I would like to know whether and when any changes in policy took place
regarding Medicare eligibility for immigrants.  Specifically, how long
has the requirement - that the immigrant has to have lived in this
country continuously for 5 years in order to become eligible - been in
existence?

I have an in-law who has become a permanent resident in the last year.
 She is a senior citizen.  My parents-in-law were told by a Medicare
representative that as long as they were willing to "sponsor" my
grandmother-in-law and she had obtained permanent resident status,
that she would be considered eligible for Medicare.  So my
parents-in-law went through the process of getting a green card for
the grandmoter and brought her into the country from overseas, with
the idea that they would take care of her in her final days with
Medicare assistance.

However, when my parents-in-law followed up, they were informed (I
think) that there had been a change in eligibility requirements, which
now says that immigrants have to be in this country for the last 5
years before they become eligible.    This is a problem, as she has
not been in the country for the last 5 years continuously.  My
parents-in-law hope to appeal.   In order to do so, they need to know
that the grandmother would have been eligible under the former
requirements (to rule out that they had been misinformed) and when the
change took place.  They hope to be able to say in the appeal that
when they initiated their application for Medicare, the grandmother
was eligible.

I tried looking myself for information on Medicare eligibility
requirements and found information for Medicare in my state (MA).  But
when I gave this information to my in-laws, they said that they needed
information regarding federal Medicare, not our state Medicare
program.  (Indeed there were changes made regarding Medicare
eligibility in Massachusetts, in August 2003).  I don't know very much
about Medicare, so I didn't question this, but if you find such a
distinction doesn't make sense, please explain why.

Here is what I found regarding state changes.  
http://www.state.ma.us/sec/spr/sprpub/013004e.pdf 
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=19229 

Please let me know if you need clarification or more information from
me.  You'll potentially be helping a very sweet blind grandmother.

Thanks,  

Marissa

Hello mmerse-ga,

This change in federal law occurred as a result of the "The Personal
Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L.
104-193)?, also known as the ?Welfare Reform Bill.?


However, apparently Massachusetts did not change until July of 2003.



For more information on federal eligibility see:


US Department of Health and Human Services
Centers for Medicare & Medicaid Services
Immigrant Eligibility for Medicaid and SCHIP
http://www.cms.hhs.gov/immigrants/
?Immigrant Eligibility for Medicaid and SCHIP 
The Personal Responsibility and Work Opportunity Reconciliation Act of
1996 (PRWORA), as amended, significantly changed the eligibility of
non-citizens for Federal means-tested public benefits, including
Medicaid and the State Children's Health Insurance Program (SCHIP). As
a general rule, only "qualified aliens" may be eligible for coverage.
In addition, some immigrants cannot be eligible for coverage for five
years from the date they enter the country as a qualified alien.
Finally, in determining the eligibility of some immigrants, the income
and resources of the immigrant's sponsor must be counted in
determining the immigrant's eligibility. The questions and answers
provided on this Website help to explain the current rules governing
immigrants' eligibility for Medicaid and SCHIP.?

---

Five-Year Bar 

Certain immigrants are not eligible for Medicaid or SCHIP for five
years from the date they enter the United States in a qualified-alien
status.?


Click on ?Questions and answers on the application of the five-year
bar? to download the following document in PDF format.

Questions and Answers on the Five-Year Bar
http://www.cms.hhs.gov/immigrants/alien2.pdf
?Q4. Which immigrants are affected by the five-year bar?
The five-year bar only applies to qualified aliens who entered the
United States on or after August 22, 1996. In addition, several
categories of qualified aliens are exempt from the bar, regardless of
their date of entry into the country. (The exemptions are discussed in
question 5.) As a practical matter, the following qualified aliens are
subject to the five-year bar to eligibility for both Medicaid and
SCHIP (1) if the immigrant entered the United States on or after
August 22, 1996 and (2) unless the immigrant qualifies for one of the
exemptions discussed in question 5:
---Lawful permanent residents (LPRs);
---Aliens granted parole for at least one year;
---Battered aliens.
In addition, the following qualified aliens are subject to the
five-year bar to eligibility for separate state programs under SCHIP,
unless the immigrant qualifies for one of the exemptions discussed in
question 5:
---Members of a Federally-recognized Indian tribe; and
---American Indians born in Canada to whom §289 of the INA applies.

