The Personal Responsibility and Work Opportunity and Reconciliation Act of 1996, P.L. 104-193 (PRWORA) restricted the eligibility of non-citizens for means-tested benefits programs, including Medical Assistance (MA). The previous categories of lawful permanent residents and non-citizens permanently residing in the United States under color of law (PRUCOL) no longer apply.
MA eligibility for non-citizens is based on whether the individual is a qualified non-citizen or is lawfully present.
Certain qualified non-citizens 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 obtained qualified non-citizen status (referred to as the “five year bar”). Qualified non-citizens subject to the five year bar may receive State-funded MA (GA-related MA).
Other qualified non-citizens who meet an exemption from the five year bar may receive federally-funded MA.
Lawfully present children under age 21 and pregnant women may receive federally-funded MA under Section 214 of the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA), Public Law 111-3.
Lawfully present non-pregnant adults age 21 and over may receive State-funded MA (GA-related MA).
Individuals subject to the five year bar, lawfully present non-pregnant adults age 21 and over and undocumented non-citizens may be eligible for federally-funded MA to cover an emergency medical condition only if all other conditions of eligibility are met. (See Section 322.33, Non-Citizens Who Can Get Emergency MA Benefits).
NOTE: All lawfully present non-citizens are eligible to purchase coverage through the Health Insurance Marketplace and, if income eligible, may qualify for Advance Payment Premium Tax Credit (APTC) and/or Cost-Sharing Reduction (CSR) cost savings.
42 CFR § 435.406(a)(2)(i) Public Law 104-193 Sec 411(b)(1) Public Law 111-3 sec 214
Section 322.31 Qualified Non-Citizens included a list of qualified non-citizens. Sections 322.311 The Five Year Bar and 322.312 Qualified Non-Citizens Exempt from the Five Year Bar provide more explanation of the five year bar as well as those qualified on-citizens who are exempt from the five year bar. Section 322.32 Lawfully -Residing Children Under age 21 and Pregnant Women provides more explanation on lawfully present children and pregnant women.
The following is a list of qualified non-citizens:
Non-citizens lawfully admitted for permanent residence under the Immigration and Nationality Act (INA), 8 USC 1101 et seq. (LPRs or Green Card Holders).
The CAO must ask for (a) USCIS Form 1-551 or (b) for recent arrivals, a temporary 1-551 stamp in a foreign passport or on Form 1-94.
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 non-citizen’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.
Non-citizens 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. 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.
Non-citizens 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.
Non-citizens 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.”
Non-citizens 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 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).
The non-citizen 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.
NOTE: 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).
An individual with a non-citizen status that falls into one of the following scenarios:
The individual non-citizen suffered abuse caused by a family member (spouse, parent, family member) residing in the same home as the non-citizen and the non-citizen’s spouse or parent consented to the abuse.
A non-citizen whose child has suffered abuse by a family member (spouse, parent, family member) residing in the same home as the non-citizen and the non-citizen’s spouse or parent consented to the abuse but the non-citizen did not participate in the abuse.
A non-citizen child whose parent (with whom they reside) suffered abuse (spouse, parent, family member) residing in the same home as the non-citizen and the non-citizen’s spouse or parent consented to the abuse.
Additionally, for each scenario described above, all of the following requirements must also be present: (a) abuse consists of battery/extreme cruelty that occurred in the U.S.; (b) there is a substantial connection between the abuse and the need for the benefits, and; (c) the non-citizen had a petition approved , or pending, which based on one of the following statuses under the Immigration and Nationality Act: lawfully admitted spouse or child of a U.S. citizen (8 U.S.C. 1154(a)(1)(A)(ii)-(iv));lawfully admitted family member (child / spouse / brother / sister)(8 U.S.C. 1154(a)(1)(B)(ii)-(iii));request for suspension of deportation (8 U.S.C. 1254(a)(3)),or; request for cancellation of removal.
Victims of a severe form of trafficking under § 107(b)(1) of the Trafficking Victims Protection Act of 2000 (TVPA), Public Law 106-386 and applicants for a victim of trafficking visa (See Supplemental Handbook, Chapter 730).
An individual with a non-citizen status who has a petition approved, or pending, for nonimmigrant status as one of the following:
A victim of human trafficking.
A spouse, child, or sibling of a victim of human trafficking.
