Last Updated: October 2005

The material in this chapter was prepared by The Legal Aid Society’s
Health Law Unit

Who is eligible for Medicaid, Family Health Plus and Child Health Plus?

A: All legal immigrants in New York are eligible for Medicaid, Family Health Plus (“FHPlus”) and the children’s Medicaid program, called Child Health Plus A (“CHPlus A”) so long as the applicant meets the other eligibility requirements of the program. Use the “Access NY Health Care” application to apply.

The immigration rules are the same for Medicaid (both community and long-term care Medicaid), FHPlus, and CHPlus A.

Only two groups of Immigrants are NOT eligible for full Medicaid, FHPlus and CHPlus A. They are:

• Undocumented (e.g. people with no United States Citizenship and Immigration Services- USCIS, formerly called INS—paperwork).
• Nonimmigrants (e.g. short-term visa holder, like students, tourists who are not adjusting their status with USCIS.

But, all New York State residents, including people who are undocumented, may be eligible for the following three types of government health insurance:

1. Medicaid coverage for the treatment of an emergency medical condition (sometimes referred to as “Emergency Medicaid”) pays for urgently needed medical care. Fill out a full Medicaid application plus a physician’s attestation form, called a MAP-2151 (NYC version) or DSS-3955 (upstate version);
2. Prenatal Care Assistance Program (PCAP) which provides Medicaid to cover prenatal care for pregnant women (fill out a Growing Up Healthy or Access NY Health Care application) and
3. CHPlus B which is health insurance for low-income children up to age 19 who don’t qualify for CHPlus A (fill out a Growing Up Healthy or Access NY Health Care application).

Q. Which Categories of Immigrants are Eligible for Health Insurance?

A. Immigrants eligible for Medicaid, FHPlus or CHPlus A must be U.S. citizens, national, Native Americans belonging to a federally recognized tribe born outside the U.S. (like Canada), or have “satisfactory” immigration status. 

Here are some examples of satisfactory immigration status:

1. Qualified Aliens
   • Legal Permanent Residents (or “Green Card” holders)
• Refugees
• Asylees
• Persons granted withholding of deportation or removal
• Cuban-Haitian entrants
• Amerasians
• Persons who are battered (e.g. battered women) or subject to extreme cruelty and their dependents
• Conditional entrants
• Veterans or active U.S. armed forces and their immediate family members
• Victims of trafficking
2. Immigrants who are Permanently Residing Under Color of Law (PRUCOL). See Appendix E of this Guide, SDOH Documentation Guide, pages 3-4, for a complete list of satisfactory and PRUCOL immigration categories.

Q. What is a Qualified Alien?

A. Qualified aliens are immigrants who live and/or work here with the permission of the United States Citizenship and Immigration Services (USCIS, formerly called INS). Examples of Qualified Aliens are: Green Card Holders (or Lawful Permanent Residents of “LPRs”), people who have been granted asylum because of political or religious persecution, refugees and so forth. All Qualified Aliens are eligible for Medicaid, FHPlus or CHPlus so long as they meet the relevant health program’s other eligibility criteria. There is no five-year waiting period for receipt of health benefits.

Q. What is a PRUCOL Immigrant?

A. PRUCOL immigrants are also eligible for Medicaid, FHPlus and CHPlus. Let’s break down what PRUCOL stands for:

Explaining the term PRUCOL:
The New York State Department of Health says that PRUCOL immigrants are people who are living here with USCIS’ “knowledge or acquiescence” and USCIS is not taking steps to deport the immigrant

“Acquiescence” is an important word. It means by default (or inaction)
As we explain later, if the client has documents showing that USCIS has received the immigrant’s request to adjust his or her status (or become a Green Card holder), he or she is probably a PRUCOL immigrant until USCIS makes its decision.

PRUCOL Rule of thumb: A PRUCOL immigrant is a person who lives in the U.S. for good and has some kind of legal status from USCIS or has applied for legal status with USCIS. PRUCOL is a term used by New York State to grant State-funded benefits, like Medicaid, FHPlus, CHPlus and Safety Net Assistance.

USCIS does not grant “PRUCOL” status. USCIS will not give the immigrant a piece of paper that says the immigrant is PRUCOL. You will have to review the immigrant’s documents to see if he or she fits in a PRUCOL category. Most PRUCOl immigrants do not know that they are “PRUCOL.” Instead, the immigrant is likely to believe that he or she is an immigrant who is in the process of adjusting his or her immigration status.

Because USCIS takes so long to make immigration decisions, many immigrants will have complicated immigration documents, which prove that they are PRUCOL. In summary, if the immigrant has properly filed paperwork with USCIS to remain in the U.S. permanently, and USCIS has acknowledged that filing (even by issuing a receipt or a return receipt requested or a canceled check made out to USCIS), the immigrant should be considered a PRUCOL immigrant.

It is your job to help your immigrant client prove that his or her status is at least PRUCOL. Let’s figure out how to do this job with the immigrant’s documents.

Q: Do All Immigrants Have to Provide Social Security Numbers When They Apply for Government Health Insurance in New York?

A: No. Some immigrants like pregnant women applying for PCAP and undocumented people applying for Medicaid coverage for the treatment of an emergency medical condition or CHPlus B do not have to have a Social Security Number.

Immigrants who are PRUCOL and do not have a Social Security Number (SSN) should try to apply for one. A Medicaid/FHPlus/CHPlus application cannot be delayed or denied if the immigrant does not have a Social Security Number or cannot get “proof” (like a letter) from Social Security that he or she tried to apply.

