In these last days of Open Enrollment, immigrant families need to know affordable coverage options are available

In these last days of Open Enrollment, immigrant families need to know affordable coverage options are available

Affordable coverage options are available in the Health Insurance Marketplace for eligible immigrant families. In fact, most people shopping for coverage on the Marketplace can find a plan with monthly premiums of $75 or less. But, act soon:  January 31, 2016 is the final deadline for you to sign up at or for 2016 coverage.  Don’t miss out on getting coverage for 2016 and risk owing a fee of $695 or more.

If you work with immigrant communities, we need your help to make sure people who are eligible for coverage understand that they should not be worried about applying for coverage if they have a family with mixed immigration status.

Here are 10 things immigrant families need to know about Marketplace coverage:

  1. To buy private health insurance through the Marketplace, you must be a U.S. citizen, a U.S. national, or be lawfully present in the United States. In addition, immigrants with certain other statuses are also eligible.  See a list of immigration statuses that qualify for Marketplace coverage.
  2. If you recently gained U.S. citizenship or had a change in your immigration status that makes you newly eligible to enroll in coverage through the Marketplace, you may qualify for a Special Enrollment Period. See if you can enroll in a Marketplace health plan outside Open Enrollment.
  3. Financial help is available. If you’re a lawfully present immigrant and meet other eligibility criteria, you can buy private health insurance through the Marketplace, and may be eligible for lower costs on monthly premiums and lower out-of-pocket costs based on your income. More than 8out of 10 people who have enrolled in a health insurance plan through the Marketplace have qualified for financial help. In fact, most people can find monthly premiums for $75 or less, after financial assistance. In general, individuals and families whose household income for the year is between 100 percent and 400 percent of the federal poverty line for their family size may be eligible for the premium tax credit or financial assistance to pay for your premium.  You can find the levels here based on the household size. If you make less than 100 percent of the federal poverty line, which is $11,770 for an individual or $24,250 for a family of 4 (higher in Alaska and Hawaii) and you aren’t eligible for Medicaid because of your immigration status, you may still qualify for lower costs on Marketplace coverage.
  4. If you’re a “qualified non-citizen” and meet your state’s income and other eligibility rules, you may be eligible for Medicaid or Children’s Health Insurance Program (CHIP) coverage. See a list of “qualified non-citizen” statuses and other important details.
  5. If you’re a “qualified non-citizen,” you may have a 5-year waiting period to get full Medicaid or CHIP coverage. This means you must wait 5 years after receiving “qualified” immigration status and meet all other eligibility rules in the state before being eligible for full Medicaid or CHIP. See a list of exceptions to the 5-year waiting period and other important details.
  6. Many immigrant families are of “mixed status,” with members having different immigration and citizenship statuses. Mixed status families can apply for financial assistance for private insurance for their dependent family members who are eligible for coverage through the Marketplace, or for Medicaid and CHIP coverage. Family members who aren’t applying for health coverage for themselves won’t be asked if they have eligible immigration status.
  7. Federal and State Marketplaces, as well as state Medicaid and CHIP agencies, can’t require you to provide information about the citizenship or immigration status of any family or household members who aren’t applying for coverage for themselves.
  8. States can’t deny you benefits because a family or household member who isn’t applying has not provided his or her citizenship or immigration status.
  9. Information that you provide to the Marketplace won’t be used for immigration enforcement purposes.
  10. If you’re not eligible for Marketplace coverage or you can’t afford a health plan, you can get low-cost health care at a nearby community health center. Community health centers provide primary health care services to all residents in the health center’s service area. Find more information here.

Washington MFFS Preliminary Evaluation Report

By Patrick Conway, M.D., CMS Principal Deputy Administrator and Chief Medical Officer

Today we released a report summarizing preliminary results from the Washington Health Homes demonstration under the Medicare-Medicaid Financial Alignment Initiative. This demonstration, which began serving enrollees in July 2013, seeks to leverage Medicaid health homes to improve service quality and integration while reducing costs of care for high-risk, high-cost Medicare-Medicaid enrollees (sometimes referred to as “dual eligibles”) in Washington State.

