Updated September 2022

Key Facts:
Health Insurance Affordability Programs’ Eligibility
Based on Immigration Status
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 there are immigration-related eligibility restrictions that block many people
from qualifying for these health insurance affordability programs.

What are the immigration status Which categories of immigration

requirements for Medicaid and CHIP? statuses are qualified statuses?
The general rules related to eligibility based off Categories of immigration statuses include:
immigration status for Medicaid and CHIP are
• Lawful Permanent Resident status (LPR, or
grounded in the Personal Responsibility and Work
green card)
Opportunity Reconciliation Act (PRWORA) of 1996.
PRWORA created Two categories of immigration • Refugee status
statuses used in determining eligibility: “qualified”
• Asylum status
and “not qualified”. In general, people who are
immigrants must be in a qualified status to be • Withholding of deportation/removal, or
eligible for Medicaid and CHIP. However, even conditional entrants
people with qualified immigration statuses may
not be eligible because they have not met a five- • Cuban/Haitian entrants
year waiting period after they obtain qualified • Individuals paroled into the United States, for
status. Individuals who are not eligible for a period of at least one year
Medicaid because of their immigration status may
be eligible for Medicaid payment of emergency • Certain domestic violence survivors and their
services, and some may be eligible for children and/or parents
marketplace coverage. Additionally, states have
• Certain trafficking survivors and in some
the option to adopt broader eligibility rules for
cases their spouses and children (for adult
children and pregnant women who are
victims) and spouses, children, parents and
immigrants.
minor siblings (for child victims).
 • Compact of Free Association (COFA) (Medicaid • Certain American Indians born abroad
Only)
• Individuals receiving Foster Care, and in most
All other immigration statuses are considered not states, Supplemental Security Income
qualified for purposes of Medicaid and CHIP recipients
eligibility.
• Some people arriving from Ukraine and
Are people with qualified immigration granted parole into the U.S.
statuses eligible for Medicaid or CHIP It is important to note that a few states restrict
immediately upon obtaining a eligibility for some adults with a qualified
qualified status? immigration status even after the five-year wait.1
In general, people with qualified immigration
statuses who entered the U.S. on or after August Can states have less restrictive
22, 1996, must wait five years after obtaining a eligibility requirements for people who
qualified status before meeting the immigration- are immigrants?
related eligibility requirements for Medicaid or Yes. States have the option to provide Medicaid
CHIP. This is often referred to as the “five-year and CHIP coverage to children and/or pregnant
bar.” However, there are exceptions. People with people with a lawfully present immigration status.
the following qualified immigration statuses do The term lawfully present includes all qualified
not have to meet the five-year waiting period immigration statuses, as well as many other types
requirement: of immigration statuses who have permission to
• Refugee live or work in the United States. (See Table 1 for
a full list of immigration statuses considered
• Asylum lawfully present for the purpose of enrollment in
• Individuals granted withholding of insurance affordability programs).
deportation/removal Under the CHIP option to provide prenatal
• Cuban/Haitian entrants services, states can use CHIP funding to provide
prenatal care to people who are otherwise
• Amerasian immigrants ineligible for Medicaid and/or CHIP regardless of
their immigration status. In addition, some states
• Trafficking survivors
use state or county funds to provide Medicaid and
• Iraqi or Afghan special immigrant status CHIP to other groups, such as people with lawfully
present immigration statuses who do not have a
• Veterans or individuals on active military duty qualified status and to children without a
and their spouse (un-remarried surviving documented immigration status.2
spouse), or child

1 For more information on how states restrict coverage, 2Center for Medicaid and State Operations, State
see footnotes 6 and 7 on the National Immigration Law Health Official Letter #09-006, May 8, 2009:
Center document, “Overview of Immigrant Eligibility for www.medicaid.gov/Federal-Policy-
Federal Programs,” available at: Guidance/downloads/SHO050809.PDF.
www.nilc.org/issues/economic-support/overview-
immeligfedprograms/.

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What are the immigration-related requirement, but there are some exceptions. An
eligibility requirements to enroll in a important exception is individuals granted
marketplace plan? deferred action under the Deferred Action for
Childhood Arrivals (DACA) program. The U.S.
Only people with a lawfully present immigration Department of Homeland Security can grant
status can enroll in a marketplace plan. (See temporary administrative relief from deportation,
Table 1 for a list of immigration statuses that are which is referred to as deferred action, for a
considered lawfully present for the purpose of variety of reasons. While individuals granted
marketplace eligibility). In general people deferred action are generally eligible to enroll in
permitted under the law to be in the U.S. meet the marketplace coverage, people with DACA are

