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 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 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 Lack of coverage, regular source of care, finances 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 Disparities in disease incidence: 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 Communications barriers Language Cultural barriers Provider discrimination Columbus Somali Population 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 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 Estimated at 3.4% of Columbus population 2000 official count: 25,000 Varied nationalities, languages, customs Varied immigration status Introduction to Medicaid What is Medicaid? 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 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 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 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? 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? Doctor’s visits Prescriptions Hospitalization Immunizations Eyeglasses Dental care Mental health care Prenatal care Two months postpartum care Who is eligible? HSHF is for children, adults with children living with them and pregnant women. 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 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. 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 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 Even $1.00 is enough Need documentation (even a receipt) Retroactive Medicaid 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 Families CAN be reimbursed for paid bills Include copies of old bills and proof of income from the month of service with HSHF app. Pregnant Women & Expedited Medicaid 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? Complete an application No face to face interview is required! You must attach copies of: 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 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 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 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 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 Immigrant: not US citizen or national; enters US with intent to remain indefinitely. “Qualified alien” includes: 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) Medicaid status for “Qualified Aliens” entering after 8/22/96 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 “Not Qualified” Immigrant: No Medicaid (except AEMA) 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 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 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 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 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. AEMA: “Emergency Medical Condition” 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 Must meet MA financial and categorical eligibility Must be resident of Ohio 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) 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 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 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 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! “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 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 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 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? ODJFS Community Medical Services (CMS) decides, unless either: 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 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 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 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 HCAP: for all Ohio residents, regardless of immigration status Hospitals’ voluntary financial assistance programs HCAP: Hospital Care Assurance Program – only if no AEMA 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? 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 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 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 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 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 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 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” 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? 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 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 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: 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 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 Confidentiality Accuracy Completeness Impartiality Resolving conflict of interest Conveying cultural frameworks Allowing patient self-determination 10/3/2015 Standards for Interpreters in Central Ohio Purpose of Standards 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 Ethical Standards for Interpreters Role of Interpreters Professional Conduct Standards Process for Qualifying as Interpreter in Central Ohio Role of the Interpreter Conduit Clarifier Interpret what is said faithfully, but in a way that is would be understood Cultural Broker 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 Address behavior which might effect access to or quality of service and compromise dignity Process for qualifying as an Interpreter 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 No Certification in a State of Ohio Interpreters receive Certificate of Completion upon successful completion of Screening/assessment Training Post-test Field training Available Interpreter Training Minimum of 24 hour interpreter training Curriculum must include, but not limited: Ethical and practice standards Terminology Interpretation Skills Professional Conduct Standards of Regulating and Governing Bodies Cultural Competency Agency Records 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 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 Allow the interpreter to take control of interview Make no attempt to guide the interpreter when there are problems Tips 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 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 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 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. 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: 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 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 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 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 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 Budget crisis: keep program cheap Lack of ODJFS urgency 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 Ensure access to language services and financial assistance counselors in hospital Troubleshoot problem AEMA, Medicaid cases; challenge bad decisions Document hardship cases – share them with hospital administration and OHA 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 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!