August 26, 2019 - The Centers for Medicare & Medicaid Services issued guidance to states last week regarding how they should determine certain sponsored immigrants’ eligibility for Medicaid and the Children’s Health Insurance Program (CHIP). Today’s guidance follows the issuance of the Presidential Memorandum on Enforcing the Legal Responsibilities of Sponsors of Aliens, which directs relevant federal agencies to update or issue procedures and guidance as needed, to ensure compliance with the sponsor deeming and repayment obligations under current law. 

The CMS guidance, contained in a State Health Official Letter (SHO), provides direction to states on provisions of the Immigration and Nationality Act (INA).  The INA generally requires that the income and resources of the sponsors of certain immigrants be counted in determining the immigrant’s eligibility for federal means-tested benefit programs, including Medicaid and CHIP.  Under the INA, the sponsors of the affected immigrants are also responsible for reimbursing the state agency for the cost of most benefits provided to the sponsored immigrant. These rules only apply to Lawful Permanent Residents (LPRs) who have a sponsor who has executed an Affidavit of Support (Form I-864 Affidavit of Support). 

The guidance reminds states of their obligation to comply with the sponsor deeming requirements, along with information on the repayment and recovery of costs requirements. 

In considering the income and resources of a sponsor when determining eligibility for the sponsored immigrant, states may align to one of several options outlined in the letter or present an alternative approach to CMS for approval.  States also have the flexibility to combine two or more options. The SHO provides guidance on the INA requirements and help states comply with the law.

The issues in this letter include:

• Application of the sponsor deeming requirements;
• Methodologies for deeming a sponsor’s income and resources;
• Reimbursement obligations of, and recovery of costs from, a sponsor;
• Data collection and reporting on sponsor recovery; and
• Other operational considerations.

CMS will issue additional guidance for states on how to document their sponsor deeming policies and procedures and will ensure states have the support they need to update their practices. 

For more information, please visit: https://www.medicaid.gov/federal-policy-guidance/downloads/sho19004.pdf
Source: CMS