The Personal Responsibility and Work Opportunity and Reconciliation Act of 1996, P.L. 104.193 (PRWORA) substantially restricted the eligibility of aliens for means-tested benefits programs, including Medical Assistance (MA). MA eligibility for aliens is based on whether the alien is a qualified or non-qualified alien. Certain qualified aliens who entered the United States (U.S.) on or after August 22, 1996 are not eligible for Federally funded MA for five years beginning with the date the individual entered the U.S. with a qualified alien status (referred to as the Five Year Bar). Other qualified aliens who meet an exemption from the five year bar may receive Federally-funded MA. The previous categories of lawful permanent residents and aliens permanently residing in the United States under color of law (PRUCOL) no longer apply. Non-qualified aliens may be eligible for MA to cover an emergency medical condition only if all other conditions of eligibility are met (see Section 322.33, Aliens Who Can Get Emergency MA Benefits). Section 322.31 includes a list of qualified aliens. Section 322.32 provides more explanation of the five year bar as well as those qualified aliens who are exempt from the five year bar. 55 Pa. Code § 150.1
The following is a list of qualified aliens:
Aliens lawfully admitted for permanent residence under the Immigration and Nationality Act (INA), 8 USC 1101 et seq. The CAO must ask for (a) USCIS Form I-551 or (b) for recent arrivals, a temporary I-551 stamp in a foreign passport or on Form I-94.
Refugees admitted to the U.S. under Section 207 of the INA (see Supplemental Handbook, Chapter 730). The CAO must ask for (a) USCIS Form I-94 annotated with a stamp showing entry to the U.S. as a refugee under Section 207 of the INA and the date of entry; (b) USCIS Form I-688B annotated “274a.12(a)(3)”; (c) USCIS Form I-766 annotated “A3”; or (d) USCIS Form I-571. Refugees usually change to lawful permanent resident status after 12 months in the U.S., but for eligibility purposes they are still considered refugees. Therefore, the CAO must check the coding on Form I-551 for codes RE-6, RE-7, RE-8 or RE-9.
NOTE: If an alien’s Form I-688B is stamped “none” or has no stamp, there are no terms or conditions that limit his or her general authorization to work without restrictions. “None” is a standard notation on Employment Authorization Documents (EADs) and is actually most preferred.
Aliens granted asylum under § 208 of the INA (see Supplemental Handbook, Chapter 730). The CAO must ask for (a) USCIS Form I-94 annotated with a stamp showing a grant of asylum; (b) USCIS Form I-688B annotated with “274a.12(a)(5); (c) USCIS Form I-766 annotated “A5”; or (d) USCIS Form I-551 annotated “AS-6,” “AS-7,” or “AS-8.”
Cuban and Haitian Entrants, as defined in § 501 (e) of the Refugee Education Assistance Act of 1980. USCIS processes refugees from Cuba and Haiti the same way as other refugees and provides an I-94 when the individual enters the U.S. If the I-94 shows that USCIS admitted the Cuban or Haitian entrant to the country under one of the provisions listed in Supplemental Handbook Chapter 730.2, the CAO must assign citizenship code 04 to the individual.
NOTE: Individuals who (a) were granted parole status as a Cuban or Haitian entrant, (b) have gotten another status under the Immigration and Nationality Act, and (c) are not being sought to be expelled from the U.S. are eligible for MA, SNAP and Supplemental Security Income (SSI) benefits for up to seven years from the date that they were paroled into the U.S. These individuals must have documents that prove Cuban or Haitian Entrant or refugee status and the date of legal entry into the U.S.
Cuban or Haitian Entrants must present either Form I-551 or Form I-94 stamped “Humanitarian Parole,” “Paroled in the Public Interest,” “Parolee” “Paroled as a Refugee,” “Cuban/Haitian Entrant status pending,” “Form I-589 Filed,” “Parole,” “Paroled,” “Asylee,” “Asylum” or “CH-6.”
If the USCIS notes on the G845S Document Verification Request form that the document used for proof has expired, then the CAO must ask the individual if he or she has current documents verifying parolee status before taking any adverse action.
Aliens granted parole for at least one year under § 212(d)(5) of the INA. The CAO must ask for USCIS Form I-94 annotated with a stamp showing grant of parole under Section 212(d)(5) of the INA and a date showing grant of parole for at least one year.
Aliens whose deportation is being withheld under (1) § 243(h) of the INA as in effect prior to April 1, 1997 or (2) § 241(b)(3) of the INA as amended. The CAO must ask for (a) an order from an immigration judge showing deportation withheld under Section 243(h) of the INA and the date of the grant; (b) USCIS Form I-688B annotated “274a.12(a)(10)”; or (c) USCIS Form I-766 annotated “A10.”
