Tag Archive for: Lawfully Present

Cyrus Mehta

Keeping Tabs On a Non-Citizen’s Eligibility For Health Coverage Under The Affordable Care Act

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President Obama’s healthcare law, the Affordable Care Act (ACA), is here to stay especially after the law withstood a challenge in King v. Burwell that allows the federal government to provide subsidies to poor and middle class people to buy health insurance on a nationwide basis.

Even non-citizens who are lawfully present may access the health exchange to buy insurance under the ACA. Many non-citizens will also be subject to the individual mandate or “individual shared responsibility provision” if they do not maintain essential health coverage. It is thus important to keep track of a non-citizen’s eligibility as well as when such an individual may be penalized on his or her next tax return for not maintaining essential coverage, which has been explained in Who is Lawfully Present Under the Affordable Care Act?

Becoming Lawfully Present After Enrollment Period Has Closed

The next open enrollment period for 2016 starts November 1, 2015 and ends January 31, 2016. The last open enrollment closed on February 15, 2015. What if a non-citizen becomes eligible for ACA coverage between February 15, 2015 and November 1, 2015?

Take the example of a US citizen who has sponsored her parents, John Smith and Jane Smith, under the immediate relative category through the filing of an I-130 petition while they were outside the United States. They came to the United States on June 25, 2015 as permanent residents upon the approval of the I-130 and the issuance of immigrant visas at the consular post overseas. A permanent resident is a qualified alien who is eligible for coverage on a health exchange and is also subject to the mandate. Although the open enrollment closed on February 15, 2015, John and Jane are eligible under the 60 day special enrollment period because they just became permanent residents after the prior enrollment period closed on February 15, 2015. Assuming that they do not have minimum essential coverage as yet, if John and Jane do not take advantage of the special enrollment period and get coverage in the first full month during which they are present for the entirety of the month, they will be subject to a penalty when they file their tax returns for 2015. Even if John and Jane choose to return to their original country for two years on a reentry permit to wrap up their business and sell their home, they must still enroll for health coverage or qualify for an exception, which includes qualifying under the foreign earned income exclusion pursuant to section 911(d)(1)(A) or 911(d)(1)(B) of the Internal Revenue Code. This is more fully explained in the blog entitled The Impact of Obamacare on Green Card Holders Who Reside Outside the United States.

Let’s discuss another example of a person who applies for permanent residence from within the United States. Maria Fernandez entered the United States on a B-2 visitor’s visa on January 1, 2009 and has remained ever since. She overstayed her authorized stay as a visitor after July 1, 2009. As a result of overstaying her B-2 visa status, she is not considered lawfully present under the ACA. On April 1, 2015, Maria married a US citizen, who filed an I-130 petition on her behalf and she concurrently filed an I-485 application for adjustment of status. Under the definition of “lawfully present” in 45 CFR 152.2(4)(vii), she is not yet lawfully present as the underlying I-130 visa petition has not been approved. For immigration purposes, Maria will be considered lawfully present as an adjustment application, but some of the definitions of “lawfully present” under the ACA are not in harmony under immigration law. However, if Maria obtains employment authorization as an adjustment applicant, she will be considered lawfully present pursuant to 45 CFR 152.2(4)(iii). Suppose Maria obtains employment authorization on July 1, 2015, although the next open enrollment starts on November 1, 2015 and assuming she does not have minimum essential coverage, Maria will be eligible for the special 60 day enrollment period under 45 CFR 155.420(d)(3).

If on the other hand, Maria does not apply for employment authorization as an adjustment applicant pursuant to 8 CFR 274a.12(c)(9), she will not be considered lawfully present until after her I-130 petition is approved or when she becomes a lawful permanent resident, whichever is earlier.

Special enrollment is available when “[t]he qualified individual, or his or her dependent, which was not previously a citizen, national, or lawfully present individual gains such status.”  45 CFR 155.420(d)(3). It is unclear whether special enrollment would be available to someone who was previously lawfully present, then fell out of status, and now regains another status.  However, it would be bizarre if this rule precluded someone who had ever been lawfully present in their life previously. If the rule was applied so rigidly, someone like Maria in the above example would not qualify for special enrollment and would have to wait for the next open enrollment on November 1, 2015. Even visitors in B-2 status may be considered lawfully present under the ACA, but they may not be required to seek health coverage if they have not yet become tax residents.  Special enrollment ought to cover anyone who goes from not being lawfully present to being lawfully present.

