Medicaid for Legal Permanent Residents

Some people who apply for a green card (lawful permanent residence) or visa to enter the U.S. must pass a «public charge» test — which examines whether the person is likely to use certain government services in the future. In making this decision, immigration officers consider factors such as age, income, health, education or ability, family status, and their sponsor`s affidavit of support or contract. You can also determine whether a person has been primarily dependent on certain benefits in the past. If immigration officials determine that a person is likely to become a public burden in the future, they may deny that person permission to enter the United States or deny their application for a green card or lawful permanent resident status. In addition, California, Illinois, Massachusetts, New York, Oregon, Washington and the District of Columbia have expanded their Medicaid programs to provide insurance to all income-eligible children, regardless of immigration status. These programs include services such as regular checkups, vaccinations, doctor visits to sick children, prescriptions, vision and dental care, hospitalization, mental health and addictions. There are few options available for unauthorized immigrants (also known as undocumented or illegal immigrants), usually limited to emergency services, charities, or community health centers. Some states are also taking steps to expand fully government-funded coverage to adult immigrants. California Gov. Gavin Newsom`s proposed 2022-2023 budget would not provide fully state-funded Medicaid coverage to all income adults ages 26 to 49, regardless of immigration status, until Jan. 1, 2024, at the earliest.

The state previously extended state-funded Medicaid coverage to young adults ages 19 to 26, regardless of immigration status, and adults 50 and older will be eligible on May 1, 2022. In December 2020, Illinois extended state-funded coverage to low-income individuals 65 and older who were ineligible due to their immigration status. Starting in May 2022, coverage will also be extended to low-income immigrants aged 55 to 64, regardless of immigration status, and the bill would extend this coverage to all adults aged 19 and older. In Oregon, the Cover All People Act will extend publicly funded coverage to all low-income adults who do not qualify because of their immigration status, effective July 1, 2022, subject to available funds. Prior to this latest state activity, only the locally funded District of Columbia Healthcare Alliance program, launched in 1999, offered health insurance to low-income residents, regardless of immigration status. States may also provide government-funded bounty subsidies to immigrants who, because of their immigration status, are not eligible for federal subsidies in the marketplace. In Colorado, starting in 2023, state residents with FPL incomes of up to 300% who are not eligible for health insurance under the Affordable Care Act or other public programs because of their immigration status will be eligible for state-funded premium subsidies to help them purchase individual coverage. Since 1996, Medicaid has generally been limited to citizens and «skilled immigrants» without an emergency. This limited eligibility standard covers legal permanent residents, also known as green card holders, and humanitarian forms such as asylum seekers and refugees, victims of domestic violence, and victims of human trafficking. Skilled immigrants are subject to a five-year waiting period before receiving Medicaid coverage unless they have a status exempt from the waiting period, which is typically forms of humanitarian assistance. Since 2009, states can also choose to use federal funds to cover all legally present children and pregnant women without delay.

Learn more about immigrant eligibility for federal programs. To receive the full range of benefits offered under Medicaid, individuals must be U.S. citizens or qualified aliens. U.S. citizens are people born in certain U.S. territorial possessions. The term qualified foreign national was created by the Personal Responsibility and Reconciliation of Work Opportunities Act of 1996 (P.L. 104-193) and includes legal permanent residents, refugees and refugee claimants.

Lawful permanent residents who enter after August 22, 1996, are generally barred from receiving all Medicaid benefits for five years, after which coverage becomes a state option. However, children and pregnant women who are legally resident may be covered during the state`s five-year ban on choice. As of January 2017, 31 states had introduced the option for children and 23 for pregnant women (Brooks et al. 2017). Legal immigrants are non-citizens who legally reside in the United States. This group includes lawful permanent residents (LPRs, i.e. «green card» holders), refugees, refugee claimants, and others authorized to live in the United States temporarily or permanently. Persons who have been the subject of a deferred action have the right to reside in the United States and are therefore considered legally present. However, deferred action status for child arrivals does not have immigration status eligible for government-funded health insurance (see below). Unskilled foreigners (as well as qualified foreigners subject to a five-year ban on full benefits) who meet income and all other eligibility criteria for the program can only receive limited Medicaid emergency coverage. Unskilled aliens include unauthorized or illegal aliens, as well as students and other non-immigrants admitted on a temporary basis. Legally present immigrants may be eligible for Medicaid and CHIP, but are subject to certain admission restrictions.

In general, legally present immigrants must have «qualified» immigration status to qualify for Medicaid or CHIP, and many, including most lawful permanent residents or «green card» holders, must wait five years after obtaining qualified status before they can register. Some skilled status immigrants, such as refugees and asylum seekers, do not have to wait five years to register. Some immigrants, such as those with Temporary Protected Status, are legally present but do not have qualified status and are not eligible to enroll in Medicaid or CHIP, regardless of how long they stay in the country (Appendix A). For children and pregnant women, states can waive the five-year waiting period and extend coverage to legally present immigrants without skilled status. As of January 2022, 35 states had chosen this option for children and half had chosen it for pregnant people. This information is based on analysis of federal regulations and does not constitute legal advice.