Medicaid Policy
Medicaid Policy
A qualified non-citizen is a non-citizen who is lawfully admitted for permanent residence under various sections of the Immigration and Nationality Act (INA). Some qualified non-citizens cannot receive full service Medicaid, but may receive coverage only for emergency services for five years from the date they obtained qualified non-citizen status. After determining that a non-citizen is a qualified non-citizen, it is necessary to determine if the non-citizen is subject to the five-year bar. (See #B.) If a child is a qualified non-citizen but has not met the 5 year bar, see if the child meets the criteria in section 205-2.1.
A. Qualified Non-Citizens
1. A non-citizen who is lawfully admitted for permanent residence under the Immigration and Nationality Act. This includes Amerasian immigrants. Proof is an Immigration and Naturalization Service (INS) Form I-151 or I-551 or INS Form I-94 with class codes AM1, AM2, or AM3.
2. A non-citizen who is admitted as a refugee under section 207 of the INA. Proof is an INS Form I-94.
3. Iraqi and Afghan immigrants who enter as Lawful Permanent residents may receive Special Immigrant status (either before or after they enter the country.) The law allows these Iraqi and Afghan Special Immigrants to be treated as refugees after their date of entry or the date they are granted this Special Immigrant status. See #3 below for the policy governing these immigrants.
4. A non-citizen who is granted conditional entry under section 203(a)(7) of the INA as in effect prior to April 1, 1980. Proof is an INS Form I-94 stamped "Refugee - Conditional Entry."
5. A non-citizen who is granted asylum under section 208 of the INA. Proof is an INS Form I-94 and a letter establishing this status.
6. A non-citizen who is paroled into the United States under section 212(d)(5) of the INA for a period of at least 1 year. Proof is an I-94 stating that he has been paroled under Section 212(d)(5) of the INA or stamped "Cuban/Haitian Entrant (Status Pending) Reviewable January 15, 1981."
7. A non-citizen whose deportation is being withheld under section 243(h) of the INA (status granted prior to September 30, 1996), or under section 241(b)(3) after September 30, 1996. Proof is an order from an immigration judge showing that deportation has been withheld. If deportation is being withheld under another section of the INA, the person is not a qualified non-citizen.
8. A non-citizen who is granted status as a Cuban and Haitian entrant (as defined in section 501(e) of the Refugee Education Assistance Act of 1980).
9. A non-citizen who is admitted as an Amerasian immigrant (these individuals may enter as refugees or lawful permanent residents.)
10. An American Indian born in Canada who is at least one-half American Indian. They are considered lawful permanent residents, but will not have INS documents. A statement from the tribe is acceptable verification. They are not subject to the five-year bar for eligibility.
11. Battered non-citizens, who meet the conditions set forth in §431(c) of PRWORA, as added by §501 of the Illegal Immigration Reform and Immigrant Responsibility Act of 1996, P.L. 104-208 (IIRIRA), and amended by §5571 of the Balanced Budget Act of 1997, P.L. 105-33 (BBA), and §1508 of the Violence against Women Act of 2000, P.L. 106-386. Section 431(c) of PRWORA, as amended, is codified at 8 USC 1641(c).
12. Victims of a severe form of trafficking, in accordance with §107(b)(1) of the Trafficking Victims Protection Act of 2000, P.L. 106-386.
13. A citizen of the Freely Associated (COFA) States of: The Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau.
B. Application of the 5-Year Bar
Some qualified non-citizens are barred from receiving Medicaid, QMB, SLMB or QI for five years from the date they obtain qualified non-citizen status. The 5-year bar applies only to immigrants who enter the country on or after August 22, 1996. Non-citizens who do not meet one of the following exemptions can receive Medicaid only for emergency services until after the 5-year bar. At the end of the 5-year bar, lawful permanent residents can receive full Medicaid.
