PCIP Pre-existing Insurance Coverage Plan Changes

[depotoo]

From regulations.gov, due to the lack of funding, the definition of who is eligible has been changed for those in Deferred Action for Childhood Arrivals, they will not be eligible, nor will they be able to receive tax credits.

On June 15, 2012, the Department of Homeland Security (DHS)
announced that it will consider providing temporary relief from removal
by exercising deferred action on a case-by-case basis with respect to
certain individuals under age 31 who meet DHS's guidelines, including
that he or she came to the United States as children and does not
present a risk to national security or public safety.\3\ This process
is referred to by DHS as Deferred Action for Childhood Arrivals
(DACA).\4\

Though I guess they can still enroll for healthcare coverage, just not have pre-existing conditions covered.
Oh, and due to lack of funds.
Oh, wait, maybe they aren't eligible at all?

Under the amended rule, individuals with deferred action under the
DACA process are not eligible to enroll in the PCIP program. As the
PCIP program definition of ``lawfully present'' is incorporated into
the rules governing the Affordable Insurance Exchanges and the premium
tax credits, individuals whose cases are deferred under the DACA
process also will not be eligible to enroll in coverage through the
Affordable Insurance Exchanges and, therefore, will not receive
coverage that could make them eligible for premium tax credits under Treasury
regulations (see 26 CFR 1.36-2(a)(1)) or for cost-sharing reductions
starting in 2014.\7\ This is consistent with the rationale above.

oh wait, but maybe they can be under Medicaid and CHIP -

As DHS has explained, the DACA process is designed to ensure that
governmental resources for the removal of individuals are focused on
high priority cases, including those involving a danger to national
security or a risk to public safety, and not on low priority cases.\5\
Because the reasons that DHS offered for adopting the DACA process do
not pertain to eligibility for Medicaid or CHIP, HHS has determined
that these benefits should not be extended as a result of DHS deferring
action under DACA. Concurrent with this amendment, CMS is issuing a
State Health Official letter providing that individuals whose cases are
deferred under DHS's DACA process will not be eligible under the state
option.\6\

Regulations.gov
Confused yet? Seems to me they can be eligible, but not through the affordable care act. I guess they are living up to the exact words, but found away around it, even though I knew they already had when they actually stated illegal aliens would not be eligible as the alredy allow them under Medicaid & CHIP.

 

[depotoo]

Now i wonder, why can they find the funds under the 2 other programs but not under the affordable care act, according to them?

 

[Greenbeard]

What exactly is the confusion? HHS clarified that just because the administration is exercising prosecutorial discretion and not deporting young people who were brought into the country illegally as children, that does not make them eligible for publicly financed health benefits (including Medicaid, CHIP, and the PCIPs). To be extra crystal clear and avoid any confusion about that, they tweaked their original definition of what it means to be "lawfully present" in the U.S. (one criterion for accessing PCIP benefits) to make it clear this doesn't apply to these kids.

It doesn't have anything to do with funding, it has to do with them not being legally eligible to participate. This isn't rocket science.

Because the reasons that DHS offered for adopting the DACA process do not pertain to eligibility for Medicaid or CHIP, HHS has determined that these benefits should not be extended as a result of DHS deferring action under DACA.

As it also would not be consistent with the reasons offered for adopting the DACA process to extend health insurance subsidies under the Affordable Care Act to these individuals, HHS is amending its definition of ‘‘lawfully present’’ in the PCIP program, so that the PCIP program interim final rule does not inadvertently expand the scope of the DACA process.

 

[rdean]

Research: Medical Bills Leading Cause of Bankruptcy

"Most people who are driven into bankruptcy by illness and medical bills actually have coverage, but it's such inadequate coverage that it doesn't keep them from financial ruin. They're facing huge premiums and copayments and deductibles - and things that aren't covered by their insurance."

---------------------

Health Care companies are only middle men, or as Republicans like to call them, "Private sector". They only exist to skim money off policies. Obamacare limits what they can skim. No wonder they want it stopped.

