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A qualified alien is an alien who is lawfully admitted for permanent residence under various sections of the Immigration and Nationality Act (INA). Some qualified aliens cannot receive full service Medicaid, but may receive coverage only for emergency services for five years from the date they obtained qualified alien status. After determining that an alien is a qualified alien, it is necessary to determine if the alien is subject to the five-year bar. (See #B.) If a child is a qualified alien but has not met the 5 year bar, see if the child meets the criteria in section 205-2.1.
Qualified Aliens
An alien 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.
An alien who is admitted as a refugee under section 207 of the INA. Proof is an INS Form I-94.
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.
An alien 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."
An alien who is granted asylum under section 208 of the INA. Proof is an INS Form I-94 and a letter establishing this status.
An alien 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."
An alien 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 alien.
An alien who is granted status as a Cuban and Haitian entrant (as defined in section 501(e) of the Refugee Education Assistance Act of 1980).
An alien who is admitted as an Amerasian immigrant (these individuals may enter as refugees or lawful permanent residents.)
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.
Battered aliens, 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).
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.
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.
Application of the 5-Year Bar
Some qualified aliens are barred from receiving Medicaid, QMB, SLMB or QI for five years from the date they obtain qualified alien status. The 5-year bar applies only to immigrants who enter the country on or after August 22, 1996. Aliens 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.
Exceptions to the 5-Year Bar
Resident aliens who have been granted certain alien 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 aliens not subject to the 5-year bar include:
An alien who is admitted as a refugee under section 207 of the Immigration and Nationality Act (INA).
An alien who is granted asylum under section 208 of the INA.
An alien 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).
An alien granted status as a Cuban and Haitian entrant as defined in section 501(e) of the Refugee Education Assistance Act of 1980.
An alien admitted as an Amerasian immigrant.
An American Indian born in Canada who is at least one-half American Indian.
A qualified alien 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 aliens 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 alien.
A qualified alien 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 aliens and are considered to be household members.
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.
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.
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.
Legal permanent residents who first entered the country under one of the exempt categories above and who later converted to LPR status.
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.
Entry Prior to August 22, 1996
All qualified aliens 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 alien. The U.S. residency does not have to be continuous.
If they entered before August 22, 1996 without a qualified alien status and later received a qualified alien status, and have continuously resided in the U.S., they are exempt from the 5-year bar.
If they entered before August 22, 1996 without a qualified alien status and have not continuously resided in the U.S., the 5-year bar begins with the month they receive their qualified alien status, unless they meet one of the exceptions.
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 alien registration card.
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.
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.
The applicant's qualified alien status must be valid at the time of application.
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.
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.
Once you have determined that the 5-year bar applies, the alien is not eligible for full Medicaid services for five years from the date that he or she obtained qualified alien status. This will be the date on the immigrant's INS alien registration card, which may be different from the actual date of entry.
Qualified aliens who are subject to the 5-year bar can only qualify for emergency Medicaid services for five years from the date they obtained qualified alien status. (See section 205-6.)
Aliens Who Are Receiving SSI Benefits
Certain aliens 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 aliens.
Qualified aliens 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" aliens and SSI eligibility. This section also describes the additional requirements that qualified aliens must meet to be eligible for SSI benefits.
Iraqi and Afghan Special Immigrants
Federal laws allow Lawful Permanent resident immigrants from Iraq and Afghanistan who are granted a Special Immigrant 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.
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.
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.
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.
Iraqi and Afghan Special Immigrants are LPR's, not refugees. They are treated as qualified aliens 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.
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.