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The Colorado legislature has passed a bill that restores Medicaid
eligibility for several categories of immigrants lawfully present in the
United States whose eligibility was terminated by state legislation
enacted in 2003. The bill also requires the state Medicaid agency to
pursue reimbursement of medical costs from immigrants’ sponsors, a
provision that is likely to deter many immigrants from participating in
the program.
In passing the 2003 bill (SB03-176), the
legislature had relied on provisions of the Personal Responsibility and
Work Opportunity Reconciliation Act of 1996 (PRWORA) that purportedly
authorized states to determine whether to provide Medicaid to certain
groups of immigrants who are eligible for federally funded services.
See 8 USC §1612(b). In SB03-176, the legislature terminated the
Medicaid eligibility of all immigrants for whom the PRWORA does not
mandate coverage, including seniors, persons with disabilities, and
members of families who had lived in the U.S. for many years.
Litigation challenging these restrictions delayed implementation of the
law, which was never put into effect (see “District Court Enjoins
Colorado’s Termination of Immigrants’ Medicaid Eligibility,”
Immigrants’ Rights Update,
Apr. 8, 2003, p. 9, and “10th Circuit Panel
Upholds Colorado’s Authority to Terminate Medicaid for Thousands of
Immigrants,” Immigrants’
Rights Update, Feb. 17, 2004, p. 12).
The 2005 bill restores federal Medicaid to
“qualified” immigrants who (1) would have been eligible for Supplemental
Security Income based on disability, but for their immigration status;
or (2) were in the U.S. prior to Aug. 22, 1996; or (3) are no longer
subject to the federal five-year bar to receiving benefits. Immigrants
in the third category may need to add their sponsor’s income to theirs
in determining eligibility for coverage. The bill also restores
state-funded prenatal care for lawfully present immigrants and care for
immigrants who were receiving nursing home or home- and community-based
services on July 1, 1997.
Although the new bill restores Medicaid eligibility
for thousands of immigrants, it includes provisions that are likely to
have a negative effect on sponsored immigrants’ access to Medicaid.
Sponsored immigrants generally come to the U.S. through visa petitions
filed by family or employers who sign an “affidavit of support” on their
behalf. The bill requires the state to recover the costs of medical
assistance used by a sponsored immigrant from the immigrant’s sponsor,
to the extent permitted by federal law. While the state’s ability to
impose such “sponsor liability” is limited by federal law, the
provision’s effect in deterring eligible immigrants from seeking needed
health care can be expected to extend well beyond its actual
applicability. The bill also requires that sponsors’ income be “deemed”
available to sponsored immigrants when determining their financial
eligibility for Medicaid. While federal law provides exceptions to the
state’s ability to deem sponsors’ income, this practice is likely to
deny Medicaid to very-low-income immigrants for failure to meet income
eligibility standards.
By
Gabrielle Lessard, NILC
staff attorney
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