As a result of providing assistance to an investigation into human trafficking per the Immigration and Nationality Act (8 U.S.C. 1101(a)(15)(T)
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.
Amerasian immigrants, in accordance with a joint resolution making further continuing appropriations for the fiscal year 1988, and for other purposes (Pub. L. 100-202, enacted December 22, 1987).
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.
A qualified non-citizen who is subject to the five year bar is not eligible for federally-funded MA for a period of five years from the date the individual was granted their qualified non-citizen status. The five year bar only applies to qualified non-citizens who entered the U.S. on or after August 22, 1996 and to individuals who entered the U.S. prior to August 22, 1996 and did not remain continuously present in the U.S. and later obtained qualified non-citizen status. Several categories of qualified non-citizens are exempt from the bar, regardless of their date of entry into the country (See Section 322.312 for exemptions).
Once it is determined that the five-year bar applies, the five-year bar start date is the date that the individual obtained qualified non-citizen status; this may or may not be the same date as the individual’s entry date into the U.S. After the case is processed, the worker must create a manual alert to re-evaluate for federally-funded MA after the five year bar has passed.
NOTE: Some immigration documents include a date of entry, others do not. For an individual who enters the U.S. and later obtains qualified non-citizen status, the date on the document granting the “qualified non-citizen status” is the date to be used to calculate the five year bar. For an individual who entered the country at some earlier date, the “grant date” of the qualified status will no longer reflect the initial date of entry. Since Case Processing (CP) calculates the 5 Year Bar Date based on the U.S Entry Date on the Alien/Refugee screen, the CAO must ensure that the date in the U.S. Entry Date field is the date that the individual obtained qualified non-citizen status. If this date has changed, the CAO must update the date in this field.
Example: An individual enters the U.S. as a temporary resident (Citizenship Code 03) on 2/1/14. The CAO enters 2/1/14 in the U.S. Date of Entry field. The individual later becomes a lawful permanent resident (Citizenship Code 02) on 10/1/15. The CAO must update the U.S. Entry Date to the grant date which is 10/1/15 to ensure that the 5 Year Bar Date is set for 10/1/20.
For non-citizens who entered the US prior to August 22, 1996:
A “qualified non-citizen” who entered the U.S. prior to August 22, 1996 is not subject to the five year bar.
Non-citizen individuals who entered the U.S. prior to August 22, 1996, remained continuously present in the U.S., and later obtained qualified non-citizen status are also not subject to the five year bar. For these non-citizens, once qualified non-citizen 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.
A non-citizen 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 non-citizen status was obtained.
An immigration document includes a date of entry or a grant date. For an individual who entered the U.S. and later had an adjustment or change in immigration status, the date of entry or grant date becomes the date of status adjustment. The new document with the new status no longer reflects the initial date of entry or grant date.
For a non-citizen claiming a date of entry prior to August 22, 1996, the initial date of entry and continuous presence prior to obtaining the qualified non-citizen 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 non-citizens, USCIS maintains a record of arrivals to and departures from the U.S. Initial date of entry/grant date 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 non-citizens. For former undocumented non-citizens, they must provide (a) proof of current non-citizen 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.
Tax records or medical records spanning the period of time in question.
Qualified non-citizens subject to the five year bar and lawfully present non-pregnant adults age 21 and over 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 non-citizens subject to the five year bar and lawfully present non-pregnant adult age 21 and over may only receive federally funded MA to cover an emergency medical condition.
A qualified non-citizen subject to the five year bar or lawfully present non-pregnant adult age 21 and over determined eligible for ongoing GA-related MA must 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.
The following qualified non-citizens 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:
Lawfully present children under age 21.
Lawfully present pregnant women, through the 60-day postpartum period.
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.
Through Section 214 of the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA), Public Law 111-3, “lawfully present” immigrant children under the age of 21 and pregnant women in the United States will be provided federally-funded MA if they meet all other non-financial and financial criteria.
As covered in Section 322.312 Qualified Non-Citizens Exempt from the Five Year Bar, qualified non-citizen children under age 21 and pregnant women through the postpartum period are exempt from the five-year bar. However, Section 214 of CHIPRA also permits states to cover other children and pregnant women considered to be “lawfully present”, which includes both qualified non-citizens (Citizenship Code 02) and certain temporary non-citizens (Citizenship Code 03), in the U.S. and who are otherwise eligible for MA. For these children and pregnant women, “lawfully present” is broader than the term “qualified non-citizen.”