Lawfully Present Non-Citizens with Low Incomes

Lawful Permanent residents are excluded from Medicaid unless they have had this status for at least 5 years under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA). The Children’s Health Insurance Program of 1997 (CHIP), however,  allows pregnant women and children lawfully residing in the United States to access both Medicaid and CHIP even if they have not resided in the United States for five years. Not all states, though, have lifted the 5 year waiting period for CHIP coverage.  Although newly minted LPRs with low incomes may not be able to access Medicaid within the first five years unless they qualify for CHIP, the ACA provides subsidies to eligible non-citizens, which are now protected even if offered through the federal health exchange after King v. Burwell. Lawfully present non-citizens with incomes up to 250% of the Federal Poverty Level (FPL) are eligible for cost sharing subsidies, and those up to 400% of the FPL are eligible for tax credits to offset the costs of purchasing private plans. Due to the 5 year Medicaid ban, lawfully present immigrants that have incomes under 100% of the FPL can also receive subsidies and tax credits that their US citizen counterparts are precluded from obtaining in states that have refused to expand Medicaid.  Although the Supreme Court in National Federation of Independent Business v. Sibelius upheld the constitutionality of the ACA, it also gave states the choice of whether or not to expand Medicaid. At the time of writing, 30 states including the District of Columbia have opted for expanded Medicaid.

Low income non-citizens who avail of either Medicaid or other subsidies will not be rendered a public charge for immigration purposes.  According to USCIS policy, “Non-cash or special purpose cash benefits that are generally supplemental in nature and do not make the person primarily dependent on the government for subsistence do not impact a public charge determination.” On the other hand institutionalization for long term care through Medicaid or other subsidies would be considered as a factor in making a public charge determination.

Conclusion

In King v. Burwell, Chief Justice Roberts who wrote the majority opinion stated that “Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them.” Since the ACA is here to stay and will most likely be firmly entrenched in the nation’s DNA like Social Security and Medicare, many qualified and lawfully present non-citizens will also be able to access benefits the ACA and may also become subject to the mandate. At this point, undocumented immigrants or recipients of Deferred Action for Childhood Arrivals (DACA) cannot access the health exchanges or avail of the subsidies. Some states may have their own rules, so for example in New York, DACA recipients and other ‘permanent residents under color of law” (PRUCOL) can still avail of Medicaid since the New York Court of Appeals in Aliessa ex rel. Fayad v. Novello held that PRWORA violated New York’s Equal Protection Clause.  The ACA is becoming more and more linked to immigration issues. While an immigration practitioner need not be an expert in other disciplines, he or she must be aware of eligible statuses for coverage under the ACA, the deadlines for enrollment and when the 60 day special enrollment may become available and the potential for someone to be subject to additional payment to the IRS for failing to obtain coverage, unless the client can qualify for an exemption.

Cyrus Mehta

Who is ‘lawfully Present’ Under the Affordable Care Act?

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By Gary Endelman and Cyrus D. Mehta

 

Had I been present at the creation, I would have given some useful hints for the better ordering of the universe.

Alphonse X the Wise of Castile

Many non-citizens will be subject to additional payment to the Internal Revenue Service if they do not maintain “minimum essential healthcare coverage” under the Patient Protection and Affordable Care Act (Affordable Care Act – ACA).  This is known as the “individual mandate” or the “individual shared responsibility provision.”  By the same token, eligible non-citizens can also access health plans on the health exchanges or Marketplace. The last day to enroll is February 15, 2015 for the current year.  Our first blog discussed the impact of the ACA on lawful permanent residents or green card holders who reside outside the United States.  This blog focuses on non-citizens who are lawfully present in the United States. Section 1411(a) (1) of the ACA renders non-citizens lawfully present in the United States subject to the individual mandate.

The ACA is linked to immigration issues, just as it is joined at the hip with tax law, and it behooves the careful practitioner to consider the commonality   of all these issues and how each of them can inform our understanding of the others when advising non-citizen clients. While an immigration practitioner need not be an expert in other disciplines, he or she must be aware of the eligible statuses for coverage under the ACA, the deadlines for enrollment, and the potential for the client to being subject to an additional payment to the IRS for failing to obtain coverage, unless the client can qualify for an exemption.