Q5. Which immigrants are exempt from application of the five-year bar?
The following qualified aliens are exempt from the five-year bar to
eligibility for both Medicaid and SCHIP:1
---Refugees;
---Asylees;
---Cuban and Haitian Entrants;
---Victims of a severe form of trafficking;
---Aliens whose deportation is being withheld;
---Qualified aliens who also are (1) an honorably discharged veteran,
(2) on active duty in the U.S. military or (3) the spouse (including a
surviving spouse who has not remarried) or unmarried dependent child
of an honorably discharged veteran or individual on active duty in the
U.S. military;
---Aliens admitted to the country as an Amerasian immigrant;2
---Legal permanent residents who first entered the country under
another exempt category (i.e. as a refugee, asylee, Cuban or Haitian
entrant, trafficking victim, or alien whose deportation was being
withheld) and who later converted to LPR status.
In addition, the five-year bar to eligibility for Medicaid only
(including Medicaid expansion programs under SCHIP) does not apply to
---Members of a Federally-recognized Indian tribe, as defined in 25
U.S.C. 450b(e); and
---American Indians born in Canada to whom §289 of the Immigration and
Nationality Act applies.

Q6. Does the five-year bar apply to immigrants who are applying for
coverage of emergency treatment only?
No. The five-year bar never applies to immigrants who are applying for
treatment of an emergency medical condition only. Thus, all immigrants
? both qualified and non-qualified aliens as well those who are
residing in the country in an undocumented status ? may be eligible
for treatment of an emergency medical condition only, provided that
they otherwise meet the eligibility criteria for the state?s Medicaid
program.?


========================================================================


Regarding State and Local programs:


Office of the Assistant Secretary for Planning & Evaluation  
HUMAN SERVICES POLICY  
Summary of Immigrant Eligibility Restrictions
Under Current Law As of 10/15/03
http://aspe.hhs.gov/hsp/immigration/restrictions-sum.htm
?IV.  State and Local Programs 
States have authority to determine immigrants? eligibility for state
and local programs, with some conditions.  (Sec 411, 412)

A.  Eligibility for state/local public benefits 
Undocumented immigrants are not eligible for state/local public
benefits unless the state passes a new law after 8/22/96 affirmatively
making them eligible.  No legislation is required to retain access to
state and local benefits for non­immigrants or aliens paroled into the
U.S. for less than 1 year.  (Sec 411(a))

B.  States may restrict eligibility 
States may restrict the eligibility of qualified aliens,
non­immigrants, and certain parolees.  They may not restrict
eligibility for:  refugees, asylees, or aliens whose deportation has
been withheld, during their first five years from entry; members of
the military, veterans, and their family members; and those who have
been credited with 40 qualifying quarters.  (Sec 412)

States may not deny access by any alien to state or local benefits
that meet the definition of excepted services described in Sec 411(b).
 States can now require an applicant for state or local public
benefits to provide proof of eligibility.  (Sec 413)?


========================================================================


A question similar to yours was addressed at the website of the
National Asian Pacific Center on Aging (NAPCA).


NAPCA.ORG
Medicare v.s Medicaid
http://www.napca.org/mvsm.html#A.781(1).
?Q.781(1). My mom is 71 years old and living in Taiwan. I want to
bring her to the U.S. so she can live with me. According to the new
law (welfare reform laws), I have to sponsor her and be responsible
for her financially. I will be able to support her daily living
expenses, would not be able to afford her health care costs. Are there
health insurance and services that can help with her health care? From
a reader in Lake Charles, LA

A.781(1). Since your mother would arrive in the U.S. after August 22,
1996 (when laws were passed limiting certain public benefits to
certain legal immigrants), your eligibility for government funded
health insurance is limited.

For those legal immigrants who arrived after August 22, 1996, there
are at least 17 States that provide State or locally funded medical
services to some or all immigrants. Some of the programs provide full
medical care comparable to Medicare, while others provide only certain
services. A few States have imposed residency requirements. This means
you might have to live in the State for a certain amount of time
before becoming eligible for particular health services. In some
States, the income of an immigrant's sponsor is counted as part of
what is available to help you with your health costs. All immigrants,
however, are still eligible for immunizations and the treatment of
communicable disease symptoms whether or not the symptoms are in fact
caused by the disease (like tuberculosis or hepatitis).

The other option is to enroll in a private insurance company that
offers health care coverage. The cost and types of health insurance
policies vary among States and from one company to the next. To learn
more about which insurance policies may be right for your mother,
contact your local insurance counseling and assistance program. In
Louisiana, you can contact the Senior Health Insurance Information
Program at 1-800-259-5301 or 1-504-342-0825. They provide information
about various types of health insurance available and can help you
find the right one for your parents.?


