A person must be a U.S. citizen or qualifying lawful immigrant to be eligible for Medicaid. In this case, the petitioner was an immigrant with “temporary protected status.” Her Medicaid application was mistakenly approved in 2022 and the Covid-19 rules prevented her disenrollment until her first renewal. ALJ Teresa Perez concluded the petitioner’s immigration status made her ineligible for MA.
This decision was published with support from the Elder Law & Special Needs Section of the State Bar of Wisconsin and the Wisconsin chapter of the National Academy of Elder Law Attorneys.
Preliminary Recitals
Pursuant to a petition filed on January 16, 2024, under Wis. Stat. § 49.45(5), and Wis. Admin. Code § HA 3.03(1), to review a decision by the St. Croix County Health & Human Services regarding Medical Assistance (MA), a hearing was held on February 28, 2024, by telephone.
The issue for determination is whether Petitioner’s immigration status renders her ineligible for Institutional Medical Assistance.
There appeared at that time the following persons:
PARTIES IN INTEREST:
Petitioner:
—
Respondent:
Department of Health Services
1 West Wilson Street, Room 651
Madison, WI 53703
By: Dayna Stellrecht
St. Croix County Health & Human Services
1752 Dorset Lane
New Richmond, WI 54017-1063
ADMINISTRATIVE LAW JUDGE:
Teresa A. Perez
Division of Hearings and Appeals
Findings of Fact
- Petitioner (CARES # —) is an 82-year old resident of Pierce County who applied and was found eligible for Medical Assistance in June 2022.
- Petitioner resides in a skilled nursing facility.
- Petitioner immigrated to the United States in 2018 and has remained in the United States since then. She has been granted “temporary protected status” (hereafter, TPS) by the Department of Homeland Security.
- During the Covid-19 related public health emergency, Medical Assistance recipients were not required to complete renewals. As a result, after Petitioner was first found eligible, she was not required to undergo a program renewal until December 2023.
- By notice dated December 1, 2023, the agency informed Petitioner that her Long Term Care Medical Assistance had ended as of November 1, 2023 because she is not a U.S. citizen or an eligible immigrant; however, her benefits, in fact, continued through December 31, 2023.
- On January 16, 2024, Petitioner submitted a request for fair hearing with the Division of Hearings and Appeals.
Discussion
To be eligible for Long Term Care Medical Assistance, an individual must be either a citizen or have some other qualifying immigration status. See Medicaid Eligibility Handbook §7.3, et.al. In this case, the agency explained that Petitioner has been granted “temporary protected status” which, although an immigration status that allows Petitioner to be lawfully present in the United States, does not constitute a qualifying immigration status for purposes of establishing Medicaid eligibility. The agency representative at hearing testified that the agency mistakenly found Petitioner to be eligible for Long Term Care Medical Assistance in June 2022 and was unable to correct its mistake at that time because special rules in place during the Covid-19 related public health emergency allowed most Medical Assistance recipients to have continuous coverage.
Petitioner’s niece, who advocated admirably for her aunt, presented written statements, medical records, and credible testimony explaining her aunt’s medical and financial challenges. She did not however dispute the agency’s evidence regarding her aunt’s immigration status. As an administrative law judge, I am empowered only to apply the relevant laws as they are written and reasonably interpreted. Based on the record before me, I must find that Petitioner’s immigration status does not qualify her for Long Term Care Medical Assistance.
Conclusions of Law
Petitioner is not a citizen or an eligible immigrant as that term is defined in Medicaid Eligibility Handbook §7.3.3; she is thus not eligible for Long Term Care Medical Assistance.
THEREFORE, it is
Ordered
That Petitioner’s appeal is dismissed.
[Request for a rehearing and appeal to court instructions omitted.]