“Lawfully present” guidance issued by the Centers for Medicare and Medicaid Services (CMS) relies on existing immigration regulations for the purpose of defining lawful presence and existing MA requirements to establish residency. A child under age 21 or pregnant woman shall be considered “lawfully present” if he or she is:
A qualified non-citizen as defined in Section 431 of PRWORA (8 U.S.C. § 1641), see Section 322.31 Qualified Non-Citizens for a list of qualified non-citizens.
A non-citizen in nonimmigrant status who has not violated the terms of the status under which he or she was admitted or to which he or she has changed after admission.
A non-citizen who has been paroled into the U.S. pursuant to Section 212(d)(5) of the Immigration and Nationality Act (INA) (8 U.S.C. § 1182(d)(5)) for less than one year, except for a non-citizen paroled for prosecution, for deferred inspection or pending removal proceedings.
A non-citizen who belongs to one of the following classes:
Is currently in temporary resident status pursuant to Section 210 or 245A of the INA (8 U.S.C. §§ 1160 or 1255a, respectively.
Is currently under Temporary Protected Status (TPS) pursuant to Section 244 of the INA (8 U.S.C. § 1254a), and pending applicants for TPS who have been granted employment authorization.
Has been granted employment authorization under Section 8 CFR 274a.12(c)(9),(10),(16),(18),(20),(22), or (24).
Is a family Unity beneficiary pursuant to Section 301 of Public Law 101-649, as amended.
Is currently under Deferred Enforced Departure pursuant to a decision made by the President.
Is currently in deferred action status.
NOTE: Individuals with deferred action under Deferred Action for Childhood Arrivals (DACA) are not considered “lawfully present” individuals for MA benefits and should be coded as Citizenship Code 05. These individuals may be reviewed for federally-funded MA under Emergency MA.
Whose visa petition has been approved and who has a pending application for adjustment of status.
A pending applicant for asylum under Section 208(a) of the INA (8 U.S.C. 1158) or for withholding of removal under Section 241(b)(3) of the INA (8 U.S.C. 1231 or under the Convention against Torture who has been granted employment authorization, and such an applicant under the age of 14 who has had an application pending for at least 180 days.
A non-citizen who has been granted withholding of removal under the Convention Against Torture.
A child who has a pending application for Special Immigrant Juvenile status as described in Section 101(a)(27)(J) of the INA (8 U.S.C. § 1101(a)(27)(J).
A non-citizen who is lawfully present in the Commonwealth of Northern Mariana Islands under 48 U.S.C. § 1806(e).
A non-citizen who is lawfully present in American Samoa under the immigration laws of American Samoa.
A temporary non-citizen (Citizenship Code 03) child who reaches age 21 or pregnant woman whose postpartum period has expired is no longer eligible for federally-funded MA. These individuals should be reviewed for GA-related MA.
NOTE: If there is medical documentation that supports a medical emergency, the individual may be eligible for federally-funded MA under Emergency MA. See Section 322.34 Emergency Medical Services for more information.
The following non-citizens are eligible for MA, but only for emergency medical services, if they meet all other requirements:
Qualified non-citizens subject to the five year bar and lawfully present non-pregnant adults age 21 and over 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 non-citizens 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 non-citizen 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 non-citizens, 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 non-citizens 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 non-citizens to the USCIS.
Qualified non-citizens, subject to the five year bar, lawfully present non-pregnant adults age 21 and over, and undocumented non-citizens may receive federally-funded MA to cover an emergency medical condition if the non-citizen meets the income, resources and category requirements of the MA program.
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: Qualified non-citizens subject to the five year bar, lawfully present non-pregnant adults age and over and undocumented non-citizens 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 non-citizen 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.
A non-citizen who needs emergency medical services must meet all other eligibility rules.
Exception: The non-citizen is not required to:
Attest to satisfactory immigration status on the application for benefits.
Verify his or her non-citizen status.
Verify his or her Social Security number.
NOTE: 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.
NOTE: For emergency medical services involving ongoing treatment (such as dialysis, approved 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. If the individual is applying for payment of Long Term Care (LTC) services, the medical condition must be reviewed by the Bureau of Policy prior to authorization of MA. LTC services include both Home and Community-Based Services and LTC facility services.
