Medical Benefits for Asylum Applicants and Torture Victims (AATV) & Victims of Trafficking, Torture or Other Serious Crimes (VTTC)

01/23/2024

Policy Memo

This memo clarifies and updates the procedures in MR #17.19: Medical Benefits for Non-Citizen Victims of Trafficking, Torture or Other Serious Crimes

Summary:

• Asylum Applicants and Torture Victims (AATV): a non-citizen victim of torture or an Asylum Applicant may be eligible for state funded medical assistance when not otherwise eligible for federally funded medical benefits.
• Victims of Trafficking, Torture or Other Serious Crimes (VTTC): a non-citizen victim of trafficking, torture or other serious crimes and their derivative family members may be eligible for state funded medical assistance when not otherwise eligible for federally funded medical benefits if they have applied or intend to apply for "T" Non-immigrant status, "U" Non-immigrant status, or Asylum Status "AS".
• Individuals who meet Non-Citizen/USCIS status for AATV or VTTC benefits must meet all other financial and non-financial factors of eligibility.
• This memo clarifies and updates the procedures in MR #17.19: Medical Benefits for Non-Citizen Victims of Trafficking, Torture or Other Serious Crimes on processing VTTC applications subsequent to IES production updates taking effect in January 2024.

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1. Introduction: Asylum Applicants and Torture Victims (AATV) and Victims of Trafficking, Torture or Other Serious Crimes (VTTC)
2. Eligibility Criteria
   1. Special Non-Financial Eligibility Requirements
   2. Non-Financial Eligibility Requirements
   3. Financial Eligibility Requirements
3. Application Process
   1. IES 'Non-Citizens Details' Page Updates
   2. Who to Include in the Case
   3. Medical TOA Progression
4. EDG/MANG P
5. Redeterminations
6. Non-Citizen Status Changes
7. Ending Eligibility

Introduction: Asylum Applicants and Torture Victims (AATV) and Victims of Trafficking, Torture or Other Serious Crimes (VTTC)

Subject to the availability of funding, Asylum Applicants and Torture Victims (AATV), pursuant to 305 ILCS 5/5-2(14); 89 Admin 120.550, may be eligible for state funded medical assistance when not otherwise eligible for federally funded medical benefits, when they have a pending application for asylum or an appeal of an application for asylum with the U.S. Citizenship and Immigration Services (USCIS), or individuals are victims of torture.

Effective 01/01/18, a foreign-born victim of Survivor Support and Trafficking Prevention (VTTC: Victims of Trafficking, Torture or Other Serious Crimes), pursuant to 305 ILCS 5/5-2(20); 89 IL Admin 120.560, and their derivative family members, may be eligible for state funded medical assistance when not otherwise eligible for federally funded medical benefits. To qualify for medical benefits, otherwise ineligible non-citizens must have applied for, or are preparing to file, an application with USCIS for "T" Non-immigrant status, "U" Non-immigrant status, or for Asylum Status "AS".

• • "Derivative Family Member" means a person who is the spouse, child, parent, or sibling under age 18 of the principal victim who is eligible, or potentially eligible, for one of the above statuses. A spouse must have been married to the principal victim before the principal victim entered the United States.
• Note: This memo provides a clarifications and updates to the AATV/VTTC policy in MR #17.19: Medical Benefits for Non-Citizen Victims of Trafficking, Torture or Other Serious Crimes and revises the procedures on processing VTTC applications subsequent to IES production updates taking effect in January 2024.

Eligibility Criteria

Special Non-Financial Eligibility Requirements

T Non-immigrant Status

The "T" non-immigrant status, also known as the T Visa, was created to provide immigration protection to victims of a severe form of human trafficking. Under Federal law, the term "severe forms of trafficking" can be broken into two categories:

1. Sex trafficking: recruitment, harboring, transportation, provision or obtaining of a person for the purpose of a commercial sex act where the commercial sex act is induced by force, fraud or coercion, or the person being induced to perform such act is under 18 years of age.
2. Labor trafficking: recruitment, harboring, transportation, provision or obtaining of a person for labor or services through the use of force, fraud, or coercion for the purpose of involuntary servitude, peonage, debt bondage, or slavery.