Aliens granted conditional entry under § 203(a)(7) of the INA in effect before April 1, 1980. The CAO must ask for (a) USCIS Form I-94 with a stamp showing admission under Section 203(a)(7) of the INA (refugee-conditional entry); (b) USCIS Form I-688B annotated “274a.12(a)(3)” ; or (c) USCIS Form I-766 annotated “A3.”
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). The spouse (male or female), parent of an unmarried child under age 21 or child of a U.S. citizen or lawful permanent resident who has been battered or abused in the U.S. and has petitioned on his or her own to obtain lawful permanent residence status under the Violence Against Women Act (VAWA) and has been placed into deferred action (meaning the service will not begin proceedings to remove the individual) under INA Section 204(a)(i)(A)(iii). The petition goes to the USCIS for review. The USCIS will decide whether the petitioner has met basic requirements and provided enough supporting evidence. If the individual has submitted sufficient evidence to have his or her petition considered, the USCIS will issue a notice of prima facie case (Form I-797). For the purpose of eligibility, an immigrant who has an established prime facie case is considered “qualified” for public benefits (U.S. Code Title 8 Chapter 14 Subchapter IV Section 1641). After further investigation, the USCIS will make a determination on the immigrant’s petition for lawful permanent residency.
Victims of a severe form of trafficking under § 107(b)(1) of the Trafficking Victims Protection Act of 2000 (TVPA), Public Law 106-386 (See Supplemental Handbook, Chapter 730). The CAO must ask for a letter from the Office of Refugee Resettlement.
NOTE: Under the TVPA, eligible relatives of trafficking victims are allowed to get visas designated as “T-2,” “T-3,” “T-4,” or “T-5” (collectively referred to as “derivative T visas”). When the T visas are issued, the relatives can get the same federally funded or administered benefits as direct victims of trafficking, as long as they meet the other eligibility criteria for the programs. Holders of the T visas are treated the same as refugees.
The five year bar only applies to qualified aliens who entered the U.S. on or after August 22, 1996. It is the date of entry into the U.S. which determines the application of the five year bar. A qualified alien who is subject to the bar is not eligible for Federally-funded MA for a period of five years from the individual’s date of entry into the U.S. as a qualified alien. Several categories of qualified aliens are exempt from the bar, regardless of their date of entry into the country.
A qualified alien who entered the U.S. prior to August 22, 1996 is not subject to the five year bar. Temporary and undocumented aliens who entered the U.S. prior to August 22, 1996, remained continuously present in the U.S., and later obtained qualified alien status are also not subject to the five year bar. For these aliens, once qualified alien status is obtained, the individual is eligible for MA with no five year bar, provided all other conditions of eligibility are met. Any single absence from the U.S. of more than 30 days or a total combination of absences of more than 90 days is considered an interruption in continuous presence. An alien with an interruption in continuous presence is considered as not having entered the U.S. prior to August 22, 1996. Therefore, the individual is subject to the bar for five years from the date qualified alien status was obtained.
An immigration document includes a date of entry. For an individual who entered the U.S. and later had an adjustment or change in immigration status, the date of entry becomes the date of status adjustment. The new document for the new status no longer reflects the initial date of entry. For an alien claiming a date of entry prior to August 22, 1996, the initial date of entry and continuous presence prior to obtaining the qualified alien status must be verified in order to determine if the individual is subject to the bar. The individual may provide original immigration documents if available. Otherwise, the date may be verified through the USCIS. For lawfully-admitted aliens, USCIS maintains a record of arrivals to and departures from the U.S. Initial date of entry and possibly continuous presence may be verified by requesting additional verification through SAVE. If it is not available through SAVE, it may be verified by submitting Form G-845 and Form G-845 Supplement to USCIS.
There are no such records for undocumented aliens. For former undocumented aliens, they must provide (a) proof of current alien status, (b) proof of date of entry prior to August 22, 1996 and (c) proof of continuous presence in order to determine if they are subject to the bar. Examples of such proof may include letters from employers, a series of pay stubs, utility bills in the individual’s name, school records, tax records or medical records spanning the period of time in question.
Qualified aliens subject to the five year bar may receive State-funded MA (General Assistance-(GA) related MA) if they meet all conditions of eligibility for GA-related MA. For GA-related MA categorical requirements see Chapter 305.
Qualified aliens subject to the five year bar may only receive federally funded MA to cover an emergency medical condition. A qualified alien determined eligible for ongoing GA-related MA may be reviewed for MA in a federally funded category when experiencing an emergency medical condition. The emergency medical condition must be verified and meet the requirements of an emergency medical condition (see Section 322.33, Aliens Who Can Get Emergency MA Benefits). The individual must meet all eligibility criteria for the federally funded category. When the emergency medical condition ends, the federally funded MA category must be closed and the individual must be reviewed for ongoing GA-related MA eligibility. Public Law 104-193 Sec 403(a)
The following qualified aliens are exempt from (or not subject to) the five year bar and may receive Federally-funded MA, if all other conditions of eligibility are met: Public Law 104-193 Sec 403(b)
Children under age 21.
