322.3 Non-Citizen Status

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. 

 

 

 

 

 

 

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.

   

322.31 Qualified Non-Citizens

The following is a list of qualified non-citizens:

 

 

 

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.

 

 

 

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.

 

 

 

 

 

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).

 

 

 

 

 

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.

 

 

 

 

 

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.    

 

 

 

 

  

322.311 The Five Year Bar

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:

 

 

 

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:

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.

   Public Law 104-193 Sec 403(a)

 

322.312 Qualified Non-Citizens Exempt from the Five Year Bar

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:   

   Public Law 104-193 Sec 403(b)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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.

 

322.32  Lawfully Present Children Under age 21 and Pregnant Women

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.

Public Law 111-3 sec 214

 

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:

 

 

 

 

 

 

 

 

 

 

 

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. 

 

 

 

 

 

 

 

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.

 

322.33 Non-Citizens Who Can Get Emergency MA Benefits

The following non-citizens are eligible for MA, but only for emergency medical services, if they meet all other requirements:         

   55 Pa. Code § 150.11

 

 

 

 

NOTE:  A lawful temporary non-citizen may present USCIS documents, including, but not limited to, the following forms:

 

 

 

 

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.

 

322.34 Emergency Medical Services

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, otherwise known as Emergency Medical Assistance (EMA).

 

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 (EMC) is a medical condition with acute symptoms of such severity including severe pain, that without immediate attention, the result may be:

 

 

An emergency medical condition includes labor and delivery services (without postpartum coverage). 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.

55 Pa. Code § 150.11(d)

 

The written statement must:

 

 

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:     

55 Pa. Code § 150.11(c)     

 

NOTE:  The CAO must authorize MA 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. If the duration of the emergency medical condition is less than two months the MA should be processed as a noncontinuous eligibility (NCE) span. If the duration of the emergency medical condition is greater than two months the MA should be processed as an ongoing eligibility span.          

55 Pa. Code § 150.11(e)

 

For labor and delivery services only, 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.

 

55 Pa. Code § 150.11(b)

 

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 Alien/Refugee screen in eCIS.

322.35 Proof of Non-Citizen Status

PMA 18486-322, Systematic Alien Verification for Entitlements (SAVE) – Upload and Attach Secondary Verification, May 16, 2017

 

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.      

  55 Pa. Code § 150.31

 

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:

 

 

 

 

 

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.

 

 

 

 

 

 

 

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.

42 CFR § 435.407(k)

 

Updated September 19, 2023,  Replacing October 5, 2018