie’s father asked her to apply for health coverage for the family through the state’s health exchange, Covered California, she gladly filled out the application at a local health fair sponsored by AltaMed.

Marketing Coordinator Laura Ochoa works on AltaMed’s “Dreamers and Medi-Cal” program, which screens DACA recipients for eligibility for the state’s Medi-Cal program for low-income families. DACA recipients can qualify for coverage under the state’s recognition of the Permanently Residing in the United States Under Color of Law (PRUCOL), a public benefits eligibility category created by the courts.

According to US immigration officials, “an individual may be eligible for Medicaid (Medi-Cal), if the individual is an alien residing in the United States with the knowledge and permission of the Immigration and Naturalization Services (INS) and the INS does not contemplate enforcing the alien’s departure,” as in the case of DACA recipients.

California and New York see DACA recipients as having met the PRUCOL standard, Lessard said.

Requirements to qualify for California Medi-Cal for DACA recipients include having a valid work permit, a social security number, identification and proof they are low-income, Ochoa told EGP.

But Stephanie’s case was more complicated. Her family’s combined household income of $46,000 exceeded the maximum Federal Poverty Level (FPL) of 138%, or $33,534 a year for a family of four to qualify for Medi-Cal. Their mixed-immigration status, her parents are still undocumented, also made group coverage through the health exchange unlikely. Private insurance is too expensive, Stephanie said.

A study by the UCLA Labor Center’s Dream Resource Center found that one in seventeen children in the U.S. live in mixed-immigration status homes.

“Mixed-status families are a growing demographic in the United States” and their health outcome provides insight into the health of the future of the U.S. population, according to “Undocumented and Uninsured; A five part Report on Immigrant Youth and the Struggle to Access Health Care in California.”

Stephanie attends Santa Monica College and works part-time. She says she’s still dependent on her family for necessities like food and the roof over her head.

According to Ochoa, Stephanie’s best option is to apply as an individual. She said students who earn about $10,000 could qualify for Medi-Cal even if their parents claim them as deductions.

“If they are part-time students and part-time workers, most likely they are eligible,” she added.

Earlier this year, Stephanie applied as an individual and was approved for Medi-Cal coverage effective June 1 through the L.A. Care Health Plan.

While exploring her family’s options, Stephanie also discovered that Mr. Martinez qualifies for coverage under Los Angeles County’s Ability to Pay (ATP) program, which offers affordable health services to L.A. county residents who do not qualify for Medi-Cal, Medicare or Covered California plans, regardless of their immigration status.

The program is free to “individuals with incomes at or below $1,367 per month” and has a “low-cost [option] for individuals with incomes above $1,367 per month,” which works for Mr. Martinez.

ATP applicants only pay for the month they visit the hospital or its partner clinics. Services include doctor and ER visits, hospital care, tests and medicines, explains the Health Services of L.A. County website.

The “Undocumented and Uninsured” study states that the health of undocumented Californians is crucial to the wellbeing of the state.

They recommend expanding ACA to all Californians regardless of their immigration status or income level.

“There’s no such thing as individual health; all health is public and communal,” states the study.

A bill by state Sen. Ricardo Lara, SB 10, the Health For All Waiver, recently approved by state lawmakers, could allow undocumented immigrants to buy health coverage through the Covered California online marketplace, but would first require federal approval.

Martinez told EGP she is happy she now has health insurance, but still worries about her father’s ongoing health issues. “He has more need than me,” she said.

Part 3 explores the penalties Dreamers without health insurance face and takes a closer look at SB 10, which could allow DACA recipients and undocumented immigrants to buy health care plans through Covered California.

[This story was originally published by EGP News.]