Helping Immigrants Obtain
Health Care and Pay for It!
Riverside Hospital
August 30, 2006
Cathy Levine, JD
Executive Director, UHCAN Ohio
(614) 456-0060
[email protected]
Topics Covered
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Central Ohio Immigrant Population
Introduction to Medicaid
Immigrant eligibility for Medicaid
Alien Emergency Medical Assistance: A Medicaid program
Hospital-based Assistance
Barriers - Public Charge; Language Access
Helping Immigrants Feel Safe
Importance of Trained Interpreters
Getting Medicaid to pay for Interpreters
How to Make the System Work Better for Immigrants
Immigrants in Central Ohio
Overview
Latino Populations
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1990 Census: Latinos were .96% of Franklin County
population (7,000 plus)
2000 Census: Latinos are 2.3% of Franklin County
population is described as “Hispanic” (17,500)
Neighborhoods served by Children’s clinics have 3.5
times the number
Unofficial estimates: 50-100,000 people
Many undocumented single young men, families
Disparities in Latino Health Access
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Lack of coverage, regular source of care, finances
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35% of employed Latinos in the US are uninsured (11%
of whites (24% of Ohio Hispanics are uninsured)
57% have regular source of care (80% whites)
45% of Hispanic adults have trouble paying for care
Scarcity of providers: 13% of population, 3.5% of
practicing doctors
Disparities in Latino Health Care
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Disparities in disease incidence:
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Hispanics 20 or older are 1.9 times more likely than
whites to have diabetes
Death rate is 40% higher for Hispanics than for whites
Disparities in health care delivery
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Communications barriers
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Language
Cultural barriers
Provider discrimination
Columbus Somali Population
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Estimated at 20,000-30,000
Grew suddenly in late ’90’s – secondary
migration
Columbus has second largest Somali
population in US
Many are refugees from civil war
Population from Former USSR
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5-7,000 people, stable
Older population was Russian Jews
More recent refugees are diverse in terms of
geography religion, culture, and LANGUAGE
Many are refugees from persecution
Asian Population of Columbus
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Estimated at 3.4% of Columbus population
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2000 official count: 25,000
Varied nationalities, languages, customs
Varied immigration status
Introduction
to Medicaid
What is Medicaid?
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Nation’s major public health insurance
program; joint state/federal funding.
Covers certain low income and medically
vulnerable people of all ages.
Must meet categorical and financial eligibility
requirements.
Must be a citizen or meet strict immigrant
requirements (except for AEMA!)
Medicaid: Categorical Eligibility
You must be a member of a group that is eligible:
 Children
 Pregnant women
 Parents or guardians
 Breast and cervical cancer
 People who are disabled
 The elderly.
If not, you’re out of luck!
What is Medicaid?
Financial Eligibility
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Kids, 200% of federal poverty level.
Pregnant women, 150% federal poverty
level.
Parents 90% federal poverty level People
with disabilities:
resource limit =$1,500;
income limit (“need standard”)= 64% fpl
=$490/mo (single); $846/mo (married)
Federal Poverty Levels – 2006
note: these change each February
Fam. Size per mo
per year
per hour
1
$816
$9,800
$4.72
2
$1,100
$13,200
$6.35
3
$1,383
$16,600
$7.98
4
$ 1,666
$20,000
$9.62
Note also: It takes twice the “federal poverty level”
for the average family to pay for its basic needs.
(Economic Policy Institute, cited in Columbus Dispatch,)
Medicaid Spend-Down for ABD
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Categorically eligible for ABD; aged, or disabled by
Social Security Administration standard (unable to
engage in substantial gainful employment for 1
year).
If categorically disabled, countable income that
exceeds “need standard” is the Spend-Down.
Individual gets Medicaid card if meets monthly S-D.
To meet S-D, consumer incurs medical expenses or
pays S-D amount.
Breast and Cervical Cancer
Medicaid
Eligibility for women who:
 have been screened for breast or cervical cancer
through ODH's BCCP
 are in need of treatment for breast and/or cervical
cancer, including precancerous conditions (eligibility
will end when the treatment is completed)
 are uninsured
 meet basic Medicaid requirements, such as
residency
Breast and Cervical Cancer
Medicaid: coverage, applying
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coverage: full Medicaid fee-for-service, not just
cancer
to apply, must go through ODH's BCCP, which
provides screening services to women who: (a) live
in households with incomes less than 200 percent
of the poverty level; (b) are uninsured or
underinsured; and (c ) are 40 to 65 years of age for
Pap tests and clinical breast exams; 50 to 65 years
of age for mammograms.
NOTE: In some counties, program is closed!
What is Healthy Start Healthy Families?
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Healthy Start Healthy Families is a no cost
public health insurance program for
children, parents and pregnant women.
It is designed for working families.
Some people call it a Medical card,
CareSource, or Medicaid.
Old
Welfare
Easier
Process
Welfare
Reform
Expanded
Eligibility
Your Help
Outreac
h
What services are covered?
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Doctor’s visits
Prescriptions
Hospitalization
Immunizations
Eyeglasses
Dental care
Mental health care