A Medicaid worker should try to help the immigrant apply for a SSN. The worker should refer the applicant to a local Social Security office and give the applicant a letter from the local Medicaid office to the Social Security office requesting a SSN. Appendix F of this Guide, page one, has a copy of the Medicaid office model letter. If the applicant still cannot get a SSN, then the applicant can submit a statement to the Medicaid worker describing how she or he tried to get an SSN. Appendix Two, page two, has a model client attestation letter.

Never advise an undocumented immigrant or an immigrant under a deportation order from USCIS to apply for a SSN.

Q. Can the Children of Some Non-immigrants Enroll in CHPlus B?

A. Maybe

CHPlus B is available to undocumented children and children of some non-immigrants who have established residency in the State of New York.

The State Child Health Plus program will review each non-immigrant child’s application individually. Proof of residency can be: employment information and the child’s school records. Non- immigrant children who probably will not be eligible for CHPlus B are children who have: medical visas; tourist visa and visas for students under the age of 19.

Q. What are Immigrant’s Rights When Applying for Medicaid, FHPlus or CHPlus?

A. An applicant has the right to:

• Be told about the programs and help he or she can get.
• Be told what he or she need to do to qualify for these programs
• Apply for these programs.
• Get an application when he or she asks for one.
• Get an interview.
• Get written notice which says whether his or her application was approved or denied.

Eligibility workers must provide their decisions in writing. An applicant should always ask for a written decision about his or her application.

Q. What if an Immigrant’s Application is denied?

A. Whenever an application for Medicaid, FHPlus or CHPlus is denied, the applicant has 60 days to appeal this denial. The applicant’s appeal will be heard at a Fair Hearing before the New York State Department of Health.

Instructions on how to ask for a Fair Hearing are on the Denial or Discontinuance Notice issued by the local Medicaid office. The local DSS must provide a written decision (or Notice) to an applicant/recipient. An applicant can ask for a Fair Hearing even if he or she is not provided a denial notice.

A Medicaid, FHPlus, or CHPlus A applicant or beneficiary can ask for a Fair Hearing in person, by telephone, by fax, by mail or over the internet by:

1. Going in person to 330 West 34th Street, 3rd floor;
2. Calling (212) 417-6550
3. Faxing (518) 473-6735; or
4. Mailing to OTDA, Fair Hearings, PO Box 1930, Albany, NY 12201-1930
5. Internet via: http://www.otda.state.ny.us/

The Legal Aid Society’s Health Law Hotline is available to assist applicants who are denied Medicaid, FHPlus or CHPlus. Call: 212-577-3575. Upstate residents may call Legal Aid’s Health Hotline toll free at: 1-888-500-2455.

Q. What Documents explain if the Immigrant is a Legal Immigrant?

A. There are four kinds of documents you can use to figure out if the immigrant applicant is eligible for Medicaid, FHPlus, or CHPlus A.

1. Permanent Resident Card or Green Cards (USCIS Form I-551)
   
   Most, but not all, Qualified Aliens will have a Permanent Resident Card or what is commonly called a “Green Card.” As long as he or she meets the other program rules, an immigrant with a Green Card is eligible for Medicaid, FHPlus or CHPlus A and should not have to provide any other proof of his or her immigration status.
   
   For these immigrants, Medicaid workers will ask for the date the immigrant entered the country and the date that he or she received Lawful Permanent Resident status so that Medicaid can get reimbursed by the federal government for some of its Medicaid costs. An application should not be denied or delayed if the immigrant cannot answer these questions or if the immigrant does not have “proof” of his or her date of entry into the U.S.
   
   Green cards are not green colored any more. In the past, Green Cards did not have expiration dates. Nowadays they do. An immigrant client whose Green Card has expired does not lose his or her immigration status, so his or her Medicaid application can still be processed.
   
   This card used to be called a “Resident Alien” Card.
   
   
2. The I-94 Arrival/Departure Record
   
   When an immigrant is first admitted into the United States, his or her passport is stamped with the I-94. The I-94 is either a stamp in the immigrant’s passport of a little white card. An I-94
   and the most common codes on the I-94 are pictured on the next page. See Appendix G of this Guide, SDOH’s Key to common I-94 codes.
   
   The I-94 often has a code written on it. The code tells you what the immigrant’s status was when he or she entered the country. Sometimes, the code on the I-94 helps us prove that the immigrant is an LPR and may be waiting for USCIS to issue a Green Card. The codes may indicate if the immigrant is eligible for Medicaid, FHPlus, and CHPlus A.
   
   Remember this is the immigrant’s status when he or she enters the country. It is possible that the immigrant’s status can improve (e.g. she or he can enter on a work visa, but may later be sponsored by an employer or elative and adjust her or his status).
   
   
3. Employment authorization Documents (Card)- (USCIS Form (I-766 or I-688B)
   
   USCIS permits many immigrants to work legally in the United States. These immigrants are issued an Employment Authorization Document, which is a card. Qualified Immigrants like Green Card holders can get employment authorization to work in the United States. In addition, PRUCOLS and people who are in the process of adjusting their status can get an Employment Authorization Card and work here legally.
   
   The Employment Authorization Card has a “category” section, which indicates a special code that can tell you the client’s immigration status. Sometimes it is hard to see the code because of the picture of an eagle in the card’s background. Also, an applicant’s immigration status may have changed since he or she was issued an employment authorization card so it is a good idea to review all of the documents in the immigrant’s possession.
   
   The State Department of Health created a chart that explains what the immigrant’s status is based on the code on the immigrant’s Employment Authorization Card.
   
   
4. Other Documents that Indicate an Immigrant is PRUCOL
   
   Some applicants for Medicaid and Family Health Plus do not have either a Green Card or an Employment Authorization card. In addition, the information on their I-94 Arrival/Departure record may be out of date. In these cases, you should ask to see the immigrant’s correspondence with USCIS to see if he or she can be considered to be PRUCOL.