Who’s Eligible For Medicaid? Rule Change Allows More Virginians to Sign Up

Thanks to a a change that took effect April 1, thousands of Virginians are now eligible. 

RICHMOND – For Sunita Singh, it’s been tough trying to find a health insurance option that will accept her mother. She’s tried for years, with one thing always getting in the way: the 10-year-rule for Medicaid. Legal permanent residents in Virginia for decades had to show a 10-year work history in the state to qualify. That all changed on April 1.

“[The 10-year work history ending in Virginia] was really great news because receiving Medicaid will help [my mother] and other permanent residents get access to the healthcare they need,” Singh said. “My mother will be very grateful to receive Medicaid now.”

Thanks to the work of Del. Mark Sickles (D-Fairfax), the General Assembly agreed last year to end the 10-year work history requirement, effective April 1, 2021. That move opened the door for Singh’s mother, and other residents, to receive free or low-cost health coverage.

Jill Hanken serves as the director of Enroll Virginia. That’s a community-based project of the Virginia Poverty Law Center. It provides free assistance with the application and enrollment process for Medicaid, FAMIS and the Affordable Care Act.

Hanken weighed in on the gravity of the change for the immigrant community. She explained why that requirement previously caused issues for some individuals and how the change could help.

A 25-year History

Up until this month, legal permanent residents who lived in America for more than five years had to prove a 40-quarter work history to gain eligibility for Virginia’s Medicaid plan. 

The requirement first arose 25 years ago. In 1996, Congress created a distinction between immigrants who came to the country before welfare reform became law in August.

The reform gave individual states the option to include immigrants already within their boundaries in the state’s Medicaid programs. Virginia put its own spin onto the reform.

“Back in 1996, Virginia had options to choose about how they were going to implement some new federal immigration rules. And they chose to require some immigrants to have a 10-year work history,” Hanken said. “And that 10 years, it’s calculated. You can actually use the work quarters of a spouse or a parent. So it’s not necessarily a full 10 years for one person.”

The Problem 

Even with the option to split the hours amongst family members, the requirement still presented issues. The 10-year work history became an obstacle for many immigrants, but it was nearly impossible for others. 

“It was a result that Virginia selected, but the result of taking that option was a bar to people getting the health services that they needed,” Hanken said. “And for some immigrants who came to the states later in life, they were coming legally to join family members, but there was really no expectation that they were even going to work in the U.S.”

The requirement created an unfortunate issue. Individuals who would normally qualify for Medicaid couldn’t because of a lack of work history. 

“It left people without access to basic health services to services they needed for chronic health conditions, prescription drugs, everything. It basically left too many people in Virginia uninsured. And while they could get help in an emergency, that’s not good medical care in terms of preventive services and addressing ongoing health needs,” Hanken said. “It’s very inadequate. And this population was, for the most part, remaining uninsured, which is a very scary place to be.”

Five-year Requirement Remains 

The adjustment still requires a federally mandated five-year residency requirement for legal permanent residents, or those who hold a green-card. 

In Virginia, the half-decade residency rule applies to most immigrants, but not all. Persons who come into the country as refugees, those seeking asylum, women who are pregnant and children may access Medicaid without the five-year requirement. 

However, healthcare options exist for many immigrants besides Medicaid. And those options become available even before immigrants reach their five-year anniversary in the United States.

“Fortunately [through] the Affordable Care Act, Marketplace is available to immigrants who are legally residing in the United States, even before they meet the five-year limit requirement,” Hanken said.

Helping People

Several populations will see the benefits from the removal of the 10-year work history requirement. One of those individuals will be central Virginia resident Sunita Singh’s mother, who was previously ineligible.

“My mother has been a legal permanent resident for 10 years now and every year we struggle with trying to find a good health insurance for her,” said Sunita Singh, a central Virginia resident. “[The 10-year work history ending in Virginia] was really great news for her because receiving Medicaid will help her and other permanent residents get access to the healthcare they need. My mother will be very grateful to receive Medicaid now.”

Some of the most impacted people will be parents and other adults under the age of 65, disabled people, the elderly over the age of 65 and individuals who require long-term care services. 

“I think it provides a lot of security and peace of mind to a population that’s been hurt in a very obvious way, especially during COVID,” Hanken said. “A lot of immigrant communities have been hit really hard and in a disparate way during the pandemic.” 

Lending a Hand

Signing up for health coverage is the first step. 

“We encourage people to apply today to get very comprehensive healthcare through Medicaid, to really have the peace of mind about access to healthcare,” Hanken said.

Enroll Virginia plans to help individuals throughout the time of transition and beyond.

“Enroll Virginia is a program of [federally and state] certified navigators who are trained to help people understand their healthcare options,” Hanken said. “So we can look at a family’s circumstances and help them understand whether or not they’re going to be eligible for Medicaid or the Marketplace or there’s a program called FAMIS. Or some immigrants may be left with only emergency services. But our navigators understand those options and can help people apply and get enrolled if they qualify for one of those options or understand the alternatives.”

All assistance is free and unbiased and available in a virtual, contact-less setting via Zoom. If an individual is not eligible for Medicaid, Enroll Virginia navigators can help them understand other options for subsidized coverage available to them through the ACA. 

Consumers can contact Enroll Virginia’s staff at 1-888-392-5132. There, they may enter their zip code for a direct transfer to a navigator in their community. Consumers can also visit Enroll Virginia’s website, where they can find a local navigator and schedule an appointment.

Amie Knowles reports for Dogwood. You can reach her at [email protected]