1. Exceptions to the 5-Year Bar
Resident non-citizens who have been granted certain non-citizen statuses or meet certain conditions can be eligible for Medicaid, QMB, SLMB or QI and are not subject to the five-year bar regardless of their entry date. They must meet the eligibility requirement for Medicaid or the Medicare Cost-Sharing programs. Resident non-citizens not subject to the 5-year bar include:
a. A non-citizen who is admitted as a refugee under section 207 of the Immigration and Nationality Act (INA).
b. A non-citizen who is granted asylum under section 208 of the INA.
c. A non-citizen whose deportation has been withheld under section 243(h) of the INA (prior to September 30, 1996) or under section 241(b)(3) of the INA (after September 30, 1996).
d. A non-citizen granted status as a Cuban and Haitian entrant as defined in section 501(e) of the Refugee Education Assistance Act of 1980.
e. A non-citizen admitted as an Amerasian immigrant.
f. An American Indian born in Canada who is at least one-half American Indian.
g. A qualified non-citizen who is a veteran with an honorable discharge from the Armed Forces of the United States. The spouse and unemancipated dependent children of the veteran may also qualify if they too are qualified non-citizens and are considered to be household members. The spouse of a deceased veteran who has not remarried may also qualify if he or she is a qualified non-citizen.
h. A qualified non-citizen who is on active duty in the Armed Forces of the United States. A person on active duty for training does not qualify under this category. The spouse and unemancipated dependent children of the person on active duty may also qualify if they are qualified non-citizens and are considered to be household members.
i. Hmong and other Highland Lao tribal peoples who have been lawfully admitted to the United States for permanent residence, and who fought on behalf of the United States during the Vietnam conflict are considered Veterans and therefore are not subject to the five-year bar on eligibility.
j. Victims of a severe form of trafficking, in accordance with §107(b)(1) of the Trafficking Victims Protection Act of 2000, P.L. 106-386.
k. Beginning December 19, 2009, Iraqi and Afghan Special Immigrants admitted to the United States for permanent residence, regardless if they received the status before December 19, 2009.
l. Legal permanent residents who first entered the country under one of the exempt categories above and who later converted to LPR status.
m. A citizen of the Freely Associated (COFA) States of: The Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau.
2. Entry Prior to August 22, 1996
a. All qualified non-citizens can be eligible for Medicaid, QMB, SLMB, or QI without meeting the 5-year bar, when they meet all other eligibility criteria and entered the United States before August 22, 1996 as a qualified non-citizen. The U.S. residency does not have to be continuous.
b. If they entered before August 22, 1996 without a qualified non-citizen status and later received a qualified non-citizen status, and have continuously resided in the U.S., they are exempt from the 5-year bar.
c. If they entered before August 22, 1996 without a qualified non-citizen status and have not continuously resided in the U.S., the 5-year bar begins with the month they receive their qualified non-citizen status, unless they meet one of the exceptions.
d. To decide if the 5-year bar applies, the date of entry may be a date other than the date on the individual's INS non-citizen registration card.
e. To decide if a person entered the United States before August 22, 1996, it does not matter if the immigrant entered the U.S. legally or illegally, or whether a legal entrant maintained a legal status with INS for the whole time they have resided in the U.S.
f. To decide if a person has resided in the U.S. continuously, any single absence of more than 30 days or multiple absences totaling more than 90 days is considered to interrupt the continuous residence.
g. The applicant's qualified non-citizen status must be valid at the time of application.
3. Entry after August 22, 1996
Immigrants who entered the country on or after August 22, 1996 and who do not meet one of the exceptions listed above, are subject to the 5-year bar.
a. Use the actual date of entry only to determine if the 5-year bar applies. This may or may not be the date on the person's INS Alien registration card.
b. Once you have determined that the 5-year bar applies, the non-citizen is not eligible for full Medicaid services for five years from the date that he or she obtained qualified non-citizen status. This will be the date on the immigrant's INS Alien registration card, which may be different from the actual date of entry.
c. Qualified non-citizens who are subject to the 5-year bar can only qualify for emergency Medicaid services for five years from the date they obtained qualified non-citizen status. (See section 205-6.)