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Prenatal care
Two months
postpartum care
Who is eligible?
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HSHF is for children, adults with children living with
them and pregnant women.
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Children under the age of 19.
Adults include parents, grandparents and non relatives with children
living with them. No legal custody is necessary.
All of the above include certain legal immigrants depending on
status.
HSHF is an income based program. To qualify you
must meet certain income guidelines – but 80% of
families work.
Adults without children are not eligible.
Financial Eligibility for Parents,
Pregnant Women and Children
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Children are eligible up to
200% of the Federal
Poverty Level
Pregnant women are
eligible up to 150% of the
Federal Poverty Level
Parents/adults with children
are eligible up to 90% of
the Federal Poverty Level
200%
150%
90%
Parents Pregnant Children
Women
Eligibility cont.
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Income is gross income - which includes taxes, not the
take home amount
Employment, child support, rental property, and
unemployment all count as income
Income eligibility is based on the 30 day period prior
to application . If a person knows that there income
will go down, they can wait until then to apply
Assets (houses, cars etc.) DO NOT count
Transitional Medicaid: Keeping
Medicaid When Income Goes up or
Eligibility Limit Goes Down
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If eligible, get TMA for 6 months regardless of
income; for second 6 months if income is below
185% FPL
Must meet reporting requirements to keep TMA
Must have been on HSHF for 3 of the last 6 months
before income changes
Must have had some earned income
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Even $1.00 is enough
Need documentation (even a receipt)
Retroactive Medicaid
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HSHF can pay for old medical bills up to 3
months old. This is called Retroactive Medicaid
In order for Retroactive Medicaid to pay old bills the
families must be income eligible at the time of
treatment and submit a copy of the bill
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Families CAN be reimbursed for paid bills
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Include copies of old bills and proof of income from
the month of service with HSHF app.
Pregnant Women & Expedited
Medicaid
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Expedited Medicaid allows a pregnant woman who meets
financial eligibility (150% FPL) to receive HSHF coverage
within 48 hours without providing proof of income
(but it is best to include if possible).
When looking at the FPL chart, a pregnant woman and one
fetus = 2 household members; pregnant woman and two
fetuses = 3members.
Pregnant women should:
 complete an application
 attach proof of pregnancy (letter/note from
nurse/doctor) with the # of fetuses (if known),
 proof of income if available
 medical bills
NOTE: Expedited MA is only good for 60 days; must submit
all documentation before then to receive ongoing coverage
How does a family enroll?
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Complete an application
No face to face interview is required!
You must attach copies of:
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the past 30 days income (all pay stubs for 30 days or
a letter from employer)
proof of pregnancy (if pregnant)
child care expenses for last 30 days
proof of status if not a citizen
Mail or drop off the application to the
County Department of Jobs and
Family Services
New: Co-Pays for Adults
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ER visits for non-Emergency services- $3
Dentist Visit- $3
Eye Exam- $2
Eyeglasses- $1
Non-Generic Rx- $2
“Prior Authorization” Rx- $3
Children, pregnant women, excluded.
Managed care plans chose to not charge co-pays
New: Adult Dental Service Limits
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One routine exam & cleaning a year
X-Rays
Fillings
Simple extractions
Full and partial dentures
General Anesthesia
Anterior (front teeth) root canals
New: Citizen Verification
Requirement
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Mandated by Congress
Ohio rule goes into effect on Sept. 25, 2006
Applies only to applicants claiming to be
citizens
Procedures for non-citizens don’t change
Citizenship Verification
requirement
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Only applies to people claiming to be citizens
Ohio rule goes into effect September 25, 2006 for
people applying or renewing
Must provide documentation once; originals only!
Applicants can’t get benefits until document
citizenship: except for presumptive eligibility
People renewing eligibility retain benefits as long as
they are cooperating in obtaining documents
County DJFS must assist those who are unable to
provide documents (including unable to pay)
Immigrant Eligibility
for Medicaid
Terminology
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Immigrant: not US citizen or national; enters
US with intent to remain indefinitely.
“Qualified alien” includes:
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Legal permanent resident (green card)
Refugee: flees country < persecution (or fear of)
and obtains status while abroad; person granted
“asylum” obtains status in US.
Cubans/Haitian; battered women; trafficking
victims; Others – see 5101:1-38-02.3, (B)(11)
Medicaid for Immigrants General Rules
Refugees get “refugee Medicaid” for first 8 months,
regardless of financial or categorical eligibility
 Citizens and certain non-citizens are eligible for Medicaid, if
they meet categorical and financial eligibility
General Rule:
 If you arrived in US before 8/22/96 and are lawfully here,
you’re eligible for Medicaid
 If you arrived in US after 8/22/96, most “qualified aliens” are
