In this Beyond the Basics webinar presented by the Center on Budget and Policy Priorities on September 24, 2021, in partnership with the National Immigration Law Center, Shelby Gonzales, Vice President for Immigration Policy, and Gabrielle Lessard, Senior Policy Attorney at the National Immigration Law Center, provide an overview of immigration status-related eligibility requirements for Medicaid, the Children’s Health Insurance Program, and for enrollment in marketplace plans.

↓ View Presentation Slides (PDF)

Jump to:

Eligibility for Marketplace Coverage Based on Immigration Status

• Immigration statuses eligible for marketplace coverage

Eligibility for Medicaid & CHIP Based on Immigration Status

• Immigration statuses eligible for Medicaid & CHIP
• 5-year bar in Medicaid & CHIP
• State residency for Marketplace, Medicaid, & CHIP
• Health coverage for people coming from Afghanistan

Other Important Eligibility Rules for Families that Include Immigrants

• Special premium tax credit rule
• Special marketplace rules for seniors
• Examples

Options for People Ineligible for Insurance Affordability Programs Due to Immigration Status

• Medicaid payment for emergency services
• People who are undocumented or have DACA status
• Programs that don’t restrict eligibility based on status
• Health services related to COVID-19

Public Charge Update

Navigating the Application Process

• How the marketplace verifies citizenship
• Documents that can be used to prove citizenship
• How the marketplace verifies immigration status
• Documents that can be used to prove immigration status

Additional Resources

Reference Guide to Immigration Documents

Key Facts: Immigrant Eligibility for Health Coverage Programs

Key Facts: Helping Families That Include Immigrants Apply for Health Coverage

August 2021

The Center for Medicaid and CHIP Services (CMCS) released an Informational Bulletin informing states that the Trump Administration’s Public Charge Rule has been vacated and is no longer in effect. Effective March 9, 2021, the U.S. Department of Homeland Security (DHS) is applying the longstanding policy known as the 1999 Interim Field Guidance. Under this policy, participation in Medicaid (with the exception of Medicaid payment for long-term care in an institution such as a nursing home), the Children’s Health Insurance Program (CHIP), and the Affordable Care Act (ACA) marketplaces are not negatively factored into public charge assessments that people undergo when they are applying for an immigration status. 

The Trump Administration’s Public Charge rule resulted in fear, and many people decided to go without benefits they were eligible for because of concerns that participation in public benefits would result in negative immigration-related consequences for themselves or a family member.

Substantial effort will be needed to raise awareness about the change in policy and to reduce fear so people feel safe in accessing benefits. Enrollment assisters can play an important role in raising awareness that participation in Medicaid (with the exception of long-term institutionalized care), CHIP, and the ACA’s premium tax credits and cost-sharing reductions are not negatively factored into public charge assessments. For more information regarding the application of public charge, please see resources published by the Protecting Immigrant Families campaign.

The bulletin also reminds states of their obligation to safeguard applicant and beneficiary information. Under federal law, states may not share information with DHS about an applicant or beneficiary’s coverage under Medicaid or CHIP for the purposes of a public charge assessment. Additionally, states generally may not provide information to DHS regarding medical assistance furnished to beneficiaries who are institutionalized.

Additional Resources

Immigrant Eligibility for Health Insurance Affordability Programs | View Resource

Helping Families That Include Immigrants Apply for Health Coverage | View Resource

In this Health Reform: Beyond the Basics webinar presented by the Center on Budget and Policy Priorities on September 24, 2020, in partnership with the National Immigration Law Center, Shelby Gonzales, Director of Immigration Policy, and Gabrielle Lessard, Senior Policy Attorney at the National Immigration Law Center, provide an overview of immigration status-related eligibility requirements for Medicaid, the Children’s Health Insurance Program and for enrollment in marketplace plans.

