What are the health insurance options for my elderly father?

[etripke 0]

Individual cases are not published on the internet unless they involve a court case. I wasn't able to find any court cases involving a suit brought because of a 212(a)(4) denial as a result of an intending immigrants advanced age and/or health condition. This is certainly not because nobody has ever been denied because of their advanced age or health since these are factors that are repeatedly emphasized in both the law and the policy manuals. I suspect it's simply because nobody chose to sue the US government after a denial on these grounds, or because I didn't use the correct search terms to find those cases.

I could give you published statistics on 212(a)(4) denials, but those wouldn't mean anything unless they included the precise reason for the denial. The public charge determination covers a broad spectrum of discretionary factors, so the statistics alone mean nothing.

You must bear in mind that the public charge determination is discretionary, and based on numerous factors. Age and health are only two of those factors. The policy manuals are clear that the ability of the intending immigrant to become self-supporting is critical in determining if factors such as age or health should weigh heavily on the decision.

The fact is that an elderly immigrant is almost certain to require medical care at some point if they spend the remainder of their lives in the United States. They aren't ever going to be eligible for health care from an earned entitlement program, so the consular officer must presume that the sponsor will either have to provide for the payment of the health care, either directly or via insurance, or be on the hook to reimburse the government if the taxpayers are forced to pay for it.

Young and healthy immigrants with job skills are denied visas all the time because their sponsor wasn't qualified at the minimum income level. The immigrant's age and health are not a factor in those cases, so the consular officer focuses on the one remaining requirement, which is a sufficient sponsor. You cannot seriously expect a consular officer to apply the same minimum standards with an immigrant who is elderly and/or has health problems when the law and policy guidance clearly says they must consider these factors.

Jim, I appreciate your research but I'm pretty experienced too. Denying family unification is VERY serious and warrant a congressional response. The only things to prove are parenthood and sponsorship. It is NOTHING like denying a K-1 or K-3 where there is so much more on the line with proving the merits of the relationship. This is a parent of a USC and I would not sweat that a fraction of a second compared to the other paths.

[Jojo92122 1,924]

Jim, I appreciate your research but I'm pretty experienced too. Denying family unification is VERY serious and warrant a congressional response. The only things to prove are parenthood and sponsorship. It is NOTHING like denying a K-1 or K-3 where there is so much more on the line with proving the merits of the relationship. This is a parent of a USC and I would not sweat that a fraction of a second compared to the other paths.

Lots of family cases are denied as evidenced by the denial threads on this forum. No congressional responses to those cases. Why would a denial here be any different?

While family reunification is a goal, the intending immigrant must show he/she is not likely to become a public charge. If a person can't show that he/she is not likely to become a public charge, the person is not going to qualify for a visa no matter what the family relationship is.

[Boiler 46,074]

Begs the question of why someone would want to bring an elderly relative to the US unless they have loads of money to pay for healthcare.

[JimVaPhuong 4,863]

Jim, I appreciate your research but I'm pretty experienced too. Denying family unification is VERY serious and warrant a congressional response. The only things to prove are parenthood and sponsorship. It is NOTHING like denying a K-1 or K-3 where there is so much more on the line with proving the merits of the relationship. This is a parent of a USC and I would not sweat that a fraction of a second compared to the other paths.

This is patently untrue. The requirements for making the public charge determination are spelled out in INA 212(a)(4). If you're looking for a congressional response, they've already provided it in the form of the law. The factors about the intending immigrant that the consular officer or immigration officer are required to take into account are:

(B) Factors to be taken into account.- (i) In determining whether an alien is excludable under this paragraph, the consular officer or the Attorney General shall at a minimum consider the alien's-

(I) age;

(II) health;

(III) family status;

(IV) assets, resources, and financial status; and

(V) education and skills

(ii) In addition to the factors under clause (i), the consular officer or the Attorney General may also consider any affidavit of support under section 213A for purposes of exclusion under this paragraph.