barred from Medicaid (exceptions described below)
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Medicaid status for “Qualified
Aliens” entering after 8/22/96
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Federal law bars them from benefits for five years
Ohio does not provide Medicaid after the federal
five year bar. LET’S CHANGE THAT!
Legal Permanent residents in Ohio: Barred from
eligibility unless they meet the requirement for 40
quarters’ work or veteran or active duty US armed
forces or become citizen
Sponsor affidavits of support signed after 12/97 (I864) create additional barrier
Exceptions: Immigrants Eligible for
Medicaid after 8/22/96
Refugees, asylees (after date asylum
granted); Deportees; battered spouse & her
children; most Cubans, Haitians, others*
 Eligible for 7 years from date of entry
 After 7 years, must be US citizen or meet
work/US veteran or active duty requirement.
*See OAC 5101:1-38-02:3
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“Not Qualified” Immigrant:
No Medicaid (except AEMA)
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Permanently Residing Under Color of Law
(PROCUL): Living in US legally and under INS
discretion
Other categories
Non-immigrants such as students and foreign
visitors
Undocumented immigrants
Review: Immigrants Eligible
for Medicaid
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LPRs w/ residency established on 8/22/96
LPRs after 8/22/96 must meet 40 quarters or
veterans or active duty, or citizenship;
sponsor deeming.
Refugees: eligible for first 7 years in US
Asylees: eligible for first 7 years after asylum
is granted
Cuban & Haitans are eligible for 1st 7 years
Immigrant Kids Eligible
for Medicaid
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U.S. born kids are U.S. citizens, eligible
for MA, regardless of parents’ status
But citizen kids w/ non-citizen parents have
less MA than citizen kids w/ citizen parents
All legal immigrant kids in U.S. before
8/22/96 are eligible
Most kids entering U.S. after 8/22/96 face
same barriers as adults
Options for
immigrants who
are not eligible for
Medicaid:
AEMA
Hospital programs
AEMA - Alien Emergency Medical Assistance:
NEW RULE, OAC 5101:1-41-20, 12/1/04
 Special category of Medicaid for people not
meeting citizenship requirement
 Must be financially and categorically eligible
 Must be state resident.
 For non citizens, regardless of
immigration status, including
undocumented
State Resident
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Living in Ohio, regardless of intent to remain
No minimum residency requirement:
eligibility begins on first day living here
Can be living here temporarily, e.g. visitor’s
visa, student visa
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But, in rare circumstances, filing for AEMA could
affect visa status – check with attorney
AEMA: “Emergency Medical
Condition”
After sudden onset, a medical condition, including
labor and delivery, manifesting itself by acute
symptoms of sufficient severity (including severe
pain) such that absence of immediate medical
attention could reasonably be expected to result in
placing patient’s health in :
-serious jeopardy
-serious impairment of bodily functions, or
-serious dysfunction of any bodily organ or part.
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AEMA: “Emergency Medical
Condition”
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An emergency medical condition does not
include care and services related to either an
organ transplant procedure or routine
prenatal or postpartum care
Emergency treatment, under AEMA, does not
have to be received in an emergency room
AEMA: Establishing Eligibility
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Must meet MA financial and categorical eligibility
Must be resident of Ohio
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Currently living here
Not receiving benefits in another state
Are people on visitor or student visas eligible for AEMA?
Must have received treatment for an emergency
medical condition
Must apply; must apply for each new episode
AEMA: Exceptions to eligibility
requirements (NEW, 12/04)
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No face-to-face interview
Not subject to sponsor-deeming provisions
Not required to show social security number
Not required to provide verification of
immigration status
AEMA – Establishing Eligibility
(12/04)
County Agency Responsibilities
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County agency determines categorical and
financial eligibility for Medicaid
County agency determines whether applicant
meets eligibility criteria for AEMA
On request, agency must assist applicant in
obtaining medical documentation to support
claim and forward it to CMS
AEMA – Establishing Eligibility (12/04)
County Responsibilities: Labor & Delivery
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County must determine AEMA eligibility span for
labor and delivery as follows:
Two days or 48 hrs following vaginal delivery;
4 days or 96 hrs after Caesarian section delivery
Time from date of admission to delivery shall not
exceed 48 hours
If hospital stay exceeds these, county forwards
medical documentation to CMS for determining
covered dates of service
AEMA – Establishing Eligibility
(12/03)
CMS Responsibilities
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CMS makes all emergency medical condition
determinations, except for labor and delivery
CMS determines if treatment was for an
emergency medical condition
CMS must determine covered dates of service
“The Episode:” How much Treatment is
Covered – Important!
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“Emergency medical condition episode” stops on
the day on which the absence of immediate medical
attention could no longer reasonably be expected to
place patient’s health in serious jeopardy, etc.
Federal case law: When “episode” stops is a
medical determination
If CMS denies coverage (1) appeal and (2) refer