 

[depotoo]

What exactly is the confusion? HHS clarified that just because the administration is exercising prosecutorial discretion and not deporting young people who were brought into the country illegally as children, that does not make them eligible for publicly financed health benefits (including Medicaid, CHIP, and the PCIPs). To be extra crystal clear and avoid any confusion about that, they tweaked their original definition of what it means to be "lawfully present" in the U.S. (one criterion for accessing PCIP benefits) to make it clear this doesn't apply to these kids.

It doesn't have anything to do with funding, it has to do with them not being legally eligible to participate. This isn't rocket science.

Because the reasons that DHS offered for adopting the DACA process do not pertain to eligibility for Medicaid or CHIP, HHS has determined that these benefits should not be extended as a result of DHS deferring action under DACA.

As it also would not be consistent with the reasons offered for adopting the DACA process to extend health insurance subsidies under the Affordable Care Act to these individuals, HHS is amending its definition of ‘‘lawfully present’’ in the PCIP program, so that the PCIP program interim final rule does not inadvertently expand the scope of the DACA process.

I guess you didn't read my link did you? And secondly, what happens to these individuals, if they do have pre-existing conditions and need urgent treatment, if, according to you, which I disagree that is does not eliminate them from medicaid or CHIP, they are not covered? Do they get turned away from hospitals then as well? And if not, who picks up that tab?

 

[WillowTree]

S U C K E R S..

 

[Greenbeard]

I guess you didn't read my link did you?

Apparently significantly more carefully than you bothered to.

And secondly, what happens to these individuals, if they do have pre-existing conditions and need urgent treatment, if, according to you, which I disagree that is does not eliminate them from medicaid or CHIP, they are not covered? Do they get turned away from hospitals then as well? And if not, who picks up that tab?

If you're asking if EMTALA has been repealed, obviously it has not. What's been clarified here is that the DREAMer kids are not eligible for the Pre-Existing Condition Insurance Plans because they don't meet the definition of "lawfully residing," despite Homeland Security's decision not to deport them. That's it. Period. That's what the regulations you posted say, that's what they mean, and that's all they do.

As to whether they're eligible for Medicaid/CHIP, there's no debate here, the answer is obviously no: http://www.medicaid.gov/Federal-Policy-Guidance/downloads/SHO-12-002.pdf

 

[depotoo]

I guess you didn't read my link did you?

Apparently significantly more carefully than you bothered to.

And secondly, what happens to these individuals, if they do have pre-existing conditions and need urgent treatment, if, according to you, which I disagree that is does not eliminate them from medicaid or CHIP, they are not covered? Do they get turned away from hospitals then as well? And if not, who picks up that tab?

If you're asking if EMTALA has been repealed, obviously it has not. What's been clarified here is that the DREAMer kids are not eligible for the Pre-Existing Condition Insurance Plans because they don't meet the definition of "lawfully residing," despite Homeland Security's decision not to deport them. That's it. Period. That's what the regulations you posted say, that's what they mean, and that's all they do.

As to whether they're eligible for Medicaid/CHIP, there's no debate here, the answer is obviously no: http://www.medicaid.gov/Federal-Policy-Guidance/downloads/SHO-12-002.pdf

see red

HHS has determined that issuing this regulation in proposed form,
such that it would not become effective until after public comment,
would be contrary to the public interest. Because the PCIP program--a
temporary program with limited funding--is currently enrolling eligible
individuals and providing benefits for such enrollees

 

[Greenbeard]

I don't know what your point is. The PCIPs are a time-limited program with a set amount of funding. They were given $5 billion total to use and they only exist through the end of next year.

That doesn't have anything to do with the policy being discussed here which, for the third time, clarifies that DREAMERer kids aren't eligible to enroll in the high-risk pools; the authors bring what you quoted up to explain why the rule is taking effect before, not after, the comment period (i.e. it was released as an interim final rule). You're quoting from a section that's purely about the process by which the rule was released, not the policy contained in the rule.