Refugee Medical Assistance (RMA)

Refugee Medical Assistance (RMA) is a 100% federally funded program that provides up to eight months of health care coverage to certain noncitizens who are considered refugees under the Immigration and Naturalization Act. To be eligible for RMA, these refugees must meet all of the following conditions:

l  Be ineligible for MA (consider MA eligibility under all other bases of eligibility first).

l  Have one of the immigration statuses noted below.

l  Provide the name of their resettlement agency to the county human services agency.

l  Not be full time students in an institution of higher learning, unless their enrollment is part of a state-approved plan.

Eligibility factors and links to standard program guidelines are provided below.

Application Process.

Eligibility Begin Date.

Renewals.

Verifications.

Social Security Number.

Citizenship/Immigration Status.

Residency.

Insurance and Benefit Recovery.

Household Composition.

Eligibility Method.

Asset Guidelines.

Income Guidelines.

Deductions/Disregards.

Spenddowns.

Covered Services.

Service Delivery.

Other Requirements.

End of Eligibility Basis.

Relationship to Other Groups/Bases.

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Application Process  (standard guidelines)

Follow standard MA guidelines.

Eligibility Begin Date  (standard guidelines)

The eight-month period of eligibility begins either on the date the refugee enters the United States with a qualifying immigration status or the date the refugee was granted a qualifying status by U.S. Citizenship and Immigration Services (USCIS) The federal agency responsible for immigration and citizenship. This agency was formerly known as the Bureau of Citizenship and Immigration Services (BCIS) and Immigration and Naturalization Service (INS). or the Office of Refugee Resettlement.

Example:

Berit entered the United States in August as a nonimmigrant, and was granted asylee status by USCIS on September 15. She applies for health care coverage in November and requests retroactive coverage. She meets all RMA requirements.

Action:

Approve RMA for Berit effective September 15.

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Renewals  (standard guidelines)

RMA enrollees are exempt from six-month renewals.

Verifications  (standard guidelines)

Follow standard MA guidelines for initial eligibility.

Note:  Changes in assets or income that occur after the date of application are not considered, so would not need to be verified.

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Social Security Number  (standard guidelines)

RMA applicants and enrollees are not required to apply for or provide SSNs.

Citizenship/Immigration Status  (standard guidelines)

RMA enrollees must have one of the following immigration statuses:

l  Refugee.

l  Asylee.

l  Cuban/Haitian entrant.

l  Amerasian immigrant.

l  Dependent children A child who lives with a parent, legal guardian, relative caretaker or foster parent and is under age 18 or 18 years old, a full-time student, expected to graduate by age 19. of people with any of the above statuses who live in the same household if the only parent or both parents in the household have refugee status. Children with a non-refugee parent in the household are not eligible for RMA.

Note:  Although federal RMA guidelines include dependent children, in practice these children will qualify for MA under another basis if they have a qualifying status. However, they may become eligible for RMA if income increases beyond the applicable standard for the other MA basis during the first eight months of U.S. residence.

l  Trafficking victim.

l  Iraqi and Afghan Special Immigrants.

People who adjust to LPR status also qualify if they previously held one of the statuses above and meet all other requirements.

Sponsor deeming does not apply to RMA enrollees.

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Residency  (standard guidelines)

Follow standard MA guidelines.

Insurance and Benefit Recovery  (standard guidelines)

If the refugee has cost effective health insurance available through employment, follow guidelines in Cost Effective Health Care Coverage - MA.

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Household Composition  (standard guidelines)

Follow standard MA guidelines.

Eligibility Method  (standard guidelines)

Use Method A for assets and income.

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Asset Guidelines  (standard guidelines)

The asset limit for initial eligibility is:

l  $10,000 for a household of one.

l  $20,000 for a household of two or more.

Exception:  For people who are eligible for automatic RMA with Refugee Cash Assistance (RCA) A program that provides financial help to refugees ineligible for both MFIP and SSI., apply the RCA asset limit instead.

Determine eligibility based on assets on the date of application. Do not consider any change in assets after the date of application until the end of the RMA eligibility period.

Income Guidelines  (standard guidelines)

The income limit for initial eligibility is 100% FPG.

Determine eligibility based on income on the date of application.

l  Do not consider any new sources or increases in income received or expected to be received after the date of application, including earnings from starting employment.

l  RMA enrollees whose income increases beyond the RMA limits remain eligible for RMA until the end of the original eight-month eligibility period.

Example:

Josef, age 35, entered the U.S. as a refugee on April 10. He is single and has no dependent children. He applies for health care coverage on April 27.

n  He does not have an MA basis of eligibility.

n  He had no income on the date of application.

n  His only asset is $300 in cash.

The worker contacts Josef on May 5 to follow up on information needed to process the application and learns that Josef began employment on May 1. His employer does not offer health insurance.

Action:

Base eligibility for the eight-month period on zero income if Josef meets all RMA requirements. Do not consider his earnings or require him to provide verification of his employment.

Example:

Rolf, age 22, entered the U.S. as a refugee on July 25. He applies for RMA on August 10. He reports he is employed 20 hours per week at $6.00 per hour.

Action:

Project this income for the eight-month RMA eligibility period. Do not consider increases or new income sources that begin after the date of application.

Refugee resettlement grants are treated as lump sum income.

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Deductions/Disregards  (standard guidelines)

Use the following Method A deductions and disregards:

l  17% earned income disregard.

l  Dependent care deduction.

l  Child support deduction.

Spenddowns  (standard guidelines)

Follow standard MA guidelines.

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Covered Services  (Prepaid MHCP Manual)

RMA enrollees are not subject to co-payments A fixed amount a person is required to pay for each episode of a particular treatment, medical supply, or equipment. For example, a policy might require a $5 co-payment for each prescription while the insurance pays the remainder..

Service Delivery  (Prepaid MHCP Manual)

People who receive Refugee Cash Assistance (RCA) A program that provides financial help to refugees ineligible for both MFIP and SSI. or Refugee Medical Assistance (RMA) A federally authorized program providing MA to refugees. are excluded from managed care enrollment.

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Other Requirements

If refugees are ineligible for MA under another basis, send a notice manually denying MA under that basis (in addition to the system-generated approval notice for RMA).

RMA clients who are admitted to an institution (such as an IMD or a penal institution) do not lose their RMA eligibility. There are no restrictions for RMA as to where the client resides.

End of Eligibility Basis

Determine if MA eligibility continues under another basis at the end of the eight-month RMA period.

l  Do not require a new application.

l  Require verification of earnings if applicable.

l  If there is no MA basis, review for MinnesotaCare eligibility. See Applications.

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Relationship to Other Groups/Bases  (standard guidelines)

Refugees receiving Refugee Cash Assistance (RCA) are automatically eligible for RMA if they are not eligible under another MA basis. Consider eligibility under other MA bases first. Refugees do not have to apply for RCA as a condition of eligibility for RMA.

If refugees who receive MA under another basis become ineligible due to increased earnings:

l  Consider eligibility for Transition Year Medical Assistance (TYMA).

l  If there is no eligibility for TYMA and the refugee has been in the United States for less than eight months, approve RMA for the remainder of the eight-month period without an eligibility determination.

Example:

Bao and her two children entered the United States as refugees on September 12. They were approved for MA effective September 1. Bao reports beginning employment on October 5. Her earnings will exceed the MA standard for herself and the children. She does not meet the eligibility criteria for TYMA because she did not receive MA three out of the last six months.

Action:

Close MA November 1 and open RMA for the remainder of the eight-month period.

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