Sponsorship is only one of the factors they are required to consider, and it's the last one in the list. The IIRIRA of 1996 added INA section 213A, which spells out the minimum requirements for an enforceable affidavit of support, but the intending immigrant must still pass muster on the first five items in INA 212(a)(4).

A K1 or K3 is actually much more serious to the US government when weighing the goal of family reunification. USCIS considers a spouse to be part of the petitioner's nuclear family. They are given greater weight than a parent. This is why an IR1/CR1 is first on the list of immediate relative visas, and why an LPR can petition for a spouse but not a parent.

This is also why USCIS will deny humanitarian reinstatement when a petitioner dies if the beneficiary is married and living with their spouse - the beneficiary already has a family that outweighs any consideration of reunification with relatives in the US. I recently helped a family friend with a humanitarian reinstatement request with exactly these circumstances. The petitioner was the beneficiary's father, but the beneficiary's mother was (and still is) living in the US, along with aunts, uncles, cousins, and virtually all of her siblings. USCIS categorically denied it because the beneficiary was married and living with her husband and daughter, and in the eyes of USCIS that was the only family that would be affected by considerations of reunification.

[Boiler 46,074]

I can think of at least one K1 who had to provide evidence of health coverage - UK Consulate.

[sergeman 0]

Jim, I appreciate your research but I'm pretty experienced too. Denying family unification is VERY serious and warrant a congressional response. The only things to prove are parenthood and sponsorship. It is NOTHING like denying a K-1 or K-3 where there is so much more on the line with proving the merits of the relationship. This is a parent of a USC and I would not sweat that a fraction of a second compared to the other paths.

Good point!

I have an example from the real life.

My college friend managed to bring his in-laws to Seattle from Russia half of year ago. Both of them in late 70's. Mother barely walks; father has a pace-art, he can't walk longer then 30 seconds and uses wheelchair.

Medical insurance for them with basic coverage and high deductible is very expensive, but the fact is that not NVC nor Consulate asked about proof of insurance during I-130 processing.

[sergeman 0]

Begs the question of why someone would want to bring an elderly relative to the US unless they have loads of money to pay for healthcare.

I believe every country has coverage for elderly in a form of free medical insurance. Expensive surgery can be scheduled and done in parent's home country. Expensive medication can be supplied for 3 - 6 moths from home country.

Emergency care covered by state insurance; here an example for NJ http://www.nj.gov/humanservices/dmahs/clients/medicaid/payment/

Emergency care will NOT be considered a "Public Charge".

[Boiler 46,074]

I believe every country has coverage for elderly in a form of free medical insurance.

The US does not, the UK does for residents. My guess is that more countries do not than do.

Expensive surgery can be scheduled and done in parent's home country.

If they have emigrated to the US then their home country is the US.

Expensive medication can be supplied for 3 - 6 moths from home country.

Admittedly medication is usually much much cheaper elsewhere than in the US. You could order on line from Canada for example.

Emergency care covered by state insurance; here an example for NJ http://www.nj.gov/humanservices/dmahs/clients/medicaid/payment/

Emergency care will NOT be considered a "Public Charge".

Medicaid is a horribly complicated subject. It is also a joint Federal/State programme so will vary state by state. It is also subject to impending budget reductions.

[sergeman 0]

The US does not, the UK does for residents. My guess is that more countries do not than do.

Agree. luckily for me, beginning from mid 1990's Russian officials stopped deny Russian citizens from using this benefit. However, there is a queue to make such surgeries, unless it's life threatening emergency.

If they have emigrated to the US then their home country is the US.

OK. Let's call it "Country of Citizenship"

Admittedly medication is usually much much cheaper elsewhere than in the US. You could order on line from Canada for example.

Well, This is another way to save a buck. I did not know that.

Medicaid is a horribly complicated subject. It is also a joint Federal/State programme so will vary state by state. It is also subject to impending budget reductions.

Q. What publicly funded benefits may not be considered for public charge purposes?

A. Non-cash benefits (other than institutionalization for long-term care) are generally not taken into account for purposes of a public charge determination.

Special-purpose cash assistance is also generally not taken into account for purposes of public charge determination.

