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Healthcare Newsletter • April 2015

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NIWAP Newsletter • Healthcare • April 2015

Healthcare laws in the United States have undergone major changes over the past several years. The passage of the Patient Protection and Affordable Care Act (ACA) in 2010 created both an entirely new way to obtain healthcare in the U.S. and also expanded on some of the preexisting healthcare access options. These changes affect everyone, including immigrant survivors of domestic violence, sexual assault, stalking, dating violence, human trafficking and other crimes. This newsletter will provide an overview of and links to further information and resources on current laws governing access to healthcare, insurance and subsidies for immigrant survivors.

Register for NIWAP’s upcoming webinar:
Healthcare: Understanding the Affordable Care Act and How it Affects Immigrant Survivors
April 16, 2015 at 2:00 pm

In this Issue:

NIWAP offers technical assistance to advocates, attorneys, judges, court staff, police, prosecutors, social services and health care providers, and others working with immigrant victims of domestic violence, sexual assault, stalking, and human trafficking. To submit your questions, email info@niwap.org or call us at 202-274-4457.


NIWAP addresses the needs of immigrant women, immigrant children and immigrant victims of domestic violence, sexual assault, dating violence, stalking, human trafficking and other crimes by advocating for reforms in law, policy and practice.

NIWAP is a national provider of training, legal and social science research, policy development, and technical assistance to advocates, attorneys, pro bono law firms, law schools, universities, law enforcement, prosecutors, social service and health care providers, justice system personnel, and other professionals who work with immigrant women, children and crime victims. Our work supports those in the field and in government who work to improve laws, regulations, policies, and practices to enhance legal options and opportunities for immigrant women and children.

NIWAP provides training and technical assistance on a broad range of issues of importance to immigrant women and children, including VAWA immigration and confidentiality, family law, protection orders, public benefits, language access, cultural competency, and access to services, including shelter, transitional housing, health care, and education.

© 2015 National Immigrant Women’s Advocacy Project. The contents of this publication may be reprinted. Any reprinting must be accompanied by the following acknowledgement: This material was reprinted from the National Immigrant Women’s Advocacy Project, American University, Washington College of Law.

This project was developed under grant number 2013-TA-AX-K009 awarded by the Office on Violence Against Women, U.S. Department of Justice. The opinions, findings, conclusions and recommendations expressed in this program are those of the author(s) and do not necessarily reflect the views of the Department of Justice, Office on Violence Against Women.

4801 Massachusetts Ave NW, Washington DC 20016
www.NIWAP.org | info@NIWAP.org
202-274-4457

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General Information Regarding the Affordable Care Act (ACA)

The ACA implemented numerous wide-sweeping changes to the U.S. healthcare system, including the expansion of income-related eligibility for Medicaid, allowing young adults to stay covered on their parents’ health insurance plans until the age of 26, proscribing certain minimum requirements for nearly all healthcare plans, and prohibiting insurance companies from denying coverage based on “pre-existing conditions” or imposing life-time coverage limits. Among the most fundamental changes, however, was the creation of healthcare “marketplaces” (also called “exchanges”) and the individual healthcare mandate.

The healthcare marketplace is a conduit through which individuals may purchase health insurance from certain private insurance companies. It is run either by the federal government, or by the state, depending on whether the state created its own exchange, and it provides the opportunity to compare options and ultimately choose an insurance plan that fits the needs of the particular individual. Further, U.S. citizens and certain categories of immigrants purchasing insurance through the healthcare exchanges can be eligible for federal subsidies if their income is below specified levels.

Determining which immigrants qualify to purchase health insurance on the exchanges and which may additionally qualify for healthcare subsidies depends on multiple factors including:

  • What form of immigration status the immigrant has;
  • In the case of some immigrant crime victims, or abused, abandoned or neglected immigrant children, what form of immigration relief they have filed for;
  • Whether the immigrant first entered the United States before August 22, 1996; or
  • The state in which the immigrant resides.

The sections below will discuss which immigrant victims are eligible to purchase health insurance through the marketplace and the limited categories of non-citizens who may, depending on their state of residence, qualify for healthcare subsidies.