↓ View Presentation Slides (PDF)

Jump to:

Eligibility for Marketplace Coverage Based on Immigration Status

• Lawfully present standard

Eligibility for Medicaid and CHIP Based on Immigration Status

• Qualified immigrant eligibility standard
• Medicaid payment for emergency services
• Examples

Other Important Eligibility Rules for Families that Include Immigrants

• Special premium tax credit rule
• Examples
• Special marketplace rules for seniors
• State residency requirement

Options for People Ineligible for Insurance Affordability Programs

• Options for people who are undocumented or have DACA
• Health programs available to all
• COVID-19 health services

Navigating the Application Process

• Eligibility verification and data-matching
• Tips for preventing and resolving data-matching issues
• Document types and examples
• Marketplace options for lawfully present people with low income

Additional Resources

Reference Guide to Immigration Documents

Webinar: Subsidy Eligibility for Immigrants Ineligible for Medicaid Due to Status

Key Facts: Immigrant Eligibility for Health Coverage Programs

Key Facts: Helping Families That Include Immigrants Apply for Health Coverage

In this Health Reform: Beyond the Basics webinar presented by the Center on Budget and Policy Priorities on October 22, 2019, in partnership with the National Immigration Law Center, Shelby Gonzales, Director of Immigration Policy, and Gabrielle Lessard, Senior Policy Attorney at the National Immigration Law Center, provide an overview of immigration status-related eligibility requirements for Medicaid, the Children’s Health Insurance Program and for enrollment in marketplace plans.

↓ View Presentation Slides (PDF)

Watch the Webinar

Additional Resources

Reference Guide: Documents Used to Verify Immigration Status

OE7 Webinar: Preventing & Resolving Data-Matching Issues

Beyond the Basics Webinar Series | View all webinars

Key Facts About Health Reform | View all key facts

Tools and Resources | View all tools and resources

Frequently Asked Questions | View FAQs

In this special Health Reform: Beyond the Basics webinar presented in partnership with the National Immigration Law Center (NILC) on September 23, 2018, Shelby Gonzales, Senior Policy Analyst at the Center on Budget and Policy Priorities, and Sonya Schwartz, Senior Policy Attorney at NILC,  provide an overview of eligibility for the premium tax credit and Medicaid based on immigration status, touch on understanding and addressing concerns immigrants may have when applying for health programs, and provide tips on how to navigate the application process for families that include immigrants.

Presentation Slides

↓ View presentation slides (PDF)

Watch the Webinar

Overview of What’s Covered

Eligibility for Medicaid and CHIP Based on Immigration Status

Jump to video section, View slides  

• Eligible immigration statuses for Medicaid and the Children’s Health Insurance Program (CHIP)
• 5-year waiting period
• State flexibility

Eligibility for Marketplace Coverage Based on Immigration Status

Jump to video section, View slides  

• Eligible immigration statuses for Marketplace coverage
• Example: Eligibility based on immigration status

Special Marketplace and PTC Eligibility

Jump to video section, View slides  

• Special Marketplace rules for seniors
• PTC for certain lawfully present people with low income
• Special rule for married nonresidents

Understanding & Addressing Concerns Immigrants May Have When Applying for Health Programs

Jump to video section, View slides  

• Concerns related to use of public benefits and proposed “public charge” rule
• Addressing concerns related to privacy
• Nonapplicants’ protections related to immigration status
• Requests for Social Security Numbers (applicants vs. nonapplicants)
• Tips for talking about immigration status

Navigating the Application Process

Jump to video section, View slides  

• Eligibility verification for citizenship and immigration status | Webinar: Preventing & Resolving Data-Matching Issues
• Documents to prove immigration status
• Documents to prove citizenship
• Processes for resolving DMIs for certain lawfully present people with low income | Explainer: Subsidy Eligibility for Immigrants Ineligible for Medicaid Due to Status

Q&A

Additional Resources

Resources | View resources links

National Immigration Law Center | Find out more

• Tips for Addressing Immigrant Families’ Concerns When Applying for Health Coverage Programs