========================================================================


Apparently, Massachusetts was one of the states that provided services
to immigrants that did not meet the 5-year requirement.


MDRC.org
What Works in Welfare Reform
Evidence and Lessons to Guide TANF Reauthorization
What Did States Do?
http://www.mdrc.org/Reports2002/TANF/TANF-states_do.htm
?Twenty-three states have incorporated the federal law's 60-month time
limit, at the end of which a family's entire welfare grant can be
terminated. Shorter limits were established by 17 states. Eight states
have time limits that reduce rather than terminate benefits, and three
effectively have no time limit at all.?

---

?Massachusetts, Ohio, and Utah adopted time limits that are
significantly shorter than the federal 60-month maximum and have
enforced them strictly.?


Massachusetts Division of Medical Assistance
Frequently Asked Questions
http://www.state.ma.us/dma/questions/questionapp.htm#Anchor-Bac-22019
?Immigration status does not affect your eligibility for MassHealth,
but may affect the type of benefits MassHealth provides.?



However, in July of 2003, Massachusetts changed its MassHealth program.


As stated in the link that you provided:

Kaisernetwork.org
Daily Health Policy Report
Medicaid | Massachusetts Medicaid Program To End Coverage for About
10,000 Documented Immigrants
[Aug 06, 2003]
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=19229
?MassHealth, Massachusetts' Medicaid program, next week will end
coverage for about 10,000 documented immigrants because the state can
no longer afford to pay for their care, the Boston Globe reports.
Massachusetts has been paying the entire cost of documented
immigrants' benefits since 1996. Covering documented immigrants this
year would cost the state about $15 million, according to the Globe.
The federal government does not require states to cover documented
immigrants and does not provide states matching funds to cover care
for documented immigrants.?



See also:


MassLegal Network
MassHealth Update ?September 2003
http://www.masslegalservices.org/page/159340;cat_id=937
?10,000 adult legal immigrants lose MassHealth in August 2003.

In response to the 2004 budget, DMA terminated full MassHealth
coverage for adult ?special status? immigrants who are lawfully
present but not federally eligible for Medicaid. Termination notices
went out in July 2003 effective in August 2003. MLRI filed a lawsuit
(Lima v. Preston) to require DMA to identify federally eligible
immigrants and provide MassHealth Limited coverage for a broad range
of emergency conditions. The lawsuit did not succeed in stopping the
cuts, but did secure a statement from DMA that kidney dialysis and
insulin are covered regardless of immigrations status. What next??


NeighborhoodLaw.org
Important Information for Legal Immigrants Losing MassHealth Coverage
http://www.neighborhoodlaw.org/page/149698;cat_id=


========================================================================


You specifically asked about Medicare. According to Medicare.gov:


?Generally, you are eligible for Medicare if you or your spouse worked
for at least 10 years in Medicare-covered employment and you are 65
years old and a citizen or permanent resident of the United States.
You might also qualify for coverage if you are a younger person with a
disability or with End-Stage Renal disease (permanent kidney failure
requiring dialysis or transplant).?
http://www.medicare.gov/MedicareEligibility/Home.asp?dest=NAV|Home|GeneralEnrollment
(Click on ?Who is Eligible for Medicare??)



Regarding Medicare enrollment, Medicare.gov states the following:


?If you are not a U.S. citizen or a lawfully admitted alien who has
lived in the U.S. continuously for a five-year period, please contact
the Social Security Administration at 1-800-772-1213 for your Medicare
enrollment and eligibility.?
http://www.medicare.gov/MedicareEligibility/Home.asp?dest=NAV|Home|MyEnrollment#TabTop


========================================================================


For a detailed summary of the federal bill see:


Bill Summary & Status for the 104th Congress
H.R.3734 
http://thomas.loc.gov/cgi-bin/bdquery/z?d104:HR03734:@@@L&summ2=m&|TOM:/bss/d104query.html|
?Title: To provide for reconciliation pursuant to section 201(a)(1) of
the concurrent resolution on the budget for fiscal year 1997.
Sponsor: Rep Kasich, John R. [OH-12] (introduced 6/27/1996)      Cosponsors: (none)
Related Bills: H.RES.482, H.RES.495, H.R.3829, S.1956
Latest Major Action: 8/22/1996 Became Public Law No: 104-193.?