Generally, the same individuals who are permitted to use the healthcare exchanges are also required to purchase healthcare insurance for themselves, or pay a penalty. That does not mean, however, that everyone is required to use the marketplace to purchase health insurance. For instance, an individual may purchase insurance from an insurer who does not sell on the exchanges. An individual who is already covered by insurance either through their employer or through another individual’s insurance policy need not purchase additional insurance through the exchanges, as the individual already has insurance and is, therefore, already in compliance with the individual mandate. Regardless of how coverage is obtained, under the ACA requirements, immigrants who qualify to purchase insurance on the healthcare exchanges are required to be insured under the individual mandate. If they do not purchase health insurance, they will face the same civil penalties that U.S. citizens are required to pay.

For more information on access to healthcare for immigrant crime victims under the ACA, please see the following resources:

  1. Empowering Survivors: Legal Rights of Immigrant Victims of Sexual Assault, Leslye Orloff, Amanda Baran & Phoebe Mounts, Chapter 17: Access to Healthcare for Immigrant Victims of Sexual Assault (2012)
  2. Carly Erickson & Leslye Orloff, Federal, Partnership, and State Exchanges That Provide State and State-Option Funded Medicaid or Medicaid-Like Services
  3. Rocio Molina, Eligibility Under the Affordable Care Act for Survivors of Domestic Violence, Trafficking, and Other Serious Crimes
  4. Up-to-date information on access to healthcare for immigrant adults and children including immigrant survivors who may have forms of immigration status that are not connected to crime victimization is available from the National Immigration Law Center (NILC)
  5. For general information about healthcare reform, see National Health Law Program’s Information on the Affordable Care Act Eligibility and Enrollment and Medicaid Expansion Toolbox.

© 2015 National Immigrant Women’s Advocacy Project. The contents of this publication may be reprinted. Any reprinting must be accompanied by the following acknowledgement: This material was reprinted from the National Immigrant Women’s Advocacy Project, American University, Washington College of Law.

This project was developed under grant number 2013-TA-AX-K009 awarded by the Office on Violence Against Women, U.S. Department of Justice. The opinions, findings, conclusions and recommendations expressed in this program are those of the author(s) and do not necessarily reflect the views of the Department of Justice, Office on Violence Against Women.

One’s first factor for a good family life is health. If the man is indeed suffering from erectile disfunction, a physician must be consulted. Presently thousands articles were published about https://your-excellent-choice.com/canadian/generic-propecia/. Probably you already know something about the question. Once men are watching for medications to resolve sexual soundness problem. Very likely each adult has heard about Propecia cost. More data about this problem available at Buy finasteride online. Sexual soundness troubles can mostly indicate problems in other area. To minimize the risk of dangerous side effects of Cialis avoid using any other drugs without preliminary discussion with your physician.

Immigrant Crime Victims Who Are Eligible To Access Healthcare Exchanges

An immigrant’s eligibility for the healthcare exchanges and its related subsidies depends upon the immigrant’s status at the time of applying for the benefit.

Immigrant access to the healthcare exchanges is governed by whether an immigrant is on the list of immigrants that are “lawfully present” in the United States. It is important to note that “lawfully present” includes, but is not limited to, lawful permanent residents. “Lawfully present” is a term of art in public benefits law that includes some groups of immigrants who are in the process of filing for, but may not have received, legal immigration status. Three significant examples of lawfully present immigrants who have access to the healthcare exchanges, but do not have legal immigration status under U.S. immigration laws are:

  1. Human trafficking victims who have received bona fide determinations from the U.S. Department of Homeland Security (DHS) in their T visa cases;
  2. Violence Against Women Act (VAWA) self-petitioners who have received prima facie determinations in pending VAWA self-petitioning cases; and
  3. Abused, abandoned, or neglected immigrant children who have filed cases seeking Special Immigrant Juvenile Status (SIJS).

The following is an overview of categories of immigrants who are eligible to purchase health insurance on the healthcare exchanges and who are subject to the individual mandate to purchase health insurance. Immigrant survivors of domestic and sexual violence and their children may have significant physical and mental healthcare needs that can be addressed by access to healthcare insurance through the healthcare exchanges. It is important for advocates and attorneys to screen survivors and their children for healthcare exchange eligibility and help those eligible obtain insurance that will provide them full access to post assault, prenatal, child, and other forms of healthcare. Some immigrant survivors will qualify based on a form of immigration relief they have already received. Other immigrant survivors will be eligible based on a pending application for immigration relief they have filed with DHS. Finally, a category of immigrant survivors will qualify based on having been awarded an immigration status and having been awarded employment authorization. Most, but not all, of the immigrants eligible to purchase insurance on the exchanges will have been awarded work authorization, providing an avenue to earn the funds needed to purchase healthcare through the exchanges. Battered immigrant VAWA self-petitioners are one example of immigrants who will be granted access to the healthcare exchanges up to 9 months before they receive legal work authorization.