Reference Guide: Document Used to Verify Immigration Status | Reference Guide

Webinar OE6: Preventing and Resolving DMIs | Webinar

Explainer: Subsidy Eligibility for Immigrants Ineligible for Medicaid Due to Status | Explainer Video

Key Facts:

• Immigrant Eligibility for Health Coverage Programs
• Helping Families that Include Immigrants Apply for Health Coverage

Beyond the Basics Webinar Series | View all webinars

Key Facts About Health Reform | View all key facts

Tools and Resources | View all tools and resources

Frequently Asked Questions | View FAQs

In this explainer video, Shelby Gonzales, Senior Policy Analyst, provides a detailed explanation of how to assist lawfully present individuals who are not eligible for Medicaid due to their immigration status and may be eligible for premium tax credits even if their income is below the poverty line.

Presentation Slides

↓ View presentation slides (PDF)

Watch the Webinar

Overview: Special Subsidy Eligibility

Jump to video section, View slides

• Marketplace subsidy eligibility for lawfully present individuals who do not qualify for Medicaid based on immigration status
• Extra steps to get to correct eligibility determination

Medicaid Eligibility Based on Status

Jump to video section, View slides

• Statuses eligible for Medicaid
• Five-year bar
• State flexibility

Eligibility for Marketplace Enrollment

Jump to video section, View slides

• Statuses considered lawfully present for the purposes of Marketplace enrollment

Example: Application incorrectly determines individual eligible for Medicaid

Jump to video section, View slides

• Step 1: Identify Medicaid eligibility based on status
• Step 2: Identify eligibility for Marketplace enrollment
• Step 3: Help consumer complete the application
• Step 4: Help complete extra steps to get correct eligibility

Example: Application incorrectly determines individual not eligible for Medicaid or premium tax credits

Jump to video section, View slides

• Step 1 and 2: Identifying eligibility for Medicaid and Marketplace enrollment
• Step 3: Help consumer complete the application
• Step 4: Help complete extra steps to get correct eligibility

Tips and Notes

Jump to video section, View slides

• Tips to prevent extra work for eligible individuals
• In states with more restrictive Medicaid eligibility

Additional Resources

Webinar: Immigrant Eligibility for Health Coverage Programs | View webinar

NILC | Tips for Addressing Immigrant Families’ Concerns When Applying for Health Coverage Programs | View resource

Reference Guide: Documents Used to Verify Immigration Status | View resource

Key Facts: Immigrant Eligibility for Health Insurance Affordability Programs | View key facts

Key Facts: Application Process for Families that Include Immigrants | View key facts

Beyond the Basics Webinar Series | View all webinars

Key Facts About Health Reform | View all key facts

Verifying Immigration Status in Healthcare.gov

November 2017

Many non-citizens in the United States are eligible for health coverage through Medicaid, the Children’s Health Insurance Program (CHIP), or subsidized plans in the Affordable Care Act (ACA) Marketplaces. In Healthcare.gov, non-citizens applying for coverage for themselves are asked to select from a drop down list of immigration document types and to provide specific numbers from their documents to prove their immigration status. This information is used by Healthcare.gov to verify applicants meet the immigration status requirement for enrollment. Those not applying for coverage are not asked to provide information about their status.

This reference guide walks through examples of the different immigration document types that can be used in Healthcare. gov and notes where different document numbers are located.

↓ View reference guide (PDF)

Note: This list is not a comprehensive list of all documents eligible immigrants may have and does not address what should be done if someone does not have one of the documents on the Healthcare.gov list. For more information on statuses that are considered an “eligible immigration status” for ACA Marketplaces, Medicaid and CHIP, see our Webinar: Immigrant Eligibility for Health Coverage Programs.

Developed as part of the Consumer Assistance Coordination Hub (CACH), the National Immigration Law Center developed a resource for assisters: Tips for Addressing Immigrant Families’ Concerns When Applying for Health Coverage Programs.