Non-cash or special-purpose cash benefits are generally supplemental in nature and do not make a person primarily dependent on the government for subsistence. Therefore, past, current, or future receipt of these benefits do not impact a public charge determination. Non-cash or special purpose cash benefits that are not considered for public charge purposes include:

Medicaid and other health insurance and health services (including public assistance for immunizations and for testing and treatment of symptoms of communicable diseases; use of health clinics, short-term rehabilitation services, and emergency medical services) other than support for long-term institutional care

Children's Health Insurance Program (CHIP)

Nutrition programs, including Food Stamps, the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), the National School Lunch and School Breakfast Program, and other supplementary and emergency food assistance programs

Housing benefits

Child care services

Energy assistance, such as the Low Income Home Energy Assistance Program (LIHEAP)

Emergency disaster relief

Foster care and adoption assistance

Educational assistance (such as attending public school), including benefits under the Head Start Act and aid for elementary, secondary, or higher education

Job training programs

In-kind, community-based programs, services, or assistance (such as soup kitchens, crisis counseling and intervention, and short-term shelter)

State and local programs that are similar to the federal programs listed above are also generally not considered for public charge purposes. Please be aware that states may adopt different names for the same or similar publicly funded programs. It is the underlying nature of the program, not the name adopted in a particular state, which determines whether or not it should be considered for public charge purposes. In California, for example, Medicaid is called "Medi-Cal" and CHIP is called "Healthy Families." These benefits are not considered for public charge purposes.

In addition, and consistent with existing practice, cash payments that have been earned, such as Title II Social Security benefits, government pensions, and veterans' benefits, among other forms of earned benefits, do not support a public charge determination. Unemployment compensation is also not considered for public charge purposes.

http://www.uscis.gov/portal/site/uscis/menuitem.eb1d4c2a3e5b9ac89243c6a7543f6d1a/?vgnextoid=829b0a5659083210VgnVCM100000082ca60aRCRD&vgnextchannel=829b0a5659083210VgnVCM100000082ca60aRCRD

[Boiler 46,074]

So some elderly LPR's have the option of going home and being treated in the country they emigrated from.

If you went back to the UK and resumed residency in the UK I could do the same.

Just thinking of my Parents and their issues at this age and older, it would just not have been practical, they had a series of emergencies requiring an ambulance and immediate treatment and on going care needs. They would have needed a season ticket on BA!

You can just turn up at an emergency room in the US and hope. All they have to do if it is life threatening is to patch you up to the minimum needed to get you out of the door.

[JimVaPhuong 4,863]

Agree. luckily for me, beginning from mid 1990's Russian officials stopped deny Russian citizens from using this benefit. However, there is a queue to make such surgeries, unless it's life threatening emergency.

OK. Let's call it "Country of Citizenship"

Well, This is another way to save a buck. I did not know that.

Q. What publicly funded benefits may not be considered for public charge purposes?

A. Non-cash benefits (other than institutionalization for long-term care) are generally not taken into account for purposes of a public charge determination.

Special-purpose cash assistance is also generally not taken into account for purposes of public charge determination.

Non-cash or special-purpose cash benefits are generally supplemental in nature and do not make a person primarily dependent on the government for subsistence. Therefore, past, current, or future receipt of these benefits do not impact a public charge determination. Non-cash or special purpose cash benefits that are not considered for public charge purposes include:

Medicaid and other health insurance and health services (including public assistance for immunizations and for testing and treatment of symptoms of communicable diseases; use of health clinics, short-term rehabilitation services, and emergency medical services) other than support for long-term institutional care

Children's Health Insurance Program (CHIP)

Nutrition programs, including Food Stamps, the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), the National School Lunch and School Breakfast Program, and other supplementary and emergency food assistance programs

Housing benefits

Child care services

Energy assistance, such as the Low Income Home Energy Assistance Program (LIHEAP)

Emergency disaster relief

Foster care and adoption assistance

Educational assistance (such as attending public school), including benefits under the Head Start Act and aid for elementary, secondary, or higher education

Job training programs

In-kind, community-based programs, services, or assistance (such as soup kitchens, crisis counseling and intervention, and short-term shelter)

State and local programs that are similar to the federal programs listed above are also generally not considered for public charge purposes. Please be aware that states may adopt different names for the same or similar publicly funded programs. It is the underlying nature of the program, not the name adopted in a particular state, which determines whether or not it should be considered for public charge purposes. In California, for example, Medicaid is called "Medi-Cal" and CHIP is called "Healthy Families." These benefits are not considered for public charge purposes.