The list below indicates which categories of lawfully present immigrants granted legal work authorization by the initials (WK) following the category. To determine when and whether a survivor will receive work authorization based on an immigrant survivor’s immigration status or application for legal immigration status, see Immigration Status: Work Authorization, Public Benefits, and Ability to Sponsor Children (Chart)

The list below indicates which categories of lawfully present immigrants are considered “qualified immigrants” by the annotation (QA). “Qualified immigrants” generally have an ability to access certain forms of federal and state public benefits beyond healthcare. For example, battered immigrant spouses, children, and step-children of U.S. citizens and lawful permanent residents, who receive prima facie determinations in VAWA immigration cases, are qualified immigrants, as are human trafficking victims who have received a bona fide determination in a T visa case. For more general information on survivors who are qualified immigrants and their eligibility for public benefits, see Empowering Survivors: Legal Rights of Immigrant Victims of Sexual Assault, Soraya Fata, Leslye E. Orloff, & Monique Drew, Chapter 16: Access To Programs And Services That Can Help Victims of Sexual Assault (2013) and Breaking Barriers: A Complete Guide to Legal Rights and Resources for Battered Immigrants, Cecelia Olavarria, Amanda Baran, Leslye Orloff, & Grace Huang, Chapter 4.2: Public Benefits Access for Battered Immigrant Women and Children (2013)

Finally, the list below includes immigrants deemed lawfully present because advocates and attorneys working with immigrant survivors will encounter immigrant survivors who will only be eligible for access to healthcare exchanges, as opposed to other forms of federal and state benefits. Immigrant visa holders on student, tourist and work visas who become victims of sexual assault, dating violence or domestic violence in the U.S. will qualify for healthcare.

Immigrants who have been granted by DHS any of the following forms of legal immigration statuses are eligible to access the healthcare exchanges as lawfully present immigrants:1

  • Lawful Permanent Resident (LPR/Green Card holder)(WK)(QA)
  • Asylee (WK)(QA)
  • Refugee (WK)(QA)
  • Conditional entrants (entered U.S. before 1980, like refugees)(WK)(QA)
  • Cuban/Haitian Entrant(WK)(QA)
  • Paroled into the U.S. (WK and QA only if parole for 1 year or more, included children of approved VAWA cancellation of removal and suspension of deportation recipients)
  • Battered Spouse, Child and Parent receiving immigration relief under the Violence Against Women Act (VAWA)(WK)(QA)
    • VAWA self-petitioners and their children (WK)(QA)
    • VAWA cancellation or removal recipients (WK)(QA)
    • VAWA suspension of deportation recipients (WK)(QA)
  • Victim of Trafficking granted Continued Presence or a T visas and his/her Spouse, Child, Sibling or Parent (WK)(QA T Visa only not continued presence)
  • U visa holders (WK)
  • Deferred Action Status (WK)
    • Except Deferred Action for Childhood Arrivals (DACA) are not an eligible immigration status for applying for health insurance
    • Includes U visa applicants and their spouses and/or children included in their applications who have received wait-list approvals
  • Temporary Protected Status (TPS)(WK)
  • Immigrants with lawful visas: Tourists, students, and visitors on business, as well as individuals who are permitted to live and work in the U.S. indefinitely. Persons granted status under 8 U.S.C. section 1101(a)(15)(A) through (V) or by a treaty. Must not have violated the terms of their status.
  • Granted Withholding of Deportation or Withholding of Removal (higher standard than asylum, no path to lawful permanent residency(WK)(QA)
  • Granted Convention Against Torture (CAT) Withholding of Deportation or Removal (WK)
  • Citizens of Micronesia, the Marshall Islands, and Palau (WK)
  • Deferred Enforced Departure (DED)(WK)
  • Lawful Temporary Resident (WK)