This resource includes suggestions on how to address concerns when talking to families, information on protections for household members not applying for coverage, and lists additional resources.

↓ View Tips for Addressing Immigrant Families’ Concerns When Applying for Health Coverage Programs

Families that include immigrants may experience barriers when applying for health coverage.  The following questions and answers explains issues that families may face and provides information about key concerns families with immigrants may have when completing the application process.  (For more information on immigrant eligibility, please see Key Facts You Need to Know About: Immigrant Eligibility for Health Insurance Affordability Programs.)

↓ Download PDF

PART I: Eligibility policies affecting immigrants in Medicaid, the Children’s Health Insurance Program (CHIP), and the federal and state marketplaces.

Will enrolling in insurance affordability programs have an impact on immigrants when they apply to change their immigration status?

No. When individuals apply for legal permanent resident status, immigration authorities determine whether someone is likely to become dependent on the government for subsistence, commonly referred to as a “public charge.”  This evaluation does not take into account whether someone applied for or received Medicaid, CHIP, or subsidized coverage in the marketplaces.  Thus, applying for or receiving these benefits does not have a negative impact on immigrants when they apply to change their status.  There is an exception:  people receiving long-term institutional care through Medicaid may be considered dependent on the government.

Can people apply for health coverage for other household members even if they are not applying for coverage for themselves (or are ineligible)?

Yes, households of people applying for insurance affordability programs can include both applicants and non-applicants.  During the application process, the person completing the application will state who is in the household and which household members are applying for coverage.  Non-applicants must include information such as their income and plans for tax filing, but they are not required to provide information about their immigration or citizenship status.

Is having a Social Security number (SSN) an eligibility requirement for insurance affordability programs?

For Medicaid and CHIP, individuals seeking coverage for themselves are generally required to provide their SSNs if they are eligible for one (unless they have a religious objection to getting an SSN).  If they are eligible for but do not have an SSN, they must apply for one and the Medicaid or CHIP agency must offer to help them apply.  They cannot be denied coverage while their application for an SSN is being processed.

Individuals seeking to enroll in a marketplace plan for themselves must provide an SSN if they have one.

Is an SSN required if an individual is applying for premium tax credits for a family member and not himself?

Individuals applying for premium tax credits for their dependents or spouse and not for themselves only need to provide their SSN if: (1) they have an SSN, and (2) they filed a tax return for the year for which tax data would be used to verify their household income and family size.  (Eligibility for the 2016 coverage year uses information from the 2014 tax return year to verify that information.)  Providing SSNs of non-applicants who have them is strongly encouraged.  The marketplaces use SSNs to conduct data matches with trusted data sources like the Social Security Administration (SSA) and the Internal Revenue Service (IRS).  When these matches can successfully verify key information like income, consumers may not have to submit proof of their circumstances.

Will a parent applying for Medicaid or CHIP coverage for his child but not for himself be required to provide an SSN?

Parents who apply for Medicaid or CHIP for their children do not have to provide an SSN.  If they have one and choose to provide it, this may help the Medicaid agency electronically verify income for the family, but it is not required.

Can a person who has an Individual Taxpayer Identification Number (ITIN) to file taxes use that number instead of an SSN on the application?

No.  ITINs are not the same as SSNs.  The application will verify SSNs with the Social Security Administration, which cannot verify ITINs.   Someone who uses an ITIN to file taxes is not required to provide an SSN on the application and should skip the question in the application.  (The application will make multiple requests for the SSN; each time the consumer should skip it.)

Can someone include a tax dependent that lives abroad in his application? 

Applicants must include information on all members of the household, including any tax dependents living abroad, for the purpose of determining the applicant’s household size and income.  Dependents living abroad will generally not be eligible to enroll in health insurance coverage.  The Healthcare.gov application asks for the address of all tax dependents but does not accept foreign addresses.  Consumers can put in the address of the tax filer in place of the address for tax dependents who live abroad.