client to nearest legal aid office and contact UHCAN
Ohio.
“The Episode:” What’s Covered: Case Law
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Luna v. Division of Social Services, 589 SE 2nd
917 (NC App 2004): Mr. Luna came to ER with
symptoms, MRI showed cancer in spine, had
surgery, transferred to rehab, found other cancer,
got IV chemo. County paid for first surgery, but not
rehab or chemo
Court: Whether rehab treatment and chemo were
treatment for emergency medical condition
manifesting itself by acute systems requiring
treatment to prevent immediate harm is medical
fact
“The Episode:” What’s Covered –
Case Law
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In Luna, the judge pointed out that the
patient sought “coverage for the rest of the
finite course of treatment of the very
condition that sent him to the emergency
room, and not for long term or open-ended
nursing care”
Tough Issue: Dialysis under AEMA
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Some states have made decision to cover
routine dialysis as a recurring emergency
Ohio does not generally cover dialysis under
AEMA, unless it’s an emergency in the ER
If this is an issue, notify Ohio Hospital Assn
What’s covered, what isn’t?
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ODJFS Community Medical Services (CMS)
decides, unless either:
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Their decision gets challenged on appeal, or
ODJFS decides to change policy
Hospitals need to start appealing these
decisions or work with state to change policy
AEMA: How to apply
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Must apply after services are received
Apply within 3 months of service
Use Medicaid application
County worker or billing office should help
Patient must sign and date application
Patient must include proof of income
AEMA: Secrets of Success
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Help patient apply and complete application while
at the hospital
Provide interpreter to help patient complete
application
Make sure complete application is submitted
If patient still needs proof of income, give patient
an addressed envelope and instructions.
Risky alternative: Hospital sends referral form to jfs.
AEMA for Labor and Delivery
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New baby is a citizen – apply for social
security number and Medicaid using usual
procedure
At same time, apply for AEMA Medicaid for
mother; complete app while she is in hospital
Make sure providers know mother’s Medicaid
number!
When AEMA
is not an
Option:
Hospital
Programs
Hospital Programs apply to
immigrants
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HCAP: for all Ohio residents, regardless of
immigration status
Hospitals’ voluntary financial assistance
programs
HCAP: Hospital Care Assurance
Program – only if no AEMA
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Ohio law requires hospital to provide all medically
necessary hospital care FREE to certain low income
patients
Eligibility: Ohio resident; incomes at or below
poverty or on DMA; not getting Medicaid.
For all Ohio residents, regardless of immigration
status.
Doesn’t cover non-hospital services (MDs, Rx, etc.)
HCAP: What’s a Resident?
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Under Ohio law, a resident is someone who is
living in Ohio.
Does not require “intent to remain
permanently”
Student, visitor can be “resident”
New HCAP rule: no eligibility if came to Ohio
to get medical treatment
HCAP: How to Apply
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Simple application at hospital; should be
translated to common languages; should
conform to ODJFS standard application.
Family size: spouse, natural or adopted
children under 18.
Use income for 3 months or one year before
date of service, whichever qualifies patient
May apply up to 3 years after notified (query:
was person notified in language he knows?)
HCAP Best Practice
Fremont, Ohio
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Large migrant worker population
Hospital relies on HCAP dollars
Move around; don’t receive hospital bills
Hospital have inpatients and outpatients fill
out and sign HCAP forms before leaving
hospital
good signage, interpreters
HCAP: Hospital Responsibilities
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Must notify patients of availability of HCAP
Must have visible signs in all areas used by
patients in common languages
Must provide language assistance
(interpreters, translated materials) to LEP
applicant for financial assistance.
If person paid hospital bill but is eligible for
HCAP, hospital must reimburse patient.
Hospital Financial Assistance
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Hospital bills shouldn’t lead to financial ruin
All hospitals should have written, publicly available
financial assistance policies for patients with
incomes too high for HCAP
Not good enough to say “Case by Case” basis
Call the hospital financial assistance department.
If a hospital has no policy for patients over income
for HCAP, contact UHCAN Ohio for help in working
with hospital to develop policies
HCAP/hospital financial assistance
cover hospital services only
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Doesn’t cover providers who are not hospital
employees or tests from non-hospital corporations.
Sometimes non-covered providers will reduce their
fee when they know the patient qualified for
financial assistance
Ask the hospital for an award letter (written notice
that patient qualified for HCAP or financial
assistance) and share it with the non-covered
providers
HCAP and Charity Care: TIPS
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First, screen patient for Medicaid, AEMA
Help patient apply for HCAP while patient is
still at hospital
If patient is over-income for HCAP, patient
should apply for hospital charity care
Once patient qualifies for HCAP/hospital
assistance, notify non-hospital providers
Pop Quiz