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: For any non-citizen mother who received full MA or emergency MA and gives birth with labor and delivery covered by MA, her newborn 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.
Proof of non-citizen status is required for an applicant unless he or she is requesting MA for an emergency medical condition only. The status of a non-citizen is established when the individual provides their immigration document type and immigration document number and the status can be verified electronically or the individual provides a current non-citizen registration card or other documentation from the USCIS showing the individual has satisfactory immigration status. See Appendix A.
For individuals who declare to have a satisfactory immigration status and provide their immigration document type and the immigration document number when applying for MA, the CAO must attempt to verify immigration status electronically first.
NOTE: Satisfactory immigration status means an immigration status that makes the individual eligible for the applicable MA category.
The CAO will use the Verify Lawful Presence (VLP) service to confirm satisfactory immigration status with the Department of Homeland Security. The CAO will initiate the verification process with the Department of Homeland Security by taking the following steps in Case Processing (CP):
1. Enter the proper citizenship code on the Demographics screen.
Note: The Alien/Refugee screen will be scheduled if anything other than a U.S. citizen is entered.
2. Complete all relevant fields in the INS section on the Alien/Refugee screen.
3. Leave the Verification Code field blank and click “Next” to place a call to the Department of Homeland Security to verify the information entered.
a. If the service approves the information entered, the CAO is taken to the following screen to continue with the workflow. The Verification Code field on the Alien/Refugee screen will be populated with “V - Electronic Verification.”
b. If the information entered could not be verified, the Alien/Refugee screen will be refreshed and the CAO will be given the notification that “The Individual Could Not Be Verified as Legally Present.”
If the VLP service returns inconsistent results or the individual declares to have a satisfactory immigration status and does not provide their immigration document type and immigration document number:
The CAO will frontload the application in CP and request immigration status verification from the individual on the PA 253.
If the individual provides the required documentation, the CAO will use the VLP service to confirm satisfactory immigrations status with the Department of Homeland Security. If electronic verification fails, the CAO must follow the SAVE procedures:
To verify a non-citizen’s status through SAVE, the CAO must complete a Document Verification Request (USCIS Form G-845). To complete the form:
1. Get the alien registration number from the non-citizen’s documentation.
2. Fill out the top portion of the form, and attach copies of the non-citizen’s documentation (front and back) to the form.
3. Retain copies of the non-citizen’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.
For more information, see Supplemental Handbook Chapter 740, SAVE Procedures.
NOTE: If the only document provided by the non-citizen is a letter from the USCIS, the CAO must confirm the alien’s status by contacting the USCIS.
If the CAO is able to confirm the individual’s satisfactory immigration status through the VLP or SAVE procedure, the CAO will update the Demographics screen with the appropriate verification code, before processing the application.
If the CAO is unable to confirm the individual’s satisfactory immigration status through both VLP and SAVE procedures, the CAO will process the individual’s application if all other conditions for MA eligibility are met and if otherwise eligible for MA. The CAO will enter “P - Verification Pending” in the Immigration Status verification field on the Demographics screen.
If the individual fails to provide the required documentation, the CAO will process the individual’s application if all other conditions for MA eligibility are met and if otherwise eligible for MA. The CAO will enter “P - Verification Pending” in the Immigration Status verification field on the Demographics screen.
Once the CAO opens MA for the individual, the CAO will request verification of the immigration status in writing if the individual did not provide the documentation or the CAO was unable to verify immigration status electronically. The request must allow a reasonable opportunity period of 90 days for the individual to provide immigration status verification.
The CAO will allow five days for mailing the request and set an alert for 95 days from the day the request is mailed.
If the individual fails to provide immigration status verification and the inconsistency is not resolved by the end of 90-day period, the CAO will close MA for that individual with a 15-day advance notice. The CAO must close MA within 30 days from the date the 90-day reasonable opportunity period ends, if the individual has not made a good faith effort to provide necessary documentation. If the individual is making a good faith effort to provide necessary documentation and there is a reasonable expectation that verification is pending from a third party or the CAO needs additional time to complete the verification process, the CAO may extend the reasonable opportunity period beyond 90 days.
NOTE: Verification is not required for emergency MA requests.
NOTE: If a lawful non-citizen's status is confirmed, the CAO will not have to re-confirm the status unless the individual states that his or her status has changed.
Updated November 8, 2017, Replacing July 8, 2016