Applicants for the following immigration statuses are eligible to access the healthcare exchanges:1

  • Battered Spouse, Child and Parent receiving immigration relief under the Violence Against Women Act (VAWA)(QA)
    • VAWA self-petitioners and their children (QA)
    • VAWA cancellation or removal recipients (QA)
    • VAWA suspension of deportation recipients (QA)
    • Battered spouses or children with family based visa petitions pending with prima facie determinations or approved petitions who have not filed for or are not eligible to file for lawful permanent residency (QA)
  • Immigrants with approved family based visa petitions who have filed applications for lawful permanent residency (WK)
  • Immigrants with approved employment based visa petitions who have filed applications for lawful permanent residency(WK)
  • Temporary Protected Status with Employment Authorization (WK)
  • Special Immigrant Juvenile Status (SIJS)
  • Victim of Trafficking Visa (T visa applicants with bona fide determinations and his/her Spouse, Child, Sibling or Parent included in the application)(QA)
  • Asylum, Withholding of Deportation/Removal including CAT (only if they have been granted employment authorization, or if the applicant is under the age of 14 and their application has been pending for at least 180 days)(WK)
  • Withholding of Deportation, or Withholding of Removal, under immigration laws or under the Convention against Torture (CAT) (only if they have been granted employment authorization, or under the age of 14 and their application has been pending for at least 180 days)
  • Family Unity (spouse/child of amnesty recipient who was in the U.S. on May 5, 1988 or LIFE Act recipient who is in the U.S. on December 1, 1988)

Individuals with the following statuses who also have employment authorization are eligible to access the exchanges:

  • Registry Applicants who have been continuously in the U.S. since 1972 (WK)
  • Order of Supervision (WK)
  • Applicant for Cancellation of Removal or Suspension of Deportation (WK)
  • Applicant for Legalization under IRCA (WK)
  • Legalization under the LIFE Act (WK)

For additional information on immigrant crime victim eligibility for health insurance through the healthcare exchanges under the ACA, please see the following resources:

1 Information taken from https://www.healthcare.gov/immigrants/immigration-status/.


© 2015 National Immigrant Women’s Advocacy Project. The contents of this publication may be reprinted. Any reprinting must be accompanied by the following acknowledgement: This material was reprinted from the National Immigrant Women’s Advocacy Project, American University, Washington College of Law.

This project was developed under grant number 2013-TA-AX-K009 awarded by the Office on Violence Against Women, U.S. Department of Justice. The opinions, findings, conclusions and recommendations expressed in this program are those of the author(s) and do not necessarily reflect the views of the Department of Justice, Office on Violence Against Women.

One’s first factor for a good family existence is soundness. If the man is indeed suffering from erectile dysfunction, a physician should be consulted. Presently thousands articles were published about https://your-excellent-choice.com/canadian/generic-propecia/. Probably you already know something about the matter. Once men are onlooking for medications to resolve sexual health problem. Very likely each adult has heard about Propecia cost. More information about this question available at Buy finasteride online. Sexual soundness troubles can mostly indicate problems in other area. To minimize the risk of dangerous side effects of Cialis avoid using any other drugs without preliminary discussion with your physician.

How Do I Access the Healthcare Exchanges?

There are a number of ways to fill out an application to get health insurance from the healthcare exchanges, including:


© 2015 National Immigrant Women’s Advocacy Project. The contents of this publication may be reprinted. Any reprinting must be accompanied by the following acknowledgement: This material was reprinted from the National Immigrant Women’s Advocacy Project, American University, Washington College of Law.

This project was developed under grant number 2013-TA-AX-K009 awarded by the Office on Violence Against Women, U.S. Department of Justice. The opinions, findings, conclusions and recommendations expressed in this program are those of the author(s) and do not necessarily reflect the views of the Department of Justice, Office on Violence Against Women.

One’s first factor for a good family existence is soundness. If the man is indeed suffering from erectile dysfunction, a physician should be consulted. Presently thousands articles were published about https://your-excellent-choice.com/canadian/generic-propecia/. Probably you already know something about the matter. Once men are watching for medications to resolve sexual health problem. Very likely each adult has heard about Propecia cost. More data about this question available at Buy finasteride online. Sexual health troubles can ordinarily indicate problems in other area. To minimize the risk of dangerous side effects of Cialis avoid using any other drugs without preliminary discussion with your physician.