The definition of “lawfully present” in 45 CFR 155.2 tracks the prior definition, as it applied to pre-existing condition insurance plans, under 45 CFR 152.2.  A summary of the definitions of “lawfully present” is posted on healthcare.gov, which we reproduce below:

Immigrants with the following statuses qualify to use the Marketplace:

  • Lawful Permanent Resident (LPR/Green Card holder)
  • Asylee
  • Refugee
  • Cuban/Haitian Entrant
  • Paroled into the U.S.
  • Conditional Entrant Granted before 1980
  • Battered Spouse, Child and Parent
  • Victim of Trafficking and his/her Spouse, Child, Sibling or Parent
  • Granted Withholding of Deportation or Withholding of Removal, under the immigration laws or under the Convention against Torture (CAT)
  • Individual with Non-immigrant Status (includes worker visas, student visas, and citizens of Micronesia, the Marshall Islands, and Palau)
  • Temporary Protected Status (TPS)
  • Deferred Enforced Departure (DED)
  • Deferred Action Status (Deferred Action for Childhood Arrivals (DACA) is not an eligible immigration status for applying for health insurance)
  • Lawful Temporary Resident
  • Administrative order staying removal issued by the Department of Homeland Security
  • Member of a federally-recognized Indian tribe or American Indian Born in Canada
  • Resident of American Samoa

Applicants for any of these statuses qualify to use the Marketplace:

  • Temporary Protected Status with Employment Authorization
  • Special Immigrant Juvenile Status
  • Victim of Trafficking Visa
  • Adjustment to LPR Status
  • Asylum (see note below)
  • Withholding of Deportation, or Withholding of Removal, under the immigration laws or under the Convention against Torture (CAT) (see note below)

Applicants for asylum are eligible for Marketplace coverage only if they’ve been granted employment authorization or are under the age of 14 and have had an application pending for at least 180 days.

People with the following statuses and who have employment authorization qualify for the Marketplace:

  • Registry Applicants
  • Order of Supervision
  • Applicant for Cancellation of Removal or Suspension of Deportation
  • Applicant for Legalization under Immigration Reform and Control Act (IRCA)
  • Legalization under the LIFE Act

Note that undocumented aliens are not included in the above definitions, including beneficiaries of the 2012 DACA program as well as future recipients of the November 20, 2014 Obama Executive Actions that expand DACA as well as the Deferred Action for Parents Accountability program (DAPA).

While the above list provides a comprehensive summary and quick reference, some analysis of the actual regulatory definitions is warranted under 45 CFR 152.2.

A nonimmigrant is only considered “lawfully present” if he or she “has not violated the terms of the status under which he or she was admitted or to which he or she has changed after admission.” See 45 CFR 152.2(2). This is unclear as a nonimmigrant may have technically violated his or her status unwittingly in many ways, but may  still have eventually cured it. For example, if a person on an H-1B visa was mistakenly admitted into the United States for a lesser period of time than the validity period in the H-1B approval notice, and does not realize this, he or she has potentially technically violated status. Still, this person can hope to correct it by filing a late extension of status in the US, or leaving the US and returning, or at times, asking the CBP to extend the date within the US.  An individual who is presently in lawful status should be considered “lawfully present” in order to access a health plan on the exchange. The larger point is that maintenance of status may now have a wider significance beyond the more modest confines of the INA. In turn, this commends the value of an inter-disciplinary approach to the whole question of ACA jurisprudence. Interestingly, while 45 C.F.R. 152.2 gives a precise definition of “lawfully present” it does not contemplate nor define “unlawful presence” thus reflecting a refreshing preference for inclusion as opposed to exclusion, something the INA would do well to emulate.