In addition, and consistent with existing practice, cash payments that have been earned, such as Title II Social Security benefits, government pensions, and veterans' benefits, among other forms of earned benefits, do not support a public charge determination. Unemployment compensation is also not considered for public charge purposes.

http://www.uscis.gov/portal/site/uscis/menuitem.eb1d4c2a3e5b9ac89243c6a7543f6d1a/?vgnextoid=829b0a5659083210VgnVCM100000082ca60aRCRD&vgnextchannel=829b0a5659083210VgnVCM100000082ca60aRCRD

An immigrant who is eligible can collect temporary means-tested public benefits without being considered a public charge. This is important for an LPR to know because if the government determines they are a public charge then they are deportable. However, even if an immigrant is not a public charge, it doesn't alter the fact that the sponsor can be held liable to reimburse the government for those benefits.

An immigrant who comes to the US after retirement age will never be eligible for earned benefits like Social Security Retirement, and they can only get Medicare if they pay for it. If a consular officer determines that an intending immigrant will never become self-supporting, and will never be eligible for earned benefits, then they can deny the visa based on the discretionary determination that the intending immigrant will likely become a public charge in the US. Read 9 FAM section 40.41 for details.

[Kathryn41 3,205]

Just a reminder that while an elderly immigrant may still qualify for medical care or treatment back in their home country, they may not be able to take advantage of that option. Medical emergencies don't wait to make travel arrangements, and the person may not physically be able to travel farther than an ambulance drive to the nearest hospital. A heart attack or stroke requires immediate intervention, and that would be in the US. It is better to plan for a realistic scenario than an overly optimistic one. You 'may' have time to travel to take care of some medical needs, but the likelihood is that you won't be able to do that for an emergency.

[sergeman 0]

An immigrant who is eligible can collect temporary means-tested public benefits without being considered a public charge. This is important for an LPR to know because if the government determines they are a public charge then they are deportable. However, even if an immigrant is not a public charge, it doesn't alter the fact that the sponsor can be held liable to reimburse the government for those benefits.

An immigrant who comes to the US after retirement age will never be eligible for earned benefits like Social Security Retirement, and they can only get Medicare if they pay for it. If a consular officer determines that an intending immigrant will never become self-supporting, and will never be eligible for earned benefits, then they can deny the visa based on the discretionary determination that the intending immigrant will likely become a public charge in the US. Read 9 FAM section 40.41 for details.

Looks like it comes down to income of I-864 sponsor. Hypothetically, ratio sponsor's_income/average_medical_insurance_cost can be taken to concentration by consular officer, which is fair. I just doubt the possibility of being asked to have some proof of medical insurance for elderly parent during the I-130 processing.

[sergeman 0]

Just a reminder that while an elderly immigrant may still qualify for medical care or treatment back in their home country, they may not be able to take advantage of that option. Medical emergencies don't wait to make travel arrangements, and the person may not physically be able to travel farther than an ambulance drive to the nearest hospital. A heart attack or stroke requires immediate intervention, and that would be in the US. It is better to plan for a realistic scenario than an overly optimistic one. You 'may' have time to travel to take care of some medical needs, but the likelihood is that you won't be able to do that for an emergency.

I personally will pay for my mothers insurance.

I just trying to say that something like glaucoma surgery can be planned and made in the country of citizenship.

[Boiler 46,074]

Personally I am not worried about the 864. Enforcement seems so rare as to make the headlines.

I would be much more worried about writing the cheques.