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In order to qualify for the full range of benefits offered under Medicaid, individuals must be citizens or nationals of the United States or qualified aliens. U.S. nationals are individuals born in certain U.S. territorial possessions. The term qualified alien was created by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L. 104-193) and includes legal permanent residents, refugees, and asylees.

Legal permanent residents entering after August 22, 1996, are generally barred from receiving full Medicaid benefits for five years, after which coverage becomes a state option. However, children and pregnant women who are lawfully present may be covered during the five-year bar at state option. As of January 2017, 31 states had adopted the option for children, and 23 had adopted it for pregnant women (Brooks et al. 2017).

Non-qualified aliens (as well as qualified aliens subject to a five-year bar on full benefits) who meet income and all other eligibility criteria for the program can only receive limited emergency Medicaid coverage. Examples of non-qualified aliens include those who are unauthorized or illegally present, as well as students and other nonimmigrants who are admitted for a temporary purpose.

TABLE 1. Eligibility for Non-Citizens

Eligibility group Federal statutory and regulatory requirements State plan options
Non-citizens Qualified immigrants1

  • Refugees, asylees, and other humanitarian immigrants are generally eligible for Medicaid upon entering the country and remain eligible for seven years.

Emergency Medicaid

  • States must provide limited coverage of emergency medical services to non-citizens who would qualify for full Medicaid benefits but for their immigration status, including unauthorized immigrants.
Qualified immigrants

  • Following five years of residency, states have the option to provide legal permanent residents with Medicaid coverage if they otherwise meet Medicaid eligibility criteria.
  • States may provide Medicaid coverage to non-citizen children who are under 21 and pregnant women, including if they are subject to the five-year waiting period,  if they are lawfully residing and are otherwise eligible for Medicaid.2
1 Section 431of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L. 104-193) classified immigrants for purposes of eligibility for public benefits as either qualified immigrants or non-qualified immigrants. Qualified immigrants include legal permanent residents, refugees, asylees, immigrants whose deportation is being withheld, Amerasians, Cuban/Haitian entrants, and victims of a severe form of trafficking. Non-qualified immigrants include unauthorized immigrants and immigrants in the country temporarily such as students or tourists. States must also cover qualified immigrants who are veterans and active duty military, their spouse, surviving spouse, and children.
2 States were given this option under Section 214 of the CHIP Reauthorization Act of 2009 (P.L. 111-3).
Source: MACPAC, 2017, Federal Requirements and State Options: Eligibility.