Second Opinion is a weekly Q-and-A series that answers questions from San Diegans on the Affordable Care Act. Ask yours here.

The Question: How do parents who are in the country illegally go about getting their citizen children insured?

Oscar Ramos is a teacher at The Preuss School, a charter school for grades 6 through 12 on UC San Diego’s campus (Ramos is also an occasional VOSD contributor). Ramos’s classroom walls are decorated with photos of previous students who have gone off to college – a feat that’s especially meaningful to Ramos because his students, like him, come from low-income and mixed-status households.

“We find out that the parent has been deported and the student is living with friends or relatives,” Ramos said. “You start to notice problems with the student’s education in class and behavior or homework completion, that kind of thing.”

Ramos, whose own parents immigrated to the United States illegally before he was born and were later granted amnesty, said he gets two or three students dealing with issues stemming from their own illegal status or their parents’ each year.

YouTube video

Video by John Rosman, KPBS

He wants to make sure health care is no longer one of those issues. Ramos said he plans to counsel his students’ parents on what new coverage options are available under the Affordable Care Act. Here’s his question:

“How will the Affordable Care Act affect the insurance coverage availability for U.S. citizen children with undocumented immigrant parents.”

The Takeaway: Parents don’t need to have legal status to sign their children up for Obamacare benefits.

First, here’s a refresher on immigration and the Affordable Care Act:

• Undocumented adults and children are not eligible for ACA benefits.

• Immigrants in the country legally, including those with deferred action, can participate in the Medi-Cal expansion and new health insurance exchange. California found a workaround for the requirement that immigrants have legal status for more than five years.

Even though the law is clear that citizen, or otherwise legal, children are covered, it’s murkier on how undocumented parents who lack Social Security numbers and other documentation sign their children up.

But health officials have worked out the details. And the first one they always communicate:

Sharing personal information to enroll children in a health plan will not result in deportation. The information will not be shared with immigration officials.

So what information is required? To sign a child up for Medi-Cal, parents would use his or her Social Security number. Parents must also prove their household income, but that doesn’t mean they need to have filed taxes last year. Proof of income can be as informal as a written note from an employer, according to the California Department of Health Care Services. Parents also need some form of identification for themselves. DHCS says something like a work badge would suffice.


Parents who earn too much money for their children to qualify for Medi-Cal ($32,500 for a family of four) can turn to the state-run insurance exchange, Covered California. A bit more documentation is needed there.

Covered California requires parents to have – or get – an Individual Taxpayer Identification Number, or ITIN. It’s like a Social Security number for people who can’t get one because of their citizenship status. A spokesman for the exchange said parents don’t have to have filed taxes in the past, but must promise to for the year the child is covered. That’s because the subsidies that bring down the monthly premium cost — yes, undocumented parents qualify for financial help — are based on prospective income and any discrepancies must be reconciled at tax time the following year.

There’s one other thing immigrant parents should know. If their children are eligible for health care, they’re supposed to cover them. In other words, the fine for not getting coverage can be levied for citizen children no matter the parent’s citizenship status.

But the government will only know whether to issue a fine if the parent files taxes. And there are hardship exemptions that many immigrant parents could qualify for.

The Orders: Be ready to make referrals.

Ramos can tell his students’ parents to go through the traditional channels to enroll their children in Medi-Cal – the county or neighborhood social service providers.

For Covered California, parents can call (888) 975-1142 or seek out locals who have been trained to help with enrollment. Family Health Centers of San Diego, Social Advocates for Youth and 2-1-1 San Diego are some of the organizations certified by the exchange.

Check out last week’s Second Opinion: What’s a grandfathered health plan?

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Megan Burks

Megan Burks is a reporter for Speak City Heights, a media project of Voice of San Diego, KPBS, Media Arts Center and The AjA Project. You can contact her...

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