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'Breakthough day' - Va. ends 10-year work requirement for legal immigrants

'Breakthough day' - Va. ends 10-year work requirement for legal immigrants

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Virginia no longer will require thousands of legal immigrants to work at least 10 years in the United States before qualifying for health coverage under the state’s Medicaid program.

The requirement, known as the “40-quarter rule,” doubles the time required under federal law for legal immigrants to qualify for health care benefits under the entitlement program that Virginia administers for the federal government and shares in the costs.

The federal government requires legal immigrants to live and work in the U.S. for five years before qualifying for Medicaid, but the state has been one of six states to impose an additional work requirement — until Thursday, the effective date of a budget amendment that Gov. Ralph Northam and the General Assembly approved last year.

“I think this is a great, breakthrough day,” said Del. Mark Sickles, D-Fairfax, who has sought for more than two years to eliminate the rule. “It’s a public health measure. It’s a humanitarian measure.”

The Virginia Department of Medical Assistance Services, the agency that operates the state Medicaid program, estimates that at least 4,000 Virginians may become eligible under the budget amendment, which will cost the state and federal governments $12.8 million in the next fiscal year, including $3.3 million from the state general fund of taxpayer money for core services.

Each year, about 28,000 Virginians become legal permanent residents, according to the Virginia Poverty Law Center in an analysis of data from the U.S. Department of Homeland Security, but the state expects to have more information soon on how many people will become eligible for benefits with the elimination of the 40-quarters rule.

“This historic policy change is long overdue,” said Karen Kimsey, Virginia’s Medicaid director. “I am so grateful we were able to break down this unjust barrier and offer these individuals access to doctor visits, prescriptions, hospital care and all of the health care services they need to be safe and thrive in these uncertain times.”

The 4,000 identified by the agency purchase health insurance on the federal marketplace created under the Affordable Care Act, but the state does not know how many legal immigrants, especially those with low incomes, could qualify if they didn’t have to prove 10 years of work experience.

“There may be some individuals who are fearful, just for applying,” Kimsey said in an interview on Wednesday. “It is a very real factor for a lot of individuals, the fear factor.”

“This ensures they get health care,” she said. “That is one they shouldn’t have to worry about.”

Currently, legal immigrants can receive emergency medical services, but not preventive care, through Medicaid, said Jill Hanken, health care attorney for the Virginia Poverty Law Center. But health cover is limited, especially for those with low incomes who otherwise would qualify for full Medicaid benefits if not for the 40-quarter rule

“It’s been a huge restriction,” Hanken said.

“We are thrilled that lawful permanent residents living in Virginia now have the opportunity to receive the quality, affordable health coverage they need to thrive,” she said.

The Medicaid agency has begun a public awareness campaign to reach people who could benefit from the change, as well as organizations that represent them, so they can apply for free or low-cost health benefits.

“It’s important for individuals in our immigrant communities to reach out and apply for coverage because there are many paths to eligibility,” said Sarah Hatton, deputy of administration at the Medicaid agency.

“Whether you’re a green card holder, a refugee, an asylee, a pregnant immigrant or fall into another category, I encourage you to contact us and learn more about the services that may be available to you and your family,” Hatton said.

Residents can apply for Medicaid coverage online at or seek free assistance through the CoverVA and Spanish language CubreVirginia websites. People also may inquire by calling the Enroll Virginia hotline at 1-888-392-5132.

The change has been a long time coming in part because the requirement wasn’t generally known about and eligibility for legal immigrants was overshadowed by the six-year political battle over expanding Virginia’s Medicaid program under the Affordable Care Act.

The General Assembly and governor approved expansion in 2018, effective Jan. 1, 2019. Since then, more than 533,000 Virginians have enrolled in Medicaid under the expanded eligibility requirements established by the 2010 federal health care law.

Sickles first sought to undo the 40-quarters requirement in 2019, but the General Assembly rejected his amendment, estimated then to cost the state $6.5 million.

“There was definite interest at that point, just not enough information,” Kimsey said.

Last year, Northam proposed to eliminate the requirement in the two-year budget the legislature approved on March 12, 2020, the same day the governor declared a public health emergency because of the COVID-19 pandemic. The state cost was lower, at $3.3 million, but the money was suspended with more than $2 billion in new spending frozen because of the health crisis. The assembly and governor restored the funding under a revised budget adopted in October during a special legislative session.

With the ongoing threat of the pandemic, Kimsey said, “from a health equity perspective, it’s important to align with what the federal rules allow.”


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