Pregnant women, through the 60-day post partum period, beginning with the last day of pregnancy.
Refugees.
Asylees.
Qualified aliens lawfully residing in any state who are honorably discharged veterans, or who are on active duty in the U.S. Armed Forces, or who are the spouse, unmarried dependent child or unmarried surviving spouse of such a veteran or active service member.
Cuban/Haitian entrants, as defined in Section 501 (e) of the Refugee Education Assistance Act of 1980.
Amerasian immigrants admitted to the U.S. pursuant to Section 584 of the Foreign Operation, Export Financing, and Related Programs Appropriation Act of 1988.
Victims of trafficking, under the Trafficking Victims Protection Act of 2000, Public Law 106.386.
Aliens whose deportation is being withheld.
Legal Permanent Residents (LPRs) who first entered the country under another exempt category (i.e., as a Refugee, Asylee, Cuban or Haitian Entrant, trafficking victim or alien whose deportation was withheld) and who later converted to LPR status.
Members of a Federally-recognized Indian tribe, as defined in 25 U.S.C. 450b(e) as “any Indian tribe, band, nation or other organized group or community, including any Alaska Native village or regional or village corporation as defined in, or established pursuant to, the Alaska Native Claims Settlement Act”.
Native Americans born in Canada to whom Section 289 of the Immigration and Naturalization Act applies, who are at least 50 percent Native American blood.
Iraqi and Afghani immigrants granted special immigrant status through Section 525 of Title V of Division G of the Consolidated Appropriations Act of 2008 (Public Law 110-161) and Section 1244 (g) of the National Defense Authorization Act (NDAA 2008) (Public Law 110-191). This group will either enter the U.S. as lawful permanent residents with special immigrant visas or will adjust to special immigrant status after entering the U.S. under another immigration status such as asylee or parolee. Iraqi and Afghani special immigrants may receive Federally-funded benefits and entitlements to the same extent and for the same period as refugees. Special Immigrant documentation for this group may include (see Appendix A):
Iraqi or Afghan passport with an Immigrant Visa stamp SI1, SI2, SI3, SQ1, SQ2 or SQ3 and a Department of Homeland Security (DHS) notation on the passport or I-94 showing date of entry.
DHS Form I-551 (“green card”) showing Iraqi or Afghan nationality and stamped SI6, SQ6, SI7, SQ7, SI9 or SQ9.
Since the Social Security Administration also imposes the five year bar on Legally Admitted Residents for Supplemental Security Income (SSI), CAOs do not have to question eligibility for Federally-funded MA for A, J or M categories.
The following aliens are eligible for MA, but only for emergency medical services, if they meet all other requirements: 55 Pa. Code § 150.11
Qualified aliens subject to the five year bar may receive federally funded MA to cover an emergency medical condition. When the emergency medical condition ends, the individual must be reviewed for GA-related MA eligibility.
Lawful aliens temporarily admitted to the U.S. for a specific period of time. This includes, but is not limited to, the following:
Visitors.
Tourists.
Foreign government representatives on official business and their families and servants.
Temporary workers, including agricultural contract workers.
Students who enter the U.S. temporarily with no plan to abandon residence in their own foreign country.
Crewmen on shore leave.
Treaty traders and investors and their families.
International organization representatives and personnel, along with their families and servants
Members of the foreign press, radio, film or other information media and their families
NOTE: A lawful temporary alien may present USCIS documents, including, but not limited to, the following forms:
Employment Authorization (I-688B or I-688A).
Arrival–Departure Record (I-94).
Canadian Border Crossing Card (I-185).
Mexican Border Crossing Card (I-186).
Mexican Border Visitor's Permit (I-94).
Crewman's Landing Permit (I-68 or I-94W).
Undocumented aliens, including aliens who are:
Not lawfully admitted for permanent residence.
Not permanently living in the U.S. with the permission of the USCIS.
Lawfully admitted with a visa that has expired.
NOTE: Undocumented aliens either were never lawfully admitted to the U.S. for any period of time or were admitted for a limited period of time and did not leave the U.S. when the period of time expired.
The CAO does not have the responsibility to report undocumented aliens to the USCIS.
A lawful temporary alien, undocumented alien or qualified alien subject to the five year bar may receive MA to cover an emergency medical condition.
As of January 1, 1988, the sixth Omnibus Budget Reconciliation Act of 1986 (SOBRA) allows for MA benefits to aliens not lawfully admitted for permanent residence or not otherwise permanently living in the United States, if the alien has an emergency medical condition and meets the income, resources and category requirements of the MA program.