Can information provided in the application be used for immigration civil enforcement purposes? 

No.  Medicaid, CHIP, and the marketplaces use the U.S. Citizenship and Immigration Services’ (USCIS) Systematic Alien Verification for Entitlements (SAVE) program to verify the citizenship or immigration status of people applying for coverage.  However, this data match is only for the purpose of confirming that applicants meet the immigration or citizenship status requirement to enroll in an insurance affordability program.  The USCIS has issued guidance that information about applicants or households obtained for health insurance eligibility will not be used for civil immigration enforcement purposes.

PART II: Applying for premium tax credits in the Federally-Facilitated Marketplace

Who needs to complete remote identity proofing (i.e. ID proofing) to submit an application on Healthcare.gov?

The Federally-Facilitated Marketplace (FFM) uses Healthcare.gov to process applications for and enroll eligible applicants in health coverage.  Healthcare.gov requires the person designated as the household contact in an application (who must be an adult) to successfully complete ID proofing to ensure that he is who he says he is before he can use the online process to apply for coverage, select health insurance plans, report changes, or renew coverage.

Why are some people not able to complete the ID proofing process on Healthcare.gov? 

Experian, the entity that verifies identity for Healthcare.gov, creates personalized questions that the household contact must answer to prove his identity in the application.  Experian often cannot generate a sufficient number of questions for household contacts with limited or no credit history.  Also, consumers have sometimes found questions generated by Experian difficult to answer.

What happens when ID proofing cannot be completed on Healthcare.gov?

When Healthcare.gov cannot complete ID proofing online, it gives household contacts a unique reference code and instructs them to call the Experian Help Desk to complete ID proofing over the phone.

What happens when ID proofing cannot be completed over the phone with Experian?

Household contacts who cannot complete ID proofing over the phone have to submit supporting documents to prove their identity if they wish to submit an application online.  They can upload electronic versions of the documents to their Healthcare.gov accounts, or can mail copies to:

Health Insurance Marketplace
465 Industrial Boulevard
London, KY 40750-0001

Table 1 lists the documents that can be used to verify identity.  When mailing copies, it is important to include the unique reference ID number provided during the online ID proofing process so the documents can be matched to the correct account.

What if consumers do not have any of the documents listed to complete Healthcare.gov’s ID proofing process?

Household contacts who do not have any of the documents needed to complete the ID proofing process will not be able to submit an application online on Healthcare.gov.  Instead, they may complete the application by mailing a completed paper application form or may apply over the phone by contacting the marketplace call center at 1-800-318-2596 (TTY: 1-855-889-4325).  They should ask to receive notices about their application by mail.  If they qualify for marketplace coverage, they will need to go through the marketplace call center to select and enroll in a plan.  To evaluate their health plan options before enrolling, applicants can use the “See plans” tool on Healthcare.gov.  Once enrolled, they will need to report any changes and complete the renewal process through the marketplace call center.

How does Healthcare.gov verify citizenship? 

In the FFM, when applicants attest to being U.S. citizens and provide an SSN, their information is checked against information in SSA’s records to verify citizenship.

SSA does not have citizenship records for some citizens, including many who were born outside the U.S.  If citizenship cannot be verified electronically through SSA, applicants are asked if they are a naturalized or derived citizen.  Some applicants who are naturalized or derived citizens can have their status verified instantly by providing numbers found in their Certificate of Citizenship or Certificate of Naturalization that will be matched with information in the SAVE program.

The SAVE program cannot immediately verify citizenship status of all derived and naturalized citizens.  When this occurs, applicants will have to upload proof of their citizenship to their Healthcare.gov accounts (see list of acceptable proof in Table 2).  Applicants can also mail document copies to:

Health Insurance Marketplace
465 Industrial Boulevard
London, KY 40750-0001

While their citizenship is being verified, applicants who otherwise meet all eligibility requirements can enroll in Medicaid, CHIP, or a marketplace plan during a “reasonable opportunity period” or “inconsistency period.”