U Non-immigrant Status

The "U" non-immigrant status, or U Visa, is designated for victims of certain crimes who have suffered mental or physical abuse because of the crime and who are willing to assist law enforcement and government officials in the investigation of the criminal activity. Examples of qualifying criminal activities include, but are not limited to, the following activities:

Asylum Status (AS)

A non-citizen may apply for asylum if they are unable or unwilling to return to their country of origin due to a well-founded fear of persecution on account of race, religion, nationality, membership in a particular social group or political opinion.

Note: A person who has a pending asylum application may qualify for medical benefits under AATV rather than VTTC. IES logic has been implemented  to check individuals' medical eligibility in the following order: Federal, VTTC then AATV. Individuals with derivative family members should never be AATV.

Non-Citizen/USCIS Verifications

AATV

Individual has an application for asylum pending/an appeal pending regarding a decision of asylum OR be receiving treatment services for torture from a federally funded torture treatment center.

• • Acceptable proof of a pending asylum application described in WAG 03-01-04-a
  • Derivative family members do not qualify

VTTC

The applicant (or if the applicant is not competent, a representative of the applicant) must provide as verification the following:

A sworn written statement that he or she is a victim of one of the crimes listed above, or is a witness to one of the above crimes and is cooperating with law enforcement authorities investigating or prosecuting these crimes, and at least one item of additional credible evidence, including but not limited to any of the following:

1. A sworn written statement that he or she is a victim of one of the crimes listed above, or is a witness to one of the above crimes and is cooperating with law enforcement authorities investigating or prosecuting these crimes, and at least one item of additional credible evidence, including but not limited to any of the following:
   1. police, government agency, or court records or files,
   2. news articles,
   3. documentation from a social service agency, trafficking/domestic violence program or rape crisis center, or a legal, clinical, medical professional, or other professional from whom the applicant or recipient has sought assistance in dealing with the crime,
   4. a written statement from any other individual with knowledge of the circumstances that provided the basis for the claim,
   5. physical evidence,
   6. a copy of a completed visa application, or
   7. a written notice from the federal agency of receipt of the visa application.
2. If a person who has provided a sworn statement is unable to provide any of the additional credible evidence listed above, medical benefits may be provided under this program if the Department has determined that the individual is credible. Supervisory approval is required and the reason for approval must be documented in case comments.

Non-Financial Eligibility Requirements

Note: Individuals who meet non-citizen/USCIS status for benefits must meet all other financial and non-financial factors of eligibility.

An individual must meet the following non-financial requirements:

Financial Eligibility Requirements

An individual must meet the following financial requirements:

The earned and unearned income of the following persons shall be counted when determining eligibility:

Application Process

The application date will be the date a signed application is received by the Department as described in PM 02-04-06. Medical eligibility may be backdated up to three months prior to the month of application if the applicant would have met the criteria for the backdated months.

IES will be programmed with eligibility rules for the VTTC program as of December 2023. A non-citizen who does not qualify for a Federally funded medical program is progressed as follows:

IES 'Non-Citizens Details' Page Updates

An AATV/VTTC individual must be denoted as "UNDOCUMENTED" in the 'Non-citizen Admission Status' field, although they might have documentation that shows their relevant pending AATV/VTTC application or intention to apply for AATV/VTTC status.

Marking "Undocumented" will enable the required AATV/VTTC questions. If the field is mistakenly marked "Documented", the necessary AATV/VTTC fields will be disabled.

Upon marking the individual as "Undocumented" the 'Asylum/Torture Victim (AATV) and Asylum, T or U Visa (VTTC) Primary Victim Information' fields will be enabled. One of the following fields must be selected as "Yes" along with the proper verification from the associated verification field.

Note: Only one field may be selected as "Yes", although an individual may fit more than one category. Best practice is for workers to reference the above eligibility flow chart to ensure the most beneficial program for that customer will result at certification.

After selecting "Yes" to one of the above highlighted fields the worker will then select the appropriate verification.

Who to Include in the Case

Policy on who to include in a case as denoted in PM 04-03-00, does not apply to AATV/VTTC cases.

Unlike AATV, medical under VTTC allows for "Derivative Family Members" to be included in a case. An individual who is the main victim on a VTTC case may be on the case by themselves or with a derivative member of their family. There can only be one victim on these cases, however there can be more than one derivative family member.

A child may be on a child-only case without their parent, if they are a foreign-born victim of trafficking, torture, or another serious crime. They are not required to have a parent on the case.

Medical TOA Progression

A worker should ensure an individual is receiving the correct type of assistance before certifying an EDG.

