Citizenship and Alien Status Requirements for the Medicaid Program

Date:  October 26, 2004 

 

4 

Trans. No.  04 OMM/ADM-7 

 

Page No. 

 

III.  PROGRAM IMPLICATIONS

 

This ADM explains the categories of immigrant and nonimmigrant statuses 

that local district eligibility workers need to know and understand in 

order to determine which Medicaid eligibility coverage is available to 

the applicant.  Specific definitions of common immigration 

categories/terms and USCIS coding are essential tools that will aid the 

eligibility worker.  Clarification of the Welfare Management System 

(WMS)  

process for authorizing Medicaid benefits to non-citizen 

applicants is important for workers to understand so as to insure 

proper reimbursement of State and/or federal shares. 

 

Immigrants who are “qualified immigrants” (as defined in the definition 

section of this directive) and who are otherwise eligible, may receive 

full Medicaid benefits with Federal Financial Participation (FFP). In 

addition, otherwise eligible qualified immigrants who entered the 

United States on or after August 22, 1996 and who, prior to Aliessa, 

were eligible for Medicaid only after five years, can be eligible for 

full Medicaid benefits with State and local funds.  In addition, 

otherwise eligible immigrants who are PRUCOL can be eligible for full 

Medicaid benefits with State and local funds.  Temporary nonimmigrants 

and undocumented immigrants are not PRUCOL and continue to be limited 

to Medicaid coverage for care and services necessary for the treatment 

of an emergency medical condition. 

 

Two groups of immigrants, given special exemption under SSL Section 

122(1)(c), will continue to receive full Medicaid benefits with State 

and local funds to the extent they are otherwise eligible: 1.) 

Immigrants who, on August 4, 1997, were residing in certain residential 

facilities and receiving Medicaid based on a determination that they 

were PRUCOL; and 2.) Immigrants who, on August 4,1997, had been 

diagnosed with AIDS, as defined in Section 2780(1) of the Public Health 

Law, and were receiving Medicaid based on a determination that they 

were PRUCOL. 

 

For some immigrants the United States Citizenship and Immigration 

Services (USCIS) (formerly the Bureau of Immigration and Naturalization 

Services [INS]) requires an Affidavit of Support (I-864).  An Affidavit 

of Support is a USCIS form signed by an immigrant’s sponsor.  In the 

Affidavit of Support, the sponsor promises to financially support the 

immigrant if the USCIS allows the immigrant into the country.  

Presently, neither sponsor deeming nor sponsor liability is being used 

in the New York State Medicaid Program.  The sponsor’s income is not 

currently counted toward the immigrant applying for health coverage, 

nor is New York State requiring sponsors to repay Medicaid for services 

used by the immigrant.  However, NYS Medicaid may implement these 

ovisions at a future date. 

pr

 

NOTE:  The provisions of this directive do not apply to pregnant women. 

A woman with a medically verified pregnancy is not required to document 

citizenship or immigration status for the duration of her pregnancy, 

through the last day of the month in which the 60-day postpartum period 

ends. 

 

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Date:  October 26, 2004 

 

5 

Trans. No.  04 OMM/ADM-7 

 

Page No. 

 

 

 IV.  REQUIRED ACTION 

 

This directive provides the necessary tools a Medicaid eligibility 

worker needs to properly determine a Medicaid applicant/recipient’s 

immigration status. By becoming familiar with the United States 

Citizenship and Immigration Services (USCIS) documents and codes, 

definitions, and the Welfare Management System’s(WMS) Alien/Citizenship 

(ACI) Codes, Coverage Codes and State/Federal Charge Codes, a worker 

will be able to effectively determine a citizen’s or immigrant’s 

eligibility for Medicaid. 

 

All legal immigrants are eligible for Medicaid, Family Health Plus and 

Child Health Plus A, as long as the applicant meets the other 

eligibility requirements of the program and have “satisfactory 

immigration status”. The Federal definition of “satisfactory 

immigration status” is an immigration status that does not make the 

individual ineligible for benefits under the applicable program. 

 

Examples of individuals who are said to be in “satisfactory immigration 

status” are:  

•

 

U.S. Citizens; 

•

 

Nationals; 

•

 

Native Americans; 

•

 

Immigrants lawfully admitted for permanent residence (LPR) and 

immigrants known as “qualified immigrants”; and 

•

 

Immigrants permanently residing in the United States under color  

of law (PRUCOL). 

 

Only two groups of immigrants are ineligible for “full” Medicaid. Those 

are: 

•

 

Undocumented immigrants (i.e. persons with no USCIS paperwork) 

•

 

Temporary nonimmigrants (i.e. short term visa holders, foreign 

students, tourists) 

 

However, providing they meet the other eligibility criteria, 

undocumented immigrants and temporary nonmmigrants may be eligible for 

e treatment of an emergency medical condition. 

th

 

Districts must accept and process new and pending Medicaid applications 

submitted by or on behalf of all persons in satisfactory immigration 

status, including PRUCOL immigrants and immigrants formerly subject to 

the five-year rule.  These Medicaid applications must be processed 

within the time frames specified in 18 NYCRR 360-2.4, which requires 

the social services district to make a Medicaid eligibility 

determination within 30, 45, or 90 days depending upon the applicant’s 

eligibility category, and Section 365-a (6) of the Social Services Law, 

which directs the district to provide prenatal care assistance program 

Medicaid benefits presumptively to eligible pregnant women. 

 

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