Current through February, 2024
Section 5100
Refugee Medical Assistance
The purpose of Refugee Medical Assistance is to help in the
effective resettlement of refugees by providing health coverage to refugees who
are not eligible for Medicaid/Pr. Dynasaur. Refugee Medical Assistance (RMA) is
authorized by the Refugee Act of 1980 and the accompanying regulations in 45 R
Part 400, and Title IV; Chapter 2 of the Immigration and Nationality Act (
8
U. S. C. §
1522(e)
).
Section 5101 Medical
Screening Examination
A medical screening examination, coordinated by the Vermont
Department of Health, is a covered service under RMA when the examination is
within the first 90 days of the refugee's initial date of entry, even if the
refugee is not eligible for either Medicaid or RMA.
Section 5110 Eligibility Requirements
(a) Any refugee or asylee may apply for
medical assistance through the state or its designated agency at any time, and
eligibility must be determined no more than 45 days from the date of
application.
(b) "Refugee" means an
individual who meets the definitions of a refugee under section
101(a)
(42) of the Immigration and Nationality
Act.
(c) "Asylee" means an
individual who has been granted asylum under section
208
of the Immigration and Nationality Act. It does not include "applicant for
asylum," which is someone who has applied for but not been granted asylee
status.
(d) Asylees are eligible
for all refugee assistance and services beginning on the date they are granted
asylum.
(e) For purposes of this
rule, the term "refugee" includes "asylee" as defined above unless specifically
designated otherwise and any other eligible category that meets immigration
status and identification requirements in 45 CPR, Part 400, Subpart D.
(f) A refugee must provide
documentation of refugee or asylee status as defined in federal rules before
the Vermont Agency of Human Services (AHS) may grant assistance. It is the
responsibility of AHS to document proof of status of the refugee or asylee and
keep a copy of supporting documentation on file.
(g) AHS will promptly notify the agency (or
local affiliate) which provided the initial resettlement of a refugee whenever
the refugee applies for medical assistance. Any refugee who has not been
referred by the local resettlement agency will be counseled by AHS to contact
the local resettlement agency to benefit from other kinds of
assistance.
Section 5120
Determining Eligibility
(a) The Vermont Agency
of Human Services (AHS) determines eligibility for medical assistance and
administers Medicaid and Refugee Medical Assistance (RMA) benefits. Refugees
who are not eligible for Medicaid may be eligible for RMA if they meet the
financial and non-financial requirements of RMA.
(b) When a refugee applies for medical
assistance, AHS must first determine eligibility for each individual member of
the refugee assistance group under Medicaid, using regulations, including those
for the medically needy, governing all other Medicaid applicants, and if an
individual is eligible, approve Medicaid for that individual. If AHS determines
that a refugee is not eligible for Medicaid, it must then determine if the
individual is eligible for RMA. Eligibility for RMA services begins on the
first day of the month of application.
(c) The RMA eligibility period is determined
annually by the director of the federal Office of Refugee Resettlement in
accordance with 45 R § 400.211 and begins on the first day of the month of
a refugee's initial date of entry. For asylees, the eligibility period begins
on the first day of the month in which they were granted asylum.
(d) A refugee who loses Medicaid eligibility
because of earnings from employment must be transferred to RMA without any
further eligibility determination if there is time remaining in the RMA
eligibility period.
(e) Individuals
enrolled in RMA receive the same services and coverage as beneficiaries of
Medicaid.
(f) A refugee will
continue to receive RMA until the end of his or her RMA eligibility period.
Changes in eligibility for benefits require 11 days' advance notice to the
beneficiary. At the end of the eligibility period, AHS must determine if the
refugee is eligible for Medicaid or other health benefit programs and, if
eligible, provide Medicaid to that individual.
(g) When AHS notifies an applicant that
medical assistance has been granted, denied, or terminated, the notice must
specify which program it applies to, clearly distinguishing between
Medicaid/Dr. Dynasaur and RMA.
Section 5121 Non-financial Eligibility
(a) Applicants for RMA must meet each of the
following criteria:
(1) Be ineligible for
Medicaid under the State's Medicaid State Plan,
(2) Have been eligible for RMA for fewer
months than the RMA eligibility period,
(3) Provide the name of the resettlement
agency that resettled them,
(4)
Meet the RMA financial eligibility standards delineated below,
(5) Meet immigration or asylee status and
identification requirements specified at 45 R, Part 400, Subpart D, or be
dependent children of and part of the same assistance group as applicants
meeting these requirements, and
(6)
Not be full-time students in institutions of higher learning unless approved by
the state as part of an employability plan or part of a plan for an
unaccompanied minor.
(b)
All beneficiaries of refugee cash assistance, who are not eligible for
Medicaid/Dr. Dynasaur, are automatically eligible for RMA, but there is no
requirement for a refugee to apply for or receive refugee cash assistance in
order to be found eligible for RMA.
Section 5122 Financial Eligibility
(a) The Agency of Human Services (AHS)
calculates financial eligibility for RMA according to the same standards and
procedures for determining financial eligibility for Medicaid (including those
for the medically needy) subject to the additional criteria in this subsection.
(1) Modified Adjusted Gross Income (MAGI)
methodology is used unless the refugee is 65 years of age or older, blind, or
disabled.
(2) For refugees 65 years
of age or older, blind, or disabled, Medicaid for the Aged, Blind, and Disabled
(MABD) methodology is used to calculate financial eligibility for
RMA.
(3) Once the financial
calculation has been completed, the financial limit for RMA is 200% of the
Federal Poverty Level (FPL).
(b) In determining financial eligibility,
only the income and resources the applicant has on the date of application may
be considered. The following are disregarded for all applicants as income and
resources:
(1) Any cash assistance payments,
and
(2) any in-kind services and
shelter provided by a sponsor or local resettlement agency.
(c) An applicant for RMA with
income or resources greater than allowed by the financial eligibility standards
must be permitted to spend down medical expenses to 200% FPL in accordance with
Medicaid rules.
(d) Any increase in
earnings from employment while a refugee is receiving RMA does not affect the
refugee's continued medical assistance eligibility.
(e) When a refugee is covered by
employer-sponsored health insurance, any payment of RMA for that individual
must be reduced by the amount of the third-party payment.
Section 5130 Limited English Proficiency
The Agency of Human Services (AHS) provides language
assistance services, including translated documents and oral interpretation,
free of charge and in a timely manner, when such services are necessary to
provide meaningful access to individuals with limited English proficiency.
Vital documents such as notices of assistance granted, denied, or terminated,
and decisions and appeal process will be communicated in writing, and will
include taglines indicating the availability of language services in the top 15
languages spoken by individuals with limited English proficiency in
Vermont.
STATUTORY AUTHORITY:
33
V.S.A. §§
105,
1901
