Family and Children's Medicaid MA-3330 CITIZEN/ALIEN REQUIREMENTS

IV. QUALIFIED ALIENS

A. Introduction

Individuals who live in the U.S. but are not citizens are aliens. For Medicaid purposes, certain aliens are referred to as "qualified aliens." Qualified aliens include: Lawful Permanent Residents (LPR), Asylees, Refugees, Cuban/Haitian entrants, persons paroled into the US for at least one year, persons granted withholding of removal/deportation, persons granted conditional entry (prior to April, 1990), certain victims of domestic violence, and victims of severe human trafficking.

Qualified aliens are potentially eligible for full Medicaid just like U.S. citizens. Some qualified aliens are banned from receiving assistance until 5 years from the date they became a qualified alien. (See B. below.) Other qualified aliens are exempt from this disqualification period. (See. C. below for who is exempt.)

An alien who is not a qualified alien is a "non-qualified alien." See XII for information on non-qualified aliens. Medicaid eligibility and level of coverage for an alien is based on whether the alien entered the U.S. before August 22, 1996, the number of years since he obtained qualified alien status, and his immigration status. The Deficit Reduction Act of 2005 (P.L. 109-171) did not change the requirements for qualified and non-qualified aliens.

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B. 5 Year Mandatory Disqualification Period (Five-Year Bar)

There is a 5-year mandatory disqualification period for certain qualified aliens if admitted on or after August 22, 1996. If the 5-year disqualification period applies, evaluate for emergency medical services only. The 5-year disqualification period does not apply to aliens applying only for emergency Medicaid. After the 5-year disqualification period expires, these qualified aliens are potentially eligible for full Medicaid just like U.S. citizens. Refugees and asylees are exempt from the 5-year mandatory disqualification period and may receive full Medicaid if otherwise eligible.

If an applicant is not a U.S. citizen, he may only receive full Medicaid if he is a qualified alien or exempt from the 5-year bar. (See Figure 2 for who is subject to the 5-year bar and who is eligible for full Medicaid.)

The Centers for Medicare and Medicaid Service (CMS) lists the following as exempt from the 5 year bar: refugees, asylees, Cuban and Haitian entrants, Amerasian immigrants, persons granted withholding of deportation, victims of trafficking, veterans and active duty military personnel and their spouses and children, as well as certain Native Americans.

The five-year bar does not apply to emergency Medicaid services.

NOTE: If the five-year bar applies, the clock begins to run on the date that the person obtained qualified status; however, if the person entered the country prior to August 22, 1996, and remained continually present until they secured qualified immigrant status, the five-year bar does not apply. The person is eligible as soon as they obtained qualified immigrant status.

This rule applies equally to persons who were in the country without documents prior to August 22, 1996. Presence will likely be difficult to establish, but, can be verified through various forms of documentation including utility bills.

C. Eligibility Status

Refer to Figure 2 to determine the alien and eligibility status of an individual and whether he is eligible for Medicaid.

D. Lawful Permanent Resident (LPR)

An LPR is an alien who is legally admitted to the U.S. by the USCIS to live and work on a permanent basis. The majority of qualified aliens are LPRs. He is often referred to as a “resident alien.” USCIS issues each LPR an I-551. This is known as a “green card,” even though it is not green. Aliens recently admitted to the U.S. as a LPR, or who have applied for a replacement I-551 may only have the I-94 with a temporary I-551 stamp. Other documents issued by USCIS for “resident aliens,” include the I-155 or I-94 stamped with AM-1, AM-2, AM-3, AM-6, AM-7, and AM-8.

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Refer to F. for documentation of LPR status.

LPRs are potentially eligible for full Medicaid. Refer to Figure 2 to determine if the 5-year mandatory disqualification period applies.

Refugees can adjust their status to LPR. If he claims he was originally admitted as a political admission, he remains potentially eligible for Medicaid based on his original status when admitted. This is verified when the I-551 indicates a code of RE-6, RE-7, RE-8, or RE-9.

Example: An individual is admitted as refugee in January 1997. He adjusts his status to LPR in 1998. Regardless, he remains potentially eligible for full Medicaid based on being admitted as a refugee/asylee.

E. Exempt Aliens Who Adjust Status to LPR

Aliens who entered the U.S. in a status exempt from the 5-year bar remain exempt after they adjust to LPR status. These include: refugees, asylees, Cuban and Haitian entrants, Amerasian immigrants, persons granted withholding of deportation, victims of trafficking, veterans and active duty military personnel and their spouses and children, as well as certain Native Americans. They remain potentially eligible for full Medicaid without the 5-year bar.