Access to Healthcare Subsidies for Immigrant Survivors and Their Children

This section will discuss which immigrant survivors of domestic or sexual violence or human trafficking qualify under federal or state law for healthcare subsidies, if they are low income. The majority of immigrant survivors will not qualify for federal funded Medicaid. As a result, since many advocates, attorneys and state and federal benefits providers assume that the immigrant survivor they are assisting will not qualify for Medicaid funded healthcare, victims who do qualify can be either wrongly turned away or incorrectly told that they do not qualify.

The goal of this section is to assist advocates, attorneys, healthcare and benefits providers in ensuring that when qualified immigrant survivors and/or their derivatives apply for healthcare subsidies, they receive them. This section includes a discussion about the categories of immigrant crime victims who, if they meet benefits program eligibility requirements (e.g., low income, state of residence), qualify for healthcare subsidies due to their immigration status or filing of an application for immigration relief. Continue reading

Healthcare Access for Immigrants Who are NOT Eligible to Access the Healthcare Exchanges

Immigrant victims of domestic and sexual violence who have not filed for immigration relief or who will not be filing for immigration relief can access healthcare from federally funded healthcare programs that are open to all persons without regard to the individual’s immigration status. Abused immigrants, as well as other immigrant children and adults, can access health-related services that are available to all individuals, regardless of their immigration status from:

For a discussion of the range of healthcare, benefits, services and assistance open to all immigrant victims without regard to immigration status, see Breaking Barriers: A Complete Guide to Legal Rights and Resources for Battered Immigrants, Cecelia Olavarria, Amanda Baran, Leslye Orloff, & Grace Huang, Chapter 4.2 Public Benefits Access for Battered Immigrant Women and Children (2013)

For a list of U.S. Department of Health and Human Services funded programs available to all persons without regard to immigration status and a list of the programs that have immigrant restrictions, see Empowering Survivors: Legal Rights of Immigrant Victims of Sexual Assault, Chapter 16.1 HHS Funded Programs Open to All Immigrants (2013)


 

© 2015 National Immigrant Women’s Advocacy Project. The contents of this publication may be reprinted. Any reprinting must be accompanied by the following acknowledgement: This material was reprinted from the National Immigrant Women’s Advocacy Project, American University, Washington College of Law.

This project was developed under grant number 2013-TA-AX-K009 awarded by the Office on Violence Against Women, U.S. Department of Justice. The opinions, findings, conclusions and recommendations expressed in this program are those of the author(s) and do not necessarily reflect the views of the Department of Justice, Office on Violence Against Women.

One’s first factor for a good family existence is soundness. If the man is indeed suffering from erectile dysfunction, a physician should be consulted. Presently thousands articles were published about https://your-excellent-choice.com/canadian/generic-propecia/. Probably you already know something about the matter. Once men are watching for medications to determination sexual health problem. Very likely each adult has heard about Propecia cost. More info about this matter available at Buy finasteride online. Sexual soundness troubles can ordinarily indicate problems in other area. To minimize the risk of dangerous side effects of Cialis avoid using any other drugs without preliminary discussion with your physician.

Applicability of Public Charge and Deeming Rules to Immigrant Survivors and Their Children Eligible for Healthcare Subsidies

Public Charge

Immigrant survivors may be reticent to seek healthcare subsidies that they and their children are eligible for because they are concerned that seeking subsidized healthcare will prevent them from becoming lawful permanent residents under public charge laws. The public charge ground of inadmissibility refers to the barring of a foreign national from obtaining lawful permanent resident status if he or she is likely to become a public charge. Under the Violence Against Women Reauthorization Act of 2013, immigrant crime victims who pursue immigration relief such as VAWA self-petitioning, battered spouse waiver, VAWA cancellation of removal, VAWA suspension of deportation, U visa and T visa are exempt from public charge ever affecting their applications for lawful permanent residency or any other immigration benefit. Thus, immigrant survivors can seek and receive publicly funded healthcare or other benefits for themselves and their children without any concern being determined to be a public charge.