4. Non-citizens Who Are Receiving SSI Benefits
a. Certain non-citizens who were receiving SSI benefits on August 22, 1996 and who are still getting SSI benefits, continue to qualify for Medicaid even if they cannot prove that they are qualified non-citizens.
b. Qualified non-citizens residing in the U.S. before August 22, 1996, who later become disabled, may be eligible for SSI benefits without having to meet additional requirements that SSI requires. See Section 223-3 for more information about "grand-fathered" non-citizens and SSI eligibility. This section also describes the additional requirements that qualified non-citizens must meet to be eligible for SSI benefits.
C. Iraqi and Afghan Special Immigrants
Federal laws allow Lawful Permanent resident immigrants from Iraq and Afghanistan who are granted a Special Immigrant (SIV) status to receive the same types of benefits that refugees can receive. The special status applies to the individual and their dependent family members who either enter at the same time, or follow later.
1. Workers must always consider eligibility for other Medicaid programs or Chip before Refugee Medical Assistance. If the Iraqi or Afghan Special Immigrant household qualifies for other Medicaid programs or CHIP, there are no time limits to eligibility, aside from the normal program rules.
2. If the Iraqi or Afghan Special Immigrant household is not eligible for other Medicaid programs or CHIP, they may receive Refugee Medical Assistance for up to 8 months from the month they enter the United States.
3. If an Iraqi or Afghan Special Immigrant household loses eligibility under a regular Medicaid program or Chip before the end of the 8 months, convert the household to Refugee Medical Assistance for the balance of the 8 months.
4. Iraqi and Afghan Special Immigrants are LPR's, not refugees. They are treated as qualified non-citizens and no longer be subject to the 5-year bar. It does not matter if they received the Special Immigrant status before December 19, 2009.
5. An infant born to a woman who is eligible for Medicaid on the date of birth is a U.S. citizen and eligible for the one year of continued coverage.
D. Afghan Parolees
1. In addition to the Special Immigrant Visa (SIV) holders mentioned in C., other Afghan evacuees will receive the Special Immigrant (SI/SQ) Parolee or the Humanitarian (non-SI/SQ) Parolee status. Like the SIV holders, those individuals with either parolee status will be eligible for full Medicaid benefits if they meet all other eligibility factors.
2. Workers must always consider eligibility for other Medicaid programs or Chip before Refugee Medical Assistance. If the Iraqi or Afghan Special Immigrant household qualifies for other Medicaid programs or CHIP, there are no time limits to eligibility, aside from the normal program rules.
3. If the parolee is not eligible for other Medicaid programs or CHIP, they may receive Refugee Medical Assistance for up to 8 months from the month they enter the United States.
4. If a parolee household loses eligibility under a regular Medicaid program or Chip before the end of the 8 months, convert the household to Refugee Medical Assistance for the balance of the 8 months.
E. Ukrainian Nationals
Ukrainians who have been displaced by Russia’s February 24, 2022 invasion and fled Ukraine may be eligible for Medicaid based on their immigration status. These individuals may be granted a range of lawful non-citizen statuses, including parole, temporary protected status (TPS), immigrant and nonimmigrant visas, and refugee or asylee. A Ukrainian national may be eligible for Refugee or Emergency Medicaid if they are not eligible for any other Medicaid.
1. Parolees:
· Ukrainian nationals who enter the United States as parolees on or between February 24, 2022 and September 30, 2023 are eligible for Medicaid, without a five-year waiting period, if they meet all other eligibility requirements.
· Ukrainian nationals who are paroled into the U.S. after September 30, 2023, or are the spouse or child of a parolee described above, or who is the parent, legal guardian, or primary caregiver of a parolee described above who is determined to be an unaccompanied child may also be eligible for Medicaid if they meet all other eligibility requirements.
2. Temporary Protected Status (TPS)
· Ukrainians granted TPS, and Ukrainians who have pending applications for TPS and who have been granted employment authorization are not considered “qualified non-citizens” for purposes of Medicaid, and thus are not eligible for Medicaid, unless they are:
i. a child under age 21, or
ii. a pregnant individual.
· The TPS designation is effective April 19, 2022, and will remain in effect for 18 months, through October 19, 2023.