Aliens can be legally admitted to the U.S. by the USCIS for many different reasons. For example, an individual may be admitted to the U.S. because he is fleeing persecution in his own country, or USCIS determines it is in the public interest for him to be admitted.

Example: An individual is admitted as refugee in January 1997. He adjusts his status to LPR in 1998. Regardless, he remains potentially eligible for full Medicaid based on being admitted as a refugee/asylee.

F. Procedures to Verify and Document Qualified Alien Status

Below are the procedures for verifying and documenting qualified alien status for applicants requesting medical assistance (applicants/recipients) except trafficking victims and battered aliens. (See VII. and VIII. below for these procedures.)

1. Verify the alien’s current status.

a. Request the alien's original USCIS documents (not copies) for current status. Verification of citizenship/alien status is required only for applicants for whom benefits are being requested.

b. Use documents listed in Figure 2 to verify the alien’s status. If the alien does not have one of these documents, he cannot be considered a qualified alien for Medicaid purposes.

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c. If an applicant presents an expired document or is unable to present any immigration documentation evidencing his alien status, refer the applicant to the local USCIS Office to obtain documentation of his immigration status. (See III.C. above for the address.)

d. Verify the authenticity of the alien document, and the date of admission using SAVE, Systematic Alien Verification for Entitlement Program. Follow procedures in EIS 1108, SAVE Verification Information System. NOTE: DO NOT use SAVE as verification for trafficking victims. Follow procedures in VII. to verify trafficking victims.

e. Under most circumstances, an automated check of SAVE records is the first step in the verification process. However, there are circumstances that require you to perform secondary verification immediately instead of checking SAVE. Refer to XIV. for a list of these circumstances.

While you are waiting on a response from the secondary verification, treat the

applicant as a non-qualified alien and process for emergency medical services only. Proceed to XII.

f. Document his current alien status on the application/ redetermination form. Attach a copy of the USCIS documentation to the a/r’s permanent record and return original document(s) to the a/r. Explain that when the person signs the form he certifies alien status for the applicant(s).

g. If the current documents verify he is a qualified alien as defined above, continue with these procedures.

2. Verify the date the alien entered the U.S.

A qualified alien who entered the U.S. before 8/22/96, and whose current alien status was granted after 8/22/96, may be able to provide a document (for example, a passport with an I-94 stamp) that shows that he was in an earlier status and the status was granted before 8/22/96. You must establish that he was continuously present in the U.S. until obtaining qualified alien status.

Potential sources of verification are tax returns, bills, rent receipts, or a letter from an employer. Any single absence from the U.S. of more than 30 days or a total of aggregate absences of more than 90 days should be considered to interrupt ‘continuous presence.’

NOTE: “Continuous presence” is measured between the alien’s last date of entry into the U.S. prior to 8/22/96 and the date qualified alien status is obtained. Therefore, if an alien entered the country on May 1, 1995, left on October 1, 1995, and returned on July 1, 1996, continuous presence is measured from July 1, 1996. The period between October 1, 1995, and July 1, 1996, is not counted as an absence.

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If the individual is unable to provide a document, accept a written statement from a sponsor, family member, or as a last resort, the alien as verification. The statement must include when the alien entered the U.S., prior alien status, and the date that status was granted.

3. Determine whether the 5-year disqualification period applies or whether the qualified alien is exempt from the disqualification period. See Figure 2.

4. Determine the appropriate citizenship/identity code 60-66 for refugee or alien status for immigrants. Refer to EIS 4000, Codes Appendix.

5. Reverify alien status when the alien status is subject to change.

Examples of when alien status is subject to change include:

a. An individual admitted under a temporary status may change to lawful permanent resident status.

b. An individual admitted under a temporary status that has expired may have updated his status.

c. A refugee may change his alien status to lawful permanent resident status.

d. An individual may meet the requirements as a battered alien or some other type of qualified alien status.

e. An illegal alien may change to a legal status.

Note: This is not an all-inclusive list. There may be other times when an individual’s alien status may change.

6. Reporting to USCIS

Individuals who apply for any Medicaid program or service are not subject to any USCIS reporting requirements and should not be reported to the USCIS.

Declining to provide documentation of alien status is not a valid reason for USCIS referral. The a/r who declines to present documentation of alien status or a SSN will only be able to receive emergency Medicaid, if otherwise eligible. Therefore, there is no reason to seek further verification of his alien status.

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7. Confidentiality of Alien Status

All rules of confidentiality must be applied in regard to alien status. It is a breach of confidentiality to discuss the alien status of an individual with employers, landlords, etc.