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Medicaid and US Citizenship | Who Is Eligible For Medicaid


Questions and Answers on Verification of Citizenship and Immigration Status

Are the verification requirements with respect to citizenship and immigration status the same for all applicants?

No. For purposes of the verification requirements relating to citizenship and immigration status, it is useful to divide applicants into four groups:

  • United States citizens and nationals

  • Immigrants who are “qualified aliens” and who, as such, may apply for the full scope of coverage under a state’s Medicaid or SCHIP state plan

  • Immigrants who are “non-qualified aliens” and therefore eligible to apply only for coverage of emergency services under Medicaid

  • Non-immigrants

Who are non-immigrants?
Non-immigrant aliens include non-citizens lawfully admitted to the United States, but only for a temporary or limited period of time, such as tourists, foreign diplomats and foreign students. Non-immigrants do not meet the definition of a qualified alien and therefore are never eligible for a separate child health program under SCHIP or for the full range of services available under any state’s Medicaid program. Non-qualified aliens may qualify for emergency services under Medicaid. But because non-immigrants generally will be unable to establish residency in any state, they generally will be ineligible for emergency assistance under Medicaid as well. However, in rare cases, a non-immigrant may be able to establish residency, in which case he or she may be eligible for emergency assistance under Medicaid, provided that all other eligibility criteria are met. The Medicaid eligibility of non-immigrants is discussed in §3211.10 of the State Medicaid Manual.

What steps are states required under Federal law to take in verifying citizenship and/or immigration status?
Citizens, U.S. nationals and qualified aliens applying for Medicaid and SCHIP must execute a declaration in writing, under penalty of perjury, stating that they are a citizen or national of the United States or, if not a citizen or national of the United States, that they are in satisfactory immigration status. In the case of an unemancipated minor under age 18 or an incompetent adult, a parent, legal guardian or other person legally qualified to act on the applicant’s behalf must sign such a declaration.
Qualified aliens also must present documentation of their immigration status. State and county Medicaid agencies must then verify an immigrant’s immigration status with the Immigration and Naturalization Service (INS) through the automated Systematic Alien Verification for Entitlements (SAVE) system, or by using an alternative verification system approved under a waiver granted by the Secretary of Health and Human Services. (It should be noted that the INS has published proposed a regulation under which all states would be required to verify the immigration status of non-citizens applying for Medicaid using SAVE; states currently using an alternative system under an approved waiver would no longer be permitted to do so. States would have 24 months to begin using SAVE after publication of the final rule.)
Agencies responsible for determining eligibility for a separate child health program under SCHIP have more flexibility in determining how to verify immigration status. SCHIP agencies can apply to the INS for participation in SAVE or use the alternative waiver system developed by the state for Medicaid, but they are not required to do so.

Non-qualified aliens and non-immigrants applying for emergency assistance under Medicaid are not required to sign a written declaration or otherwise provide documentation of immigration status.
The procedures which states should follow in complying with these verification requirements are discussed in more detail in section 3212 of the State Medicaid Manual.

The complete Q&A (PDF)


Medicaid and US Citizenship | Who Is Eligible For Medicaid