An emergency medical condition is a medical condition with acute symptoms of such severity including severe pain, that without immediate attention, the result may be:
The patient’s health is in serious jeopardy.
Serious impairment to bodily functions.
Serious dysfunction of any body organ or part.
An emergency medical condition includes labor and delivery services. It does not include care and services related to organ transplants.
55 Pa. Code § 150.11(e) USC 1611(b)(1)(A) Public Law 104-193 Sec 411(b)(1)
NOTE: If an individual who has had an organ transplant needs emergency life-threatening services related to the organ transplant but not part of the transplant procedure, the life-threatening service may be considered an emergency medical condition, if all other requirements are met.
NOTE: An undocumented alien or a lawful temporary alien may be eligible for BCCPT to cover an emergency medical condition. The individual must meet the eligibility requirements for BCCPT, and she may receive services for the emergency medical condition only.
The alien must verify that an emergency medical condition exists by providing a written statement from a medical provider. The written statement must:
Identify the emergency medical condition.
State that the medical treatment is necessary because of the medical condition.
Give a date when the emergency is expected to end.
NOTE: The CAO may contact the medical provider to get information. If a collateral contact is made, the CAO must note the information in the case record.
An alien who needs emergency medical services must meet all other eligibility rules.
Exception: The alien is not required to: 55 Pa. Code § 150.11(c)
Sign the Citizenship/Alienage Declaration form.
Verify his or her alien status.
Verify his or her Social Security number.
The CAO must authorize MA as noncontinuous eligibility (NCE) to cover only the period of time required to treat the emergency medical condition. MA for an emergency medical condition may be authorized from the beginning of treatment until the individual’s condition is no longer an emergency. Care provided after the emergency is over is not covered by MA. 55 Pa. Code § 150.11(e)
NOTE: For emergency medical services involving ongoing treatment (such as dialysis, cancer treatments, or high-risk pregnancies), eligibility must be determined on a case-by-case basis by the CAO’s executive director or someone the director names.
For labor and delivery services, the CAO must authorize MA starting on the date that active labor begins and ending when delivery is complete and the mother and child are stable. There is no postpartum coverage for the mother.
NOTE: A child born to an undocumented, lawful temporary or qualified alien mother whose delivery and labor were covered by MA is eligible for MA for one year from the date of birth under the same conditions as a child born to a citizen. (See Section 338.41, MA for Newborns).
NOTE: The pregnant alien's child, if born in the U.S., is a citizen. The CAO must review the newborn's eligibility for benefits at the first renewal.
When authorizing emergency MA services, the CAO must assign citizenship code 03 to an alien who is lawfully admitted to the U.S. for a specific period of time or 05 to an undocumented alien. The “Medical Emergency” fields must be filled out on the CARFUG screen in CIS.
Each alien must provide documentation of alien status, unless he or she is requesting MA for an emergency medical condition only. The status of an alien is established when the individual provides a current alien registration card or other documentation from the USCIS showing the individual is residing in the U.S. legally. 55 Pa. Code § 150.31
NOTE: If the only document provided by the alien is a letter from the USCIS, the CAO must confirm the alien’s status by contacting the USCIS.
The CAO must confirm the lawful alien status of each applicant identified as an alien by submitting the documentation information through the USCIS’ Systemic Alien Verification for Entitlements (SAVE) program. Each alien registered with the USCIS is assigned an alien registration number (known as the “alien number,” “A number” or “file number”). The USCIS needs this number whenever information related to alien status is requested. The CAO must also enter the alien number on the CARFUG screen in CIS.
Exception: The USCIS does not need to confirm an alien’s status for an individual applying for coverage of an emergency medical condition only.
To verify an alien’s status through SAVE, the CAO caseworker must complete a Document Verification Request (USCIS Form G-845). To complete the form:
1. Get the alien registration number from the alien’s documentation.
2. Fill out the top portion of the form, and attach copies of the alien’s documentation (front and back) to the form.
3. Retain copies of the alien’s documentation (front and back) and the completed G-845 in the case record.
4. Forward the completed G-845 to the CAO supervisor for him or her to process.
NOTE: For more information, see Supplemental Handbook Chapter 740, SAVE Procedures.
If the individual is otherwise eligible, the CAO must authorize MA benefits while waiting for the response from USCIS. When the G-845 is returned from the USCIS, the CAO must determine whether the alien is correctly receiving benefits. The CAO must keep a copy of the G-845 and the documentation used to verify alien status in the record. If lawful alien status is confirmed, the CAO will not have to confirm it again unless the individual states that his or her status has changed.
When the CAO determines that an alien is not eligible for MA because he or she does not meet the citizen or alien requirements or does not need emergency medical care, the CAO must send a PA/MA 162 notice letting the individual know that he or she is not eligible.
Updated February 14, 2012, Replacing October 29, 2008