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Lawful Immigrant Eligibility for Health Insurance Marketplace Coverage

Accounting Support • Dec 02, 2020
The individuals that meet the state's income and residency rules are qualified for coverage through Medicaid and children's insurance plan. Qualified non-citizens, mostly LPRs or
Eligibility for Lawfully Present Immigrants, For Coverage through the Health Insurance Marketplace

The lawfully present immigrants can get health insurance coverage in the Marketplace. The term “lawfully present” implies for the immigrants having:

  • “Qualified non-citizen” immigration status (without any waiting period)
  • Humanitarian status or circumstances like Special Juvenile Status, asylum applicants, Temporary Protected Status, victims of trafficking, and Convention against Torture.
  • Legal non-immigrant visas

Legal status conferred by other laws such as Temporary resident status, the LIFE Act, and Family Unity individuals.

Benefits of Marketplace Coverage to Lawfully Present Immigrants

The lawfully present immigrants can buy private health insurance during the open enrollment period. With this health insurance, they can lower the out-of-pocket costs and can become eligible for lower costs on the monthly premium.

  • The immigrants having their income about 400% of the poverty level can get premium tax credits and savings on marketplace insurance.
  • Individuals having income below 100% of the poverty level may become eligible for Medicaid. If they're not, they will surely get premium tax credits and other savings on marketplace insurance.

Medicaid & CHIP for Lawfully Present Immigrants

The individuals that meet the state's income and residency rules are qualified for coverage through Medicaid and children's insurance plan. Qualified non-citizens, mostly LPRs or green card holders can opt for Medicaid and CHIP coverage after a 5 years waiting period. After receiving a "qualified immigrant" status, they have to wait for 5 years before getting Medicaid and CHIP coverage. But exceptions for LPRS who used to be refugees or asylees also exist. They can get health coverage soon after being qualified immigrants.

“Qualified non-citizen” term is used for:

  • Lawful Permanent Residents (LPR/Green Card Holder)
  • Cuban/Haitian entrants
  • Asylees
  • Conditional candidates allowed before 1980
  • Refugees
  • Liberated into the United States for at least one year
  • The trafficking victims, their spouses, or families and individuals having a pending application for a trafficking victim visa
  • Granted withholding of deportation
  • Battered non-citizens, spouses, children, or parents
  • Member of a federally accepted Indian community or American Indian born in Canada 

How Medicaid & CHIP Coverage Is Beneficial To Lawfully Residing Children And Pregnant Women?

States can remove this 5 years waiting period for lawfully residing children and pregnant women. Lawfully residing kids and pregnant women can thus get Medicaid and CHIP coverage. The Commonwealth of Northern Mariana Islands, District of Columbia, and twenty-nine states provide Medicaid coverage without a 5-years waiting period. Twenty-one out of these twenty-nine states cover lawfully residing pregnant women and children in CHIP.

Emergency Care

 People who meet all Medicaid eligibility criteria of the state can get payment for emergency medical treatment. These eligibility criteria may include income and state residency. They can get emergency payments even if they don't have eligible immigration status. 

Medicaid, CHIP, Under “Public Charge” Status

 The definition and factors for "public charge" status are updated on 24 February 2020. New U.S. citizenship and immigration service’s regulations are now applied to it. Under the public charge final rule:

  • Enrollment with or without premium tax credits in the Marketplace plan is not a public benefit. 

The enrollment of children under 21 age and pregnant women in Medical or children's health insurance programs is not a public benefit.

Build and manage a better workforce with integrated HR solutions from ADP Marketplace partners like Points North.

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