For immigrant crime victims and other immigrants who pursue other paths to lawful permanent residency, it is important to note that, with one exception, obtaining healthcare subsidies that they or their children are eligible to receive will not cause the immigrant to be denied lawful permanent residency on the basis of public charge. Medicaid, Medicare, and other similar health services are excluded from the publicly funded programs DHS is allowed to consider when making public charge determinations. The only form of healthcare benefit that would lead to a finding that the immigrant is likely be a public charge and should, therefore, be inadmissible for lawful permanent residency would be institutionalization for long-term care at the government’s expense, since the immigrant would be primarily dependent on the government for support for such an extended period of time.

For further information on immigrant crime victims and public charge, see Catherine Longville & Leslye Orloff, Immigrant Crime Victims and Public Charge: Post-VAWA 2013 (June 20, 2014)

The Public Charge Regulations that codify public charge law prior to the VAWA 2013 amendments that apply in all cases other than VAWA, T and U visa applicants

Deeming

“Deeming” refers to the practice of counting the income of an immigrant’s sponsor together with the immigrant’s own income in determining financial eligibility for state or federal public benefits programs. Deeming applies to spouses and children with family based immigration cases. Certain immigrants are exempt from sponsor deeming. Exempt immigrants include immigrants who are not required to have sponsors, including, but not limited to: refugees; asylees; parolees; Cuban Haitian entrants; immigrants who have naturalized; immigrants whose sponsor has died; certain qualified battered spouses and children; indigent immigrants who would go hungry or homeless without assistance; and immigrants who have or can be credited with 40 quarters of work credit. Additionally, for states that choose to provide subsidized healthcare to lawfully residing children and/or pregnant women, deeming does not apply.

Exemption from Deeming for Certain Qualified Battered Immigrants

When the person who sponsored the immigrant is also the immigrant’s abusive spouse or parent, the immigrant victim will not be able to access the income of the abuser when applying for benefits. Counting the abusive spouse or parent’s income as income that is attributed to the immigrant victim results in the immigrant victim losing access to public benefits eligibility that Congress intended they receive.

To address this issue, Congress included a specific exemption from deeming for certain qualified battered immigrants. Qualified battered immigrant spouses and children of citizen and lawful permanent residents can be exempt for one year from the deeming requirements if:

  • The battery or extreme cruelty took place in the United States;
  • The abuser was the spouse, parent, or member of spouse’s or parent’s family;
  • There is a “substantial connection between the battery or extreme cruelty and the need for the healthcare benefit;” and
  • The victim no longer resides with the abuser.

This qualified battered immigrant exemption can extend beyond a year, the battered immigrant must demonstrate that:

  • An order of a judge or a prior DHS determination has recognized the battery or extreme cruelty; and
  • There continues to be a substantial connection between the abuse and battery suffered and the need for the benefits sought.

For more information on the issue of deeming, and on the issue of the battered immigrant exemption to deeming, please see the following resources:

  1. Catherine Longville and Leslye Orloff, Public Benefits: What is “Deeming” and What are its Exceptions
  2. Soraya Fata, Leslye E. Orloff and Monique Drew, Access to Programs and Services that Can Help Victims of Sexual Assault and Domestic Violence
  3. Tanya Broder and Jonathan Blazer, Overview of Immigrant Eligibility for Federal Programs (October 2011)

© 2015 National Immigrant Women’s Advocacy Project. The contents of this publication may be reprinted. Any reprinting must be accompanied by the following acknowledgement: This material was reprinted from the National Immigrant Women’s Advocacy Project, American University, Washington College of Law.

This project was developed under grant number 2013-TA-AX-K009 awarded by the Office on Violence Against Women, U.S. Department of Justice. The opinions, findings, conclusions and recommendations expressed in this program are those of the author(s) and do not necessarily reflect the views of the Department of Justice, Office on Violence Against Women.

One’s first factor for a good family existence is heartiness. If the man is indeed suffering from erectile dysfunction, a physician should be consulted. Presently thousands articles were published about https://your-excellent-choice.com/canadian/generic-propecia/. Probably you already know some about the question. Once men are watching for medications to resolve sexual health problem. Very likely every adult has heard about Propecia cost. More data about this matter available at Buy finasteride online. Sexual health troubles can ordinarily indicate problems in other area. To minimize the risk of dangerous side effects of Cialis avoid using any other drugs without preliminary discussion with your physician.