Table 1:
“Lawfully Present” Immigration Categories Eligible for Marketplace Coverage
All “Qualified” Immigration Statuses
Lawful Permanent Resident (LPR/green card holder) Battered Spouse, Child and Parent
Refugee Trafficking Survivor and his/her Spouse, Child, Sibling or
Parent
Asylee
Granted Withholding of Deportation or Withholding of
Cuban/Haitian Entrant
Removal
Paroled into the United States
Certain American Indians
Conditional Entrant
Compact of Free Association (COFA) (Medicaid Only)

PLUS Other Lawfully Present Immigration Statuses

Granted relief under the Convention Against Torture (CAT) Individual with Nonimmigrant Status (includes worker
visa; student visas; U visas; and many others)
Temporary Protected Status (TPS)
Administrative order staying removal issued by the
Deferred Enforced Departure (DED)
Department of Homeland Security
Deferred Action*
Lawful Temporary Resident

*EXCEPTION: Individuals granted deferred action under the Deferred Action for Childhood Arrivals (DACA) program
are not eligible to enroll in coverage in the Marketplace
Applicant For Any of These Statuses
Lawful Permanent Resident (LPR/green card holder) Victim of Trafficking Visa
Special Immigrant Juvenile Status Withholding of Deportation or Withholding of Removal,
under the immigration laws or under the Convention
Asylum*
Against Torture (CAT)*
*Only those who have been granted employment authorization or are under the age of 14 and have had an
application pending for at least 180 days are eligible
With Employment Authorization
Applicant for Temporary Protected Status Applicant for Cancellation of Removal or Suspension of
Deportation
Registry Applicants
Applicant for Legalization under IRCA
Order of Supervision
Legalization under the LIFE Act
Source: Health Insurance Marketplace, www.healthcare.gov/immigrants/immigration-status

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excluded and not eligible to enroll in a portion of income they will contribute is the same
marketplace plan. as for individuals with incomes at 100 percent of
the poverty line, which is zero in 2023.3 Their
What are the immigration-related premium tax credit will be equal to the cost of the
eligibility requirements for premium second-lowest silver plan available to them in
tax credits and cost sharing reductions their ZIP code.
in the ACA marketplaces? Because they are treated as if their income is at
People with a lawfully present immigration status 100 percent of the federal poverty line, they would
are eligible to purchase ACA marketplace also qualify for a cost sharing reduction, which
coverage and may also qualify for premium tax would raise the actuarial value of their plan to 94
credits and cost sharing reductions if they meet all percent. They would need to purchase a silver
other requirements such as income, tax filing, plan to receive the cost-sharing reduction, which
residence, minimal essential coverage, etc. would significantly lower their deductible,
copayments, and other out-of-pocket costs. (For
In general, only individuals with incomes above
the poverty line are eligible for premium tax more information on premium tax credits and cost
credits. However, individuals who have lawfully sharing reductions, please see Key Facts:
Premium Tax Credits and Key Facts: Cost-Sharing
present immigration statuses and are not eligible
for Medicaid because of their immigration status Reductions.)
can qualify for premium tax credits even if their
income is below the poverty line (for example, a
Are there health coverage options for
person with a lawfully present immigration status people who do not meet the
that does not have a qualified immigration status immigration-related eligibility
or has a qualified immigration status but has not requirements for health insurance
completed the five-year waiting period). While affordability programs?
Medicaid income eligibility differs in states that
People who do not meet the immigration-related
expanded Medicaid and those that did not,
eligibility requirements for Medicaid but meet all
eligibility for premium tax credits for people with a
other eligibility standards may be eligible for
lawfully present immigration status and incomes
having limited treatment for life-threatening
below the poverty line is not affected by a state’s
medical conditions paid for by Medicaid (including
decision on Medicaid expansion.
labor and delivery). People who do not have a
documented immigration status or those with
How are premium tax credits
DACA are not eligible to purchase health
calculated for people with a lawfully insurance through the ACA marketplaces, but they
present immigration status and may enroll private coverage outside the
incomes below the poverty line? marketplace.
For the purposes of determining a person’s
expected contribution to the cost of coverage, the

3This percentage is indexed and changes each year. For the current expected contribution
enrollment year. Additionally, the American Rescue percentages, see:
Plan Act lowered the expected contribution www.healthreformbeyondthebasics.org/reference-
percentages for 2021 and 2022, and the Inflation guide-yearly-thresholds/
Reduction Act extended them through the 2025 plan

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There are no immigration-related eligibility
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 people regardless
of immigration status, and a few states and local
governments provide health coverage to children
without a documented immigration status and/or
some adults that do not meet the immigration-
related requirements for health insurance
affordability programs.
People without a documented immigration status
also can sign up for employer-sponsored
insurance if their employer offers it.