How does Healthcare.gov verify immigration status? 

In the FFM, all non-citizens applying for coverage for themselves must attest to having an “eligible immigration status.”  They then must select a document type to use to prove their immigration status.  They will be asked to provide one or two numbers from their document; Healthcare.gov will use this information to attempt to immediately verify their immigration status through the SAVE program.

The SAVE program cannot immediately verify the status of all immigrants.  When this occurs, applicants will have to upload proof of their immigration status to their Healthcare.gov accounts (see list of acceptable proof in Table 3).  Applicants can also mail document copies to:

Health Insurance Marketplace
465 Industrial Boulevard
London, KY 40750-0001

While the applicant gathers and sends in documents and the agency receives and processes them, the applicant can enroll in Medicaid, CHIP, or a marketplace plan if he meets all other eligibility requirements during a “reasonable opportunity period” or “inconsistency period.”

Why are some lawfully present immigrants who are eligible for subsidies not able to immediately enroll in subsidized coverage?

Lawfully present immigrants who have income within the Medicaid eligibility range but are ineligible for Medicaid due to their immigration status can qualify for premium tax credits and cost-sharing reductions even if their income falls below the poverty line.  (Generally, consumers must have income between 100-400 percent of the poverty line to qualify for premium tax credits and cost sharing reductions.)  However, Healthcare.gov has system limitations that can result in an incorrect eligibility determination for some of these individuals.

If Healthcare.gov can instantly verify that a consumer is lawfully present but ineligible for Medicaid because of his immigration status, the applicant should receive the correct determination of eligibility for subsidies.

If Healthcare.gov cannot instantly verify that the consumer’s immigration status makes him ineligible for Medicaid, then the consumer will receive an incorrect eligibility determination for subsidies.  This is because Healthcare.gov will assume the consumer is eligible for Medicaid based on immigration status until the consumer provides proof of his immigration status, which shows he is ineligible for Medicaid. One of two erroneous determinations will occur:

• Healthcare.gov incorrectly assesses or determines he is eligible for Medicaid if the consumer otherwise appears to meet the income and other applicable requirements for Medicaid eligibility.
• Healthcare.gov incorrectly determines he is ineligible for marketplace subsidies and he is treated as if he were in the coverage gap.   This can occur in states that have not expanded Medicaid.  If the consumer does not meet the Medicaid income or other applicable requirement and his income is below the poverty line, Healthcare.gov assumes the consumer is in the coverage gap and does not send his case file to Medicaid.  These individuals are told they are only eligible to purchase a marketplace plan at full cost —without subsidies but that they may qualify for help paying for coverage but must turn in documents to prove their immigration status.

What steps need to be taken to get the correct determination for individuals incorrectly assessed or determined eligible for Medicaid? 

Consumers must be determined ineligible for Medicaid based on their immigration status before they can get the correct eligibility determination for marketplace subsidies.  When Healthcare.gov incorrectly assesses or determines individuals as eligible for Medicaid, it sends the individual’s case file to the state Medicaid agency.  The Medicaid agency will ask the consumer to provide proof of his immigration status.  After the consumer provides proof and is denied Medicaid based on his immigration status, he will be referred back to Healthcare.gov and instructed to update his application to indicate he has been denied eligibility for Medicaid based on immigration status.

After a consumer notes on the application that he has been denied Medicaid due to immigration status, he should receive a correct determination of eligibility for subsidies.

What steps need to be taken to get the correct determination for individuals incorrectly determined ineligible for subsidies and treated as if they were in the coverage gap? 