Teenage non-citizen comes in with broken
leg. How do you determine eligibility for any
programs?
BREAK TIME!
Barriers
to care:
Public
Charge
Language
Access
The Fear of “Public Charge”
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INS can deny permanent resident status or
entry to US to “public charge.”
INS guidance, 5/25/99: Non-cash benefits,
e.g. Medicaid, are not relevant to “Public
Charge.”
Public Charge (dependent on gov’t) only if
receive: (1) cash benefits (OWF, SSI); or (2)
long term care paid by Medicaid.
Dispelling Fear of Public
Charge
Non-cash public benefits NOT relevant to
“Public Charge” include:
 Medicaid (except nursing home), CHIP
 health insurance and services benefits,
including emergency medical assistance,
immunizations, testing and treatment for
communicable diseases, using health clinics.
Social Security Numbers – Do you
really need to ask for them?
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AEMA – No
HCAP – No
Hospital financial assistance – No
Medicaid: If citizen child is applying for
Medicaid but parents are not, you only need
child’s social security number, not parents’
Hospital’s own system – shouldn’t need one
Phony Social Security Numbers
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Common among undocumented immigrants
If used on application for Medicaid or other public
benefits, can lead to serious trouble
Don’t ask for SSN when it is not needed
Help patients to refrain from providing invalid SSN
or other false info to any government agency by
reminding them they do not have to provide SSN
Remind patients they do not have to provide
information on their immigration status
Title VI of Civil Rights Act
of 1964