VTTC	AATV	Federal (Regular Medicaid)
T-Visa Intends/Pending	Torture Treatment only - no intend/pending application	Asylee Status
U - Visa intends/Pending/Holder	AS - Pending	T-Visa Received
AS - intends/Pending + derivatives	AS - Appeal
AS - Intends

EDG/MANG P

An indicator and MANG P code were created to identify individuals approved under the AATV and VTTC programs. Individuals approved under AATV and VTTC can be identified by an indicator and specific MANG P code.

MANG P Code	TOA Code	TOA	Program Code	Spec Ind.	Description
TT	ADMA	AABD	VTTC	V	Victims of Trafficking, Torture or Other Serious Crimes
TV	ADMA	AABD	AATV	T	Asylees and Torture Victims

In IES an indicator "T" will be added to the existing AABD Type of Assistance (TOA) within eligibility summary to identify the individual as AATV. An indicator of "V" will be added to the existing AABD Type of Assistance (TOA) within eligibility summary to identify the individual as VTTC. There will be a "Special Approval Type" as Victim Trafficking, Torture, Serious Crimes viewable in the EDG Summary.

Redeterminations

Eligibility for AATV/VTTC medical benefits must be reviewed every 12 months. All financial and non-financial criteria, including immigration status, must be reviewed.

Note: VTTC and AATV are not subject to auto-REDE (process A) in IES.

Verifications at REDE include:

If the customer reports a change in immigration status at the redetermination, or at any time, ask for documentation. If an Alien Registration number is provided, run the Verify Lawful Presence (VLP) clearance. Complete a SAVE inquiry if necessary.

Accept information reported on a redetermination form declaring that their resources are below the resource standard for the program, unless questionable (Simplified Processing as described in PM 19-02-03-b applies).

Eligibility for VTTC shall continue so long as an individual continues to satisfy the AABD eligibility criteria and:

1. Individual has applied for "T" Non-immigrant status, "U" Non-immigrant status, or for Asylum Status "AS"; or
2. Department determined during the year of initial eligibility that the individual failed to apply for status due to one of the following:
   1. experienced a health crisis;
   2. has been unable, after reasonable attempts, to obtain necessary information from a third party;
   3. has other extenuating circumstances that prevented the person from completing his or her application for status; or
3. Individual has been approved for a U Visa.

Note: When an individual has been approved for a U Visa, they may remain on VTTC along with their Derivative Family Member(s).

Non-Citizen Status Changes

Review eligibility when a change in immigration status is reported at REDE, or any other time during the certification period.

T Visa Approved

A person who is approved for a T Visa meets federal Medicaid Qualifying Non-citizen criteria as a trafficking victim per PM 03-01-02-d. The worker must update their immigration status and determine eligibility for another medical program.

U Visa Approved

A person who is approved for a U Visa does not meet federal Medicaid Qualifying Non-citizen criteria and continues to qualify for VTTC as long as they meet all other eligibility criteria.

Note: Their Derivative Family Members may also remain on VTTC.

Asylum Application Filed

When a person provides documentation that verifies that they have a pending asylum application, they may qualify for the AATV program. However, a person whose asylum application is still pending with USCIS by the time they reach the maximum eligibility period for AATV per PM 06-21-04, may qualify for VTTC benefits.

Asylum Application Approved

A person who is approved for Asylum status meets federal Medicaid Qualifying Non-citizen criteria per PM 03-01-02-d. Their immigration status must be updated, and eligibility determined for another medical program.

Ending Eligibility

An individual shall no longer be eligible if:

1. For AATV/VTTC there is a final denial of the principal victim's visa or asylum application, or

2. For AATV there is a maximum benefit period of 36 months.

Note: 'Asylum/Torture Victim (AATV) and Asylum, T or U Visa (VTTC) Primary Victim Information' has a drop-down field which asks: "Individual has received the maximum number of months of Medical through AATV program?"

3. For VTTC the principal victim has not filed a formal application for status within one year after the date of his or her application for medical benefits, unless the worker with supervisory approval determines that during the year of initial VTTC eligibility the individual:

If the principal victim no longer meets the AATV/VTTC eligibility criteria, the principal victim and any derivative family member(s) must be evaluated for medical eligibility under other programs.

Persons applying for or receiving VTTC medical benefits are entitled to appeal rights as described in PM 01-07.

[signed copy on file]

Dulce M. Quintero

Secretary-Designate, Illinois Department of Human Services

Elizabeth M. Whitehorn

Director, Illinois Department of Healthcare and Family Services