These consumers must also be determined ineligible for Medicaid based on their immigration status before they can get the correct eligibility determination for marketplace subsidies.  Their eligibility determination notice will say they are not eligible for subsidies and are eligible for an exemption from the requirement to have health insurance, and that they may qualify subsidies but they must submit documents to prove their immigration status to make that determination.  When the marketplace receives and processes the documents, eligible consumers are sent a corrected eligibility determination notice that includes information on eligibility for subsidies, access to a special enrollment period, and instructions to return to Healthcare.gov to select a plan.

Are there any alternative steps individuals can take to get the correct eligibility determination? 

In some cases consumers can get a Medicaid denial due to immigration status more quickly by applying for Medicaid directly through the state Medicaid agency. Once denied Medicaid eligibility based on immigration status by the state agency, consumers can return to Healthcare.gov and indicate they have been denied Medicaid due to immigration status.

View all key facts

Many individuals who are lawfully present in the United States are eligible for health coverage through Medicaid, the Children’s Health Insurance Program (CHIP), or subsidized plans in federal and state marketplaces.  All U.S. citizens are eligible for these coverage programs, but eligibility rules for non-U.S. citizens differ for each program.

↓ Download PDF

What are the immigration status requirements for Medicaid and CHIP?

Immigrant eligibility requirements for Medicaid and CHIP originate from the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996.  PRWORA created two categories of immigrants used in determining Medicaid eligibility: “qualified” and “not qualified” immigrants.  In general, immigrants must be in a qualified status to be eligible for Medicaid and CHIP.  However, even qualified immigrants may not be eligible because they have not met a five-year waiting period after they obtain qualified status.  Individuals who are not eligible for Medicaid because of their immigration status may be eligible for Medicaid payment of emergency services, and some may be eligible for marketplace coverage.  Additionally, states have the option to adopt broader eligibility rules for immigrant children and pregnant women.

Which categories of immigrants are “qualified” immigrants?

Categories of immigrants with qualified status include:

• Lawful Permanent Residents (LPRs, green card holders)
• Refugees
• Persons granted asylum
• Persons granted withholding of deportation/removal, or conditional entrants
• Cuban/Haitian entrants
• Individuals paroled into the United States, for a period of at least one year
• Certain domestic violence survivors and their children and/or parents
• Certain trafficking survivors and in some cases their spouses and children (for adult victims) and spouses, children, parents and minor siblings (for child victims).

All other immigrants are considered not qualified for purposes of Medicaid and CHIP eligibility.

Are qualified immigrants eligible for Medicaid or CHIP immediately upon obtaining a qualified status?

In general, qualified immigrants who entered the U.S. on or after August 22, 1996 must wait five years after obtaining a qualified status before becoming eligible for Medicaid or CHIP.  This is often referred to as the “five-year bar.” However, there are exceptions.  The following qualified immigrants do not have to meet the five-year waiting period requirement:

• Refugees
• Asylees
• Individuals granted withholding of deportation/removal
• Cuban/Haitian entrants
• Amerasian immigrants
• Trafficking survivors
• Iraqi or Afghan special immigrant status
• Veterans or individuals on active military duty and their spouse (un-remarried surviving spouse), or child
• Certain American Indians born abroad
• Individuals receiving Foster Care, and in most states, Supplemental Security Income recipients

It is important to note that a few states restrict eligibility for some qualified immigrant adults even after the five-year wait.^[1]

Can states have less restrictive eligibility requirements for immigrants?

Yes.  States have the option to provide Medicaid and CHIP coverage to “lawfully present” children and/or pregnant women.  The term lawfully present includes all qualified immigrants, as well as many other types of immigrants who have permission to live or work in the United States.  (See Table 1 for a full list of immigration statuses considered lawfully present for the purpose of enrollment in insurance affordability programs).

States can also use CHIP funding to provide prenatal care to women who are otherwise ineligible for Medicaid and/or CHIP under the CHIP unborn child option regardless of their immigration status.  In addition, some states use state or county funds to provide Medicaid and CHIP to other groups, such as lawfully present immigrants who do not have qualified status and to children who are undocumented.^[2]

What are the immigration requirements to enroll in a Marketplace plan?