No person in the U.S. shall, on grounds of
race, color, or national origin, be excluded
from participation in, denied benefits of, or
subjected to discrimination under, any
program or activity receiving federal financial
assistance (e.g. any provider taking Medicaid,
Medicare).
Title VI & Health Care Providers
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Title VI requires linguistic accessibility to health care
HHS Office of Civil Rights: Title VI requires provision
of qualified interpreter services and translated
materials at no cost to patients
Helpful website: www.hhs.gov/ocr
OCR requires range of activities to provide
linguistically accessible service
Title VI Activities commonly
required by OCR rulings:
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Written policies, with staff aware of policies.
Written notice to clients in primary language
informing them of right to interpreter services.
Never use minors to interpret.
Use families and friends to interpret only as last
resort and only with informed consent.
Use only qualified and trained interpreters.
Make translated, written materials available.
What’s a Qualified Interpreter?

An interpreter is a specially trained
professional who has proficient knowledge
and skills in English and at least one other
language and employs that training in order
to make possible communication among
parties using different languages
10/3/2015
Skills of a Professional Interpreter
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Cultural competency
Awareness and respect for all parties involved
Mastery of the terminology
Assists in creating mutual trust and accurate
communication
Enables effective provision of services and equal
access
10/3/2015
Qualities of a Professional Interpreter
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Confidentiality
Accuracy
Completeness
Impartiality
Resolving conflict of interest
Conveying cultural frameworks
Allowing patient self-determination
10/3/2015
Standards for Interpreters in Central
Ohio
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Purpose of Standards
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Help providers ease communication with LEP
consumers
Help providers to develop internal policies
Ensure that LEP clients receive equal access and
quality of service
Create community-wide understanding on
interpreter role
10/3/2015
Overview of Standards
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Ethical Standards for Interpreters
Role of Interpreters
Professional Conduct Standards
Process for Qualifying as Interpreter in
Central Ohio
Role of the Interpreter
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Conduit
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Clarifier
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Interpret what is said faithfully, but in a way that is would be
understood
Cultural Broker
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Interpret everything that is said, exactly as it is said: add nothing,
omit nothing, change nothing.
Be aware of the possibility of cultural misunderstanding and
miscommunication
Advocate
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Address behavior which might effect access to or quality of service
and compromise dignity
Process for qualifying as an
Interpreter
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Interpreter Training
Screening/Assessment
Post test
Field Training
Certificate of Training completion
Employment orientation
Regulatory Standards
Continued professional education
Agency records
Available Training and Certification
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No Certification in a State of Ohio
Interpreters receive Certificate of Completion
upon successful completion of
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Screening/assessment
Training
Post-test
Field training
Available Interpreter Training
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Minimum of 24 hour interpreter training
Curriculum must include, but not limited:
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Ethical and practice standards
Terminology
Interpretation Skills
Professional Conduct
Standards of Regulating and Governing Bodies
Cultural Competency
Agency Records
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Signed confidentiality statement
Documentation on satisfactory completed oral
fluency exam
Written post-test with a passing grade
Course outline
Certificate of completion
Records of participation in continuing education
Documentation in accordance with policies and
procedures of the agency
Interpreter’s Mistakes
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Omitting information
Adding information
Changing the meaning
Deleting cultural information
Adding his/her own opinion
Having side conversations
Offering advise
Using 3rd person
Provider’s Mistakes