----

?Subtitle A: Eligibility for Federal Benefits - Prohibits Federal
public benefits (as defined by this Act) to aliens who are not
qualified aliens (as defined by this Act). Stipulates that such
prohibition shall not apply to: (1) emergency medical services; (2)
certain emergency disaster relief; (3) public health immunizations and
treatment of communicable diseases; (4) housing assistance; (5)
certain in-kind community services; and (6) Social Security Act
benefits under specified circumstances.

(Sec. 402) Makes qualified aliens ineligible (with limited exceptions
for refugees, asylees, certain permanent residents, veterans and
active duty personnel, aliens whose deportation is withheld, and
aliens currently receiving benefits) for: (1) supplemental security
income (SSI); (2) food stamps; (3) temporary assistance for needy
families; (4) social services block grants; and (5) Medicaid.

(Sec. 403) Makes qualified aliens ineligible (with limited exceptions
for refugees, asylees, and veterans and active duty personnel) for
Federal means-tested public benefits (as defined by this Act) for the
first five years after U.S. entry. Provides a special rule for certain
Cuban and Haitian entrant assistance.

(Sec. 404) Requires each Federal agency administering a program
covered by this title to post information and provide general
notification to the public and program recipients, either directly or
through the States, of the requirements concerning alien eligibility
for any such program pursuant to this title.

Amends the Social Security Act and the United States Housing Act of
1937 to provide for State reporting of certain illegal alien
information to the Immigration and Naturalization Service (INS).

Subtitle B: Eligibility for State and Local Public Benefits Programs -
Makes an alien who is not a qualified alien, a nonimmigrant, or a
parolee ineligible for State or local benefits (as defined by this
Act). Stipulates that such prohibition shall not apply to: (1)
emergency medical services; (2) certain emergency disaster relief; (3)
public health immunizations and treatment of communicable diseases;
and (4) certain in-kind community services.

(Sec. 412) Authorizes States to determine eligibility for State public
benefits for qualified aliens, nonimmigrants, or parolees. States that
refugees, asylees, certain permanent residents, and veterans and
active duty personnel shall be eligible for all State public benefits.
Sets forth transition provisions for aliens currently receiving
assistance.?


========================================================================


Other references:

Comparison of PRIOR LAW and the PERSONAL RESPONSIBILITY AND WORK
OPPORTUNITY RECONCILIATION ACT OF 1996 (P.L. 104-193)
http://www.aspe.hhs.gov/hsp/isp/Reform.htm


Fact Sheet
Administration for Children and Families, September 1996
The Personal Responsibility and Work Opportunity Reconciliation Act of 1996
http://www.acf.dhhs.gov/programs/opa/facts/prwora96.htm


National Immigration Law Center (NILC)
IMMIGRANTS & PUBLIC BENEFITS
http://www.nilc.org/immspbs/


National Immigration Law Center (NILC)
TABLE 1 - Overview of Immigrant Eligibility for Federal Programs
http://www.nilc.org/immspbs/special/Benefits_Overview_Table_1-23-04.pdf


========================================================================


I hope you have found this information helpful.  If you have any
questions, please request clarification prior to rating the answer.

I wish the best to your grandmother and the rest of your family.

Googlenut



Google Search Terms:


immigrant medicare eligibility 5 years
://www.google.com/search?hl=en&ie=ISO-8859-1&q=immigrant+medicare+eligibility+5+years

immigrant medicare eligibility "5 years"
://www.google.com/search?hl=en&lr=&ie=ISO-8859-1&safe=off&c2coff=1&q=immigrant+medicare+eligibility+%225+years%22

masshealth immigrants
://www.google.com/search?hl=en&lr=&ie=ISO-8859-1&safe=off&c2coff=1&q=masshealth+immigrants&btnG=Google+Search

masshealth immigrants changes
://www.google.com/search?hl=en&lr=&ie=ISO-8859-1&safe=off&c2coff=1&q=masshealth+immigrants+changes

---

Clarification of Answer by googlenut-ga on 08 Feb 2004 23:48 PST

In order to reach the medicare.gov links and the link to the federal
bill details, you will need to copy the links and paste them into your
browser.

Googlenut

Answer style was excellent altogether.  Minor suggestions - a little
more formatting might improve readability/scanability.  The researcher
did preface each resource, which was helpful.  A little more digestion
of the information would have been exceptional.  The researcher
answered my question thoroughly and earned the fee in my opinion.