Under 45 CFR 152.2(4) (vii), only an applicant for adjustment of status whose visa petition has been approved is subject to the ACA. However, it is possible to file an adjustment of status application concurrently with an I-130 or I-140 immigrant visa petition, without the need for such a petition to be approved. Thus, one who has filed an adjustment of status application concurrently with an I-130 or I-140 petition cannot have access to a plan under the health exchange until the petition is approved. Still, once the person is issued employment authorization after filing an adjustment application pursuant to 8 CFR 274a.12(c) (9) he or she can access the ACA even if the I-130 or I-140 petition has not been approved. 45 CFR 152.2(4) (iii) renders one who has been granted employment authorization under 8 CFR 274a.12(c) (9), (10), (16), (18), (20), (22), or (24) as lawfully present. But 8 CFR 274a.12(b)(20) is conspicuous by its absence in the ACA rules determining lawful presence, which allows those in a nonimmigrant status to continue employment for 240 days during the pendency of a timely filed extension request.  It is thus unclear whether someone in a period of stay authorized by the Attorney General (POSABAG) while a timely extension request is pending could take advantage of the ACA. Even if a noncitizen is lawfully present, he or she has to also be a tax resident. IRS regulations at 26 CFR 1.5000A-3(c) exempt noncitizens who are nonresident tax aliens from the individual mandate. So while a non-citizen may be lawfully present and can access the health exchange, he or she will not be subject to the individual mandate under the IRS rules. It is also worth noting that one who is lawfully present may not be eligible to access health insurance who is here in the United States briefly. 45 CFR 155.305, which establishes eligibility criteria for enrolling exchange, requires the applicant to be a “citizen or national of the United States, or is a non-citizen who is lawfully present in the United States, and is reasonably expected to be a citizen, national, or a non-citizen who is lawfully present for the entire period for which enrollment is sought.” See 45 CFR 155.305(a) (1).This durational requirement reinforces our understanding that the ACA is not a new form of government welfare nor can we view such a durational requirement as denying or abridging a fundamental constitutional right. Compare this to the lesson taught by the Supreme Court in Shapiro v. Thompson, 394 U.S. 618 (1969) that struck down waiting periods for public assistance.

Being a “resident” for immigration purposes is not the same as being a “resident” for tax purposes. Tax law uses many of the same terms as immigration but the identical words or concepts can have dramatically different meaning. It is a measure of the ever-growing extent to which immigration has become inextricably interconnected to so many other areas of American life that we are increasingly prone to use immigration terms such as “lawfully present” when discussing non-immigration topics, sometimes with significantly different meanings. Definition therefore is inherently contextual and the relationship of the ACA to our immigration law is a fluid and dynamic one. INA § 101(a)(33) states: “The term ‘residence’ means the place of general abode; the place of general abode of a person means his principal, actual dwelling place in fact, without regard to intent.” Note that the concept of domicile, which considers the applicant’s intent rather than the place where he or she actually lives, is absent from this definition. Remember, in the naturalization context,  if your client did not stay away one year, he or she must be considered a resident of the same state where they lived before leaving. 8 C.F.R. 316.5 (b) (5). See Accardi V. Shaughnessy, 347 US 260 (1954); Morton v. Ruiz, 415 US 199, 235 (1974) (“Where the rights of individuals are affected, it is incumbent upon agencies to follow their own procedures”).

Nonimmigrants are considered to be resident aliens for tax purposes if they meet the “substantial presence” test. Non-citizens are considered residents through the substantial presence test if they are physically present in the US for 31 days during the current year; and a total of 183 days during a 3-year period by counting all the days of the current calendar year, 1/3 days of the previous calendar year, and 1/6 days of the second previous calendar year. See IRC §7701(b) (1) and (3).

Even those who become tax residents under the substantial presence test may continue to remain non-residents if they meet a closer connection to a foreign country test. However, not all may be able to meet this test. A frequent tourist to the US in B-2 status can potentially become a tax resident under the substantial presence test, and thus subject to the ACA. If this tourist is the subject of an immigrant visa petition, such as an I-130 petition filed by a sibling, whose date has not become current, he or she can no longer meet the closer connection test. At the time of filing the 1040 return, this individual will be subject to the shared responsibility payment.

Most students lawfully present in the US in F, J, M or Q status, or their dependents, are exempt for 5 years from counting days of presence under the substantial presence test. Even after five years and having become subject to the substantial presence test, they can continue to be treated as nonresident aliens if they meet the closer connection to a foreign country test. Teachers or trainees present in the US in J or Q status (and their dependents) are exempt from counting days towards substantial presence only for the first two years in the United States. This includes all Js and Qs who are not students, such as research scholars, professors, short-term scholars, specialists, physicians, trainees, interns, au pairs, and camp counselors. Even if these students are not subject to the individual mandate, they can still qualify for coverage through the health exchanges in the event that the school does not provide equivalent coverage

It is hard today to harken back to a time when immigration was less central to the rhythm of American life than it is now. Yet, before the enactment of the Immigration Reform and Control Act of 1986 (IRCA), most employers did not need to worry about immigration nor was immigration policy a matter of white-hot national debate. The lasting importance of IRCA was to bring immigration and immigrants in from the shadows, a process that continues to the present day.   The ACA continues this process of inclusion and the extent to which the marriage of immigration with health care can be a lasting and meaningful one will go far towards assuring the success of both.

(Guest author Gary Endelman is the Senior Counsel at Foster)