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Allow the interpreter to take control of
interview
Make no attempt to guide the interpreter
when there are problems
Tips
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Maintain control
Do a pre-session
Arrange the seating
Speak directly to the client
Assume and insist that everything will be interpreted
Remember lack of equivalents in different languages
Speak in short sentences
Ask one question at a time
Avoid slang or difficult terminology
Check for understanding
Stay positive
Getting Medicaid to Pay for
Interpreters
Statement of Need

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Ohio’s population of LEP residents has
grown significantly in the past decade.
Increase of LEP patients provides
challenges in health care, especially
communication.
Trained medical interpreters are essential.
Trained medical interpreters are expensive!
Need for Trained Medical Interpreters
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Assure accurate & complete communication.
Assure more efficient interactions (save $).
Obtain informed consent.
Avoid lawsuits.
It’s the law!
BUT IT’S EXPENSIVE
One Solution: Medicaid Payment for
Interpreters
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At least ten other states now pay for
interpreters for Medicaid patients.
Variety of different program designs.
Many states exclude in-patient hospitalization
and managed care
ODJFS must monitor managed care
companies and enforce obligation to provide
interpreters
Summary of Proposal

LEP Medicaid fee-for-service patients would
receive trained medical interpreters when
obtaining Medicaid-covered services, at no
cost to the provider or patient.
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In the initial phase, the program would exclude
inpatient hospitalization
ODJFS needs to set more rigorous
requirements for managed care and monitor
compliance
Federal Reimbursement for
Interpreters – two sources

Regular federal/state “covered services”
match rate:

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Ohio’s regular rate is 60/40.
Ohio’s SCHIP rate is 71/29.
Or
Federal Administrative Match (50/50)
4 Models for Medicaid Reimbursement
for Language Services
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Contract with language service agencies –
directly or through brokers
Reimburse providers for hiring interpreters
(challenges: state oversight, quality of
interpreters; provider concerns)
Certify interpreters as Medicaid providers
(challenges: burden; low payment rates)
Provide access to language line
Ohio Proposal
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State contracts with regional brokers
Brokers contract with agencies (including
hospitals) or individual interpreters
Provider requests interpreter from broker
Broker arranges regional interpreter training:
minimum of 24 hours, including ethical and
practice standards, terminology,
interpretation skills, professional conduct,
cultural competency
Broker Responsibilities

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Ensure that all interpreters are trained and
qualified
Assure access to all languages and region
Ensure compliance with health care and LEP
standards and regulations
Ensure that LEP Medicaid patients know
interpreters are available at no cost
Proposed Change to Medicaid Cost
Report

A new line item would be added to the
Medicaid Cost Report, Schedule F, on which
hospitals would report costs of providing
interpreters to LEP Medicaid patients.
Challenges to Improving Medicaid
Payment for Interpreters
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Ohio Budget: trying to contain Medicaid costs
Shortage of trained medical interpreters in
most parts of state
ODJFS, executive and legislative lack of
urgency to improve LEP access
Finding qualified broker
Overcoming the Challenges
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Budget crisis: keep program cheap
Lack of ODJFS urgency
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Active stakeholder advocacy
Document and make known stories of Medicaid
patients lacking interpreter access
Shortage of trained interpreters: State should
fund training (cheap)
Broker: national search; tight standards
How to Make the System Work
Better for Immigrants
What can you do?
What can OhioHealth do?
How to Make the System Work
better for Immigrants

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Ensure access to language services and financial assistance
counselors in hospital
Troubleshoot problem AEMA, Medicaid cases; challenge bad
decisions

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Document hardship cases – share them with hospital
administration and OHA

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If it doesn’t sound right, it probably isn’t
Don’t take a wrong “NO” for an answer
Let your administration know about denials of AEMA cases, get the
hospital and OHA to work with us develop strategies for expanding
AEMA.
Engage OhioHealth, OHA, and UHCAN Ohio in collaborating
on solutions.
State Policy Fixes to Work For in
this Budget

Encourage OhioHealth and OHA to advocate
for
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Providing Medicaid to legal immigrants after the
federal 5-year bar
Instituting Medicaid and Medicaid managed care
payment for Interpreters
Expanding Medicaid to pregnant women from
150% to 200% FPL – applies to AEMA L&D
Other things to fix for
Immigrants?
Ideas, questions, comments
To Find Me…
Cathy Levine
UHCAN Ohio
404 South Third Street
Columbus, OH 43215
(614-456-0060)
[email protected]
The End
Keep in touch!
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Healthcare & Immigrants - Wright State University