Only lawfully present individuals can enroll in a marketplace plan.  (See Table 1 for a list of immigration statuses that are considered lawfully present for the purpose of marketplace eligibility).  In general people permitted under the law to be in the U.S. meet the requirement, but there are some exceptions.  An important exception is individuals granted deferred action under the Deferred Action for Childhood Arrivals (DACA) program.  The U.S. Department of Homeland Security can grant temporary administrative relief from deportation, which is referred to as deferred action, for a variety of reasons. While individuals granted deferred action are generally eligible to enroll in marketplace coverage, DACA recipients are excluded and not eligible to enroll in a marketplace plan.

What are the immigration requirements for premium tax credits and cost-sharing subsidies in the marketplace?

People who are lawfully present are eligible to purchase marketplace coverage.  Once these requirements are met, individuals who don’t have other minimal essential coverage may also qualify for premium tax credits and cost sharing reductions if they meet financial requirements.

In general, only individuals with incomes between 100 and 400 percent of the poverty line are eligible for premium tax credits.  However, an individual who is lawfully present and not eligible for Medicaid because of her immigration status can qualify for premium tax credits even if her income is below the poverty line (for example, a lawfully present immigrant who is not qualified or is qualified but in the five-year waiting period).  While Medicaid income eligibility differs in states that expand and those who do not, eligibility for premium tax credits for lawfully present immigrants with incomes below the poverty line is not affected by a state’s decision on Medicaid expansion (see Figure 1).

FIGURE 1: Coverage Landscape for Families That Include Immigrants

In States Expanding Medicaid

In States Not Expanding Medicaid

How are premium tax credits calculated for lawfully present people with incomes below the poverty line?

For the purposes of determining a person’s expected contribution to the cost of coverage, the portion of income he will contribute is the same as for individuals with incomes at 100 percent of the poverty line, which is 2.03 percent of income.^[3]  For example, if his income is $10,000, then his expected premium contribution is $203 per year (2.03 percent of $10,000).  His premium tax credit will be the cost of the second-lowest silver plan available to him minus his expected contribution.

Because he is treated as if his income is at 100 percent of the federal poverty line, he would qualify for a cost sharing reduction, which would raise the actuarial value of his plan to 94 percent.  He would need to purchase a silver plan to receive the cost-sharing reduction, which would significantly lower his deductible, copayments, and other out-of-pocket costs.  (For more information on premium tax credits and cost sharing reductions, please see Key Facts You Need to Know About: Premium Tax Credits and Key Facts You Need to Know About: Cost-Sharing Reductions.)

What options for coverage do undocumented individuals have?

Undocumented individuals and individuals excluded from insurance affordability program such as those in the DACA program are eligible for Medicaid payment for services in situations defined as emergencies in the Medicaid law, including labor and delivery.  They are not eligible to purchase health insurance through the marketplace, but they may obtain private coverage outside the marketplace with no government-sponsored subsidy.

There are no immigration status requirements for certain public health services including immunizations as well as services provided by Federally Qualified Health Centers, migrant and rural health centers, and hospital charity care.  In addition, some states provide coverage of prenatal services to women regardless of immigration status, and a few states and local governments extend health coverage to undocumented children and/or some non-citizen adults using state funds.

Undocumented individuals also can sign up for employer-sponsored insurance if their employer offers it.

^[1] For more information on how states restrict coverage, see footnotes 6 and 7 on the National Immigration Law Center document, “Overview of Immigrant Eligibility for Federal Programs, available at: nilc.org/document.html?id=108.
^[2] Center for Medicaid and State Operations, State Health Official Letter #09-006, May 8, 2009: www.medicaid.gov/Federal-Policy-Guidance/downloads/SHO050809.PDF.
^[3] This percentage is indexed and will change each enrollment year.

View all key facts