More than 10.7 million Americans are enrolled in both the Medicare and Medicaid programs. A longstanding barrier to improving quality and reducing costs of care for Medicare-Medicaid enrollees has been a lack of alignment and cohesiveness between the two programs, including misaligned incentives for payers and providers. The Washington Health Homes demonstration tests new mechanisms to coordinate services across Medicare and Medicaid for Washington State Medicare-Medicaid enrollees, and allows the State and the Federal governments to share in savings resulting from quality improvements.

The preliminary results in this report are based on experience during the first demonstration performance period, from July 2013 – December 2014. Despite the relatively short time period, estimates show a reduction of $21.6 million in Medicare spending relative to a comparison group, representing more than 6% savings.  Future analysis will include Medicaid spending estimates as the data become available.

The report also includes early quality and utilization results, eligibility and enrollment data, characteristics of the population eligible for the demonstration, beneficiary focus group findings, and a discussion of the initial implementation experience.

While these findings are preliminary, they provide an encouraging first look at how efforts in Washington to improve quality of care by focusing on the needs of high-risk, high-cost members can reduce Medicare spending.

The first annual evaluation report on the Washington demonstration, scheduled for a 2016 release, will include additional information on the context and status of the demonstration, as well as analyses of quality, utilization, and cost measures for Medicare-Medicaid enrollees eligible for the demonstration and for a comparison group.

This model further supports delivery system reform aimed at achieving better care, smarter spending, and healthier people.  It is especially important to focus on the safety net population served by this model in order to reduce disparities and coordinate care for vulnerable populations.

This report is posted on the CMS website:

Additional information about the Washington Health Homes demonstration is available on the Medicare-Medicaid Coordination Office website:

Can helping patients’ social needs also be good for their health?

A new $157 million Medicare and Medicaid project aims to bridge clinical care and social services.

Darshak Sanghavi, MD and Patrick Conway, MD, Centers for Medicare & Medicaid Services

We’ve known for a long time that an ounce of prevention can be worth a pound of cure. Yet our health care system doesn’t always encourage prevention, especially around unmet social needs. These problems can lead to poor health that requires expensive emergency room visits or hospitalizations. Many social needs, such as housing instability, hunger, and interpersonal violence, affect individuals’ health yet they may not be detected or addressed during typical, short doctor’s visits. Over time, these unmet needs may increase the risk of developing chronic conditions and reduce one’s ability to manage these conditions, resulting in increased health care utilization and costs, such as emergency room visits or hospitalizations.

Perhaps we could interrupt the cycle of unmet social needs leading to illness in the first place. To explore this opportunity, the Department of Health and Human Services this week announced a new funding opportunity of up to $157 million to fund “bridge organizations” that will ask all their Medicare and Medicaid patients about health-related social needs, and then help refer them to community resources, assign “community health navigators” to help them connect with resources, and help communities themselves become healthier.

Here’s a hypothetical example of how the bridge might help: a mother comes in to a participating community health center for her child with asthma. During a complete social screening, the center learns the mother has been living in a moldy trailer after fleeing a violent home life. They refer the family to a local safe housing program and legal aid to protect her.  The center also connects her with these services with the aid of a community health navigator. By helping the family find safe permanent housing, we reduce the frequency of the child’s visits to the ER for asthma attacks.

The five-year model, called the Accountable Health Communities Model, is the first Centers for Medicare & Medicaid Services (CMS) Innovation Center model to focus on the health-related social needs of Medicare and Medicaid beneficiaries.


The model will test three scalable approaches to addressing health-related social needs and linking clinical and community services – community referral, community service navigation, and community service alignment. Bridge organizations will inventory local community service providers and furnish referrals to those agencies as needed. A total of 44 sites will be selected to provide intensive community service navigation, such as in-depth assessment, planning, and follow-up until needs are resolved or determined to be unresolvable for high-risk beneficiaries. Over the five year period, we’ll see if the bridge organizations help reduce total health care costs, emergency department visits, and hospital stays, and improve the quality of care.


To learn more about the Accountable Health Communities Model please visit:

%d bloggers like this: