General eligibility requirements that apply to all Apple Health programs

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Citizen and immigration status definitions

Revised Date: 
July 1, 2021

Purpose: To explain basic definitions of various citizen and immigrant statuses relevant for determining eligibility for Apple Health programs.

WAC 182-503-0535 Washington apple health -- Citizenship and immigration status.

Effective March 29, 2022

  1. Definitions.
    1. Nonqualified alien means someone who is lawfully present in the United States (U.S.) but who is not a qualified alien, a U.S. citizen, a U.S. national, or a qualifying American Indian born abroad.
    2. Qualified alien means someone who is lawfully present in the United States and who is one or more of the following:
      1. A person lawfully admitted for permanent residence (LPR).
      2. An abused spouse or child, a parent of an abused child, or a child of an abused spouse who no longer resides with the person who committed the abuse, and who has one of the following:
        1. A pending or approved I-130 petition or application to immigrate as an immediate relative of a U.S. citizen or as the spouse of an unmarried LPR younger than 21 years of age.
        2. Proof of a pending application for suspension of deportation or cancellation of removal under the Violence Against Women Act (VAWA).
        3. A notice of prima facie approval of a pending self-petition under VAWA. An abused spouse's petition covers his or her child if the child is younger than 21 years of age. In that case, the child retains qualified alien status even after he or she turns 21 years of age.
      3. A person who has been granted parole into the U.S. for one year or more, under the Immigration and Nationality Act (INA) Section 212 (d)(5), including public interest parolees.
      4. A member of a Hmong or Highland Laotian tribe that rendered military assistance to the U.S. between August 5, 1964, and May 7, 1975, including the spouse, unremarried widow or widower, and unmarried dependent child of the tribal member.
      5. A person who was admitted into the U.S. as a conditional entrant under INA Section 203 (a)(7) before April 1, 1980.
      6. A person admitted to the U.S. as a refugee under INA Section 207.
      7. A person who has been granted asylum under INA Section 208.
      8. A person granted withholding of deportation or removal under INA Section 243(h) or 241 (b)(3).
      9. A Cuban or Haitian national who was paroled into the U.S. or given other special status.
      10. An Amerasian child of a U.S. citizen under 8 C.F.R. Section 204.4(a).
      11. A person from Iraq or Afghanistan who has been granted one of the following:
        1. Special immigrant status under INA Section 101 (a) (27);
        2. Special immigrant conditional permanent resident; or
        3. Parole under Section 602 (b) (1) of the Afghan Allies Protection Act of 2009 or Section 1059(a) of the National Defense Authorization Act of 2006.
      12. An Afghan granted humanitarian parole between July 31, 2021, and September 30, 2022, their spouse or child, or a parent or guardian of an unaccompanied minor who is granted parole after September 30, 2022, under Section 2502 of the Extending Government Funding and Delivering Emergency Assistance Act of 2021.
      13. A person who has been certified or approved as a victim of trafficking by the federal office of refugee resettlement, or who is:
        1. The spouse or child of a trafficking victim of any age; or
        2. The parent or minor sibling of a trafficking victim who is younger than 21 years of age.
      14. A person from the Federated States of Micronesia, the Republic of Palau, or the Republic of the Marshall Islands living in the United States in accordance with the Compacts of Free Association. 
    3. U.S. citizen means someone who is a United States citizen under federal law.
    4. U.S. national means someone who is a United States national under federal law.
    5. Undocumented person means someone who is not lawfully present in the U.S.
    6. Qualifying American Indian born abroad means someone who:
      1. Was born in Canada and has at least 50 percent American Indian blood, regardless of tribal membership; or
      2. Was born outside of the United States and is a member of a federally recognized tribe or an Alaska Native enrolled by the Secretary of the Interior under the Alaska Native Claims Settlement Act.
  2. Eligibility.
    1. A U.S. citizen, U.S. national or qualifying American Indian born abroad may be eligible for:
      1. Apple health for adults;
      2. Apple health for kids;
      3. Apple health for pregnant women; or
      4. Classic medicaid.
    2. A qualified alien who meets or is exempt from the five-year bar may be eligible for:
      1. Apple health for adults;
      2. Apple health for kids;
      3. Apple health for pregnant women; or
      4. Classic medicaid.
    3. A qualified alien who neither meets nor is exempt from the five-year bar may be eligible for:
      1. Alien medical programs;
      2. Apple health for kids;
      3. Apple health for pregnant women; or
      4. Medical care services.
    4. A nonqualified alien may be eligible for:
      1. Alien medical programs;
      2. Apple health for kids;
      3. Apple health for pregnant women; or
      4. Medical care services.
    5. An undocumented person may be eligible for:
      1. Alien medical programs;
      2. State-only funded apple health for kids; or
      3. State-only funded apple health for pregnant women.
  3. The five-year bar.
    1. A qualified alien meets the five-year bar if he or she:
      1. Continuously resided in the U.S. for five years or more from the date he or she became a qualified alien; or
      2. Entered the U.S. before August 22, 1996, and:
        1. Became a qualified alien before August 22, 1996; or
        2. Became a qualified alien on or after August 22, 1996, and has continuously resided in the U.S. between the date of entry into the U.S. and the date he or she became a qualified alien.
    2. A qualified alien is exempt from the five-year bar if he or she is:
      1. A qualified alien as defined in subsections (1)(b)(vi) through (xiv) of this section;
      2. An LPR, parolee, or abused person, who is also an armed services member or veteran, or a family member of an armed services member or veteran, as described below:
        1. An active-duty member of the U.S. military, other than active-duty for training;
        2. An honorably discharged U.S. veteran;
        3. A veteran of the military forces of the Philippines who served before July 1, 1946, as described in Title 38 U.S.C. Section 107; or
        4. The spouse, unremarried widow or widower, or unmarried dependent child of an honorably discharged U.S. veteran or active-duty member of the U.S. military.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

Clarifying Information

A person's citizenship or immigration status must be determined as part of the eligibility determination for health care coverage under Apple Health (which includes both Classic Medicaid program and the new MAGI-based Medicaid programs). Everyone falls into one of the following four citizenship/immigration status groups for purposes of coverage eligibility:

Eligibility for all programs must determine an individual's citizenship or alien status. An individual will fall into one of the following four groups for purposes of benefits eligibility:

  • Lawfully Present "Qualified Alien";
  • Lawfully Present "Nonqualified Alien";
  • Not Lawfully Present (Undocumented) Immigrant; or
  • Citizen or U.S. National.

A lawfully present immigrant refers to any noncitizen presently permitted to remain in the United States. Lawfully present means that USCIS has actively granted these immigrants permission to remain in the U.S. and has issued documentation of their lawfully present status that is currently valid. A lawfully present immigrant must still meet state residency requirements in WAC 182-503-0520 in order to qualify for health care coverage.

"Qualified Alien" and "Nonqualified Alien" are terms used in federal immigration law and do not by themselves indicate whether an immigrant is eligible for benefits. Both "Qualified Aliens" and "Nonqualified Aliens" may be eligible for health care coverage.

Note: If there is uncertainty about whether a particular individual has met the conditions for citizenship or immigration status, legal assistance is available at the Northwest Immigrant Rights Project in Western Washington at 206-587-4009 or in Eastern Washington at 509-854-2100.

Qualified Aliens

In general, Qualified Aliens who are exempt from, or who have met, the 5-year bar are eligible for federally-funded Apple Health (Medicaid) programs. Qualified Aliens who are not exempt from and have not yet met the 5-year bar are eligible for state-funded Apple Health programs if they are a pregnant woman or child or if they have a qualifying emergency under the Alien Emergency Medical (AEM) program as described under WAC 182-507-0110.

Federal law requires many qualified immigrants to wait five years before becoming eligible for Apple Health. This 5-year waiting period is commonly referred to as the 5-year bar. This 5-year waiting period usually begins when the person receives their qualifying immigration status, unless they are exempt, not when they entered the U.S.

Hmong or Highland Laotian Tribe Members

Hmong (or Highland Laotian) tribe members born before May 8, 1975, whose tribe assisted the U.S. military during Vietnam era (August 5, 1964 to May 7, 1975) are “Qualified Aliens” and eligible for Apple Health (Medicaid) without having to meet the 5-year bar. The tribe member's spouse and unmarried dependent children under age 19 automatically qualify as a result of the spouse’s special immigration status.

If the applicant does not have USCIS documentation of this status, he or she may submit the following statement under penalty of perjury: I was a Hmong (or Highland Laotian) tribe member when the tribe assisted the U.S. military during Vietnam era (August 5,1964 to May 7, 1975).

Cuban/Haitian Entrants

Individuals approved for the Haitian Family Reunification Parole (HFRP) program will enter the U.S. as Cuban/Haitian entrants under 501(e) of the Refugee Education Assistance Act of 1980 and are "Qualified Aliens" who are exempt from the 5-year bar.

Iraqi or Afghan Special Immigrants

Immigrants from Iraq or Afghanistan who were granted Special Immigrant Status under section 101(a)(27) of the INA are qualified aliens and are eligible for federally-funded Washington Apple Health. Their eligibility period starts from their date of entry into the United States or, if occurred after the U.S. entry, the date Special Immigrant Status was granted. For more information on documentation, immigration status codes, benefit eligibility and a step-by-step process for these immigrants, see Desk Aid Iraqi and Afghan Special Immigrants Benefits.

Citizens of the Republic of the Marshall Islands, the Republic of Palau and the Federated States of Micronesia

Citizens of Marshall Islands, Micronesia or Palau may have a birth certificate, current or expired I94 arrival or departure record, current or expired passport or other document verifying they are citizens of one of these countries. These individuals have special rights under Compacts of Free Association and are lawfully allowed to enter, reside and work in the U.S., but are not U.S. nationals. They are considered lawfully present qualified noncitizens exempt from the 5-year bar unless they have some other immigration status. 

Nonqualified Aliens

Nonqualified Aliens (and Qualified Aliens who are not exempt from and have not yet met the 5-year bar) are not eligible for federally-funded Apple Health programs unless they are a child, pregnant woman or they have a qualifying emergency under the Alien Emergency Medical (AEM) program as described under WAC 182-507-0110. Some lawfully present nonqualified aliens have temporary status or pending applications and consequently their status may expire when their document is expired or when a final denial of their application is issued, with the following exceptions:

  • Persons granted cancellation of removal or suspension of deportation.

Some common Nonqualified Alien statuses that are not specifically described in the WAC above are:

  • Pending applicants for Asylum, Withholding of Deportation/Removal under the Convention Against Torture (CAT) if over age 14 with an approved work authorization or if under 14 and their application has been pending for 180 days or more;
  • Immigrants who have been granted withholding of removal under the Convention Against Torture (CAT);
  • Individuals with approved relative visa petitions who have applied and are pending adjustment to LPR status;
  • Immigrants with a current nonimmigrant status who have not violated the terms of their status, such as:
    • "U" visa holders;
    • Religious workers under section 101(a)(15)(R) of the INA;
    • An individual with a petition pending for 3 years or more, as permitted under section 101(a)(15)(V) of the INA;
    • A fiancé of a citizen, as permitted under section 101(a)(15)(K) of the INA;
    • Tourist/Visitor visa holders; and
    • Visitors on business.

Undocumented Individuals

Undocumented individuals are individuals who are not lawfully present. This includes both individuals who entered the U.S. without document inspection and individuals whose lawful presence status has expired.

An individual whose lawful presence has expired may be in the process of pursuing an extension or change of status. Without evidence of actively pursuing an extension or change of status, an individual whose lawful presence status has expired will be considered an undocumented individual.

Note: Deferred Action Childhood Arrival (DACA or “Dream Act”) persons are not eligible for federally-funded Washington Apple Health. DACA persons are undocumented individuals who have been granted deferred action. DACA persons may be eligible for state-funded health care coverage, including Apple Health for Kids, Apple Health for Pregnant Women, and Medical Care Services.

Citizens and U.S. Nationals

Citizenship for Foreign-Born Natural or Adopted Children of U.S. Citizens. For children born outside the U.S. to acquire citizenship under the Child Citizenship Act of 2000, they must meet all the conditions in WAC 182-503-0530 on or after February 27, 2001. The Act applies to children related to the citizen parent by birth or adoption only - stepchildren are not included unless also adopted. Citizenship for these children can depend on which parent is a U.S. citizen, how long the citizen parent resided in the U.S., and whether the parents were married at the time.

Once a child becomes a citizen under the Act, subsequent changes in the parents' marital status, such as separation or divorce, have no bearing on the child's citizenship. Nor does it matter whether the parent in question became a U.S. citizen after entering the U.S.

If the child is 18 years or older when the parent becomes a citizen, child citizenship laws do not apply and he/she must independently apply for naturalization.

For individuals who automatically become citizens under terms of the Child Citizenship Act of 2000 or previous legislation, USCIS issues no documentation unless requested. Individuals themselves may not be aware that they or their children are already citizens.

Note: For information on the Department's naturalization assistance program, see the Social Services Manual, SSI Facilitation Chapter, Section E, subsection on SSI facilitation.

American Indians/Alaska Natives

The term “American Indian” refers to members of federally recognized (and in some cases, state-recognized) tribes in the U.S. The term “Alaska Native” refers to members of Alaska Native Villages and of Alaska Native Corporations under the Alaska Native Corporation Settlement Act.

American Indians and Alaska Natives born outside the United States are eligible for federal benefits to the same extent as American Indians and Alaska Natives born in the U.S. if they are: a member of a federally-recognized American Indian tribe (see Governor's Office of Indian Affairs website) or Alaska Native Village or Corporations (see Federal Register Notice).

Note: Noncitizen American Indians have the same eligibility for health care coverage as U.S. Citizens, but citizen documentation requirements do not apply. Instead they will need to provide tribal verification.

Example: A member of a federally recognized tribe (e.g., Pueblo) who is a Mexican citizen gives birth to a child outside of the U.S. The child qualifies as a member of the tribe but is not a citizen. That child is potentially eligible for Washington Apple Health as long as the child can establish that he or she is a member of the federal tribe.

Canadian American Indians

Canadian citizens who have at least 50 percent First Nations (Native American) ancestry (by blood) and who become residents of the U.S. automatically gain lawful permanent resident immigration status under the Jay Treaty of 1794. They may ask for a lawful permanent resident card from USCIS, but they are not required to get immigration documentation. This category does not include the spouse or child of such a person unless he or she also possesses 50 percent First Nations ancestry (by blood) and Canadian citizenship. If a Jay Treaty applicant does not have USCIS documentation, he or she can establish Jay Treaty status by providing both:

  • A First Nation (tribal) letter that verifies 50% First Nations ancestry (by blood); and
  • A Canadian birth certificate.

Immigration Documentation

Expired Documents versus Expired Immigration Status.

Many immigration documents have expiration dates; however, an expired immigration document does not necessarily mean the immigration status has expired. For instance, Qualified Alien status does not expire even if the immigration documents expire, with the following exceptions:

  • Lawful Permanent Residents with Conditions (2 year Conditional Residents): Conditional residents receive a 2 year LPR card, often based on a recent marriage to a U.S. citizen. At the end of the 2 years, they must either file a joint petition to remove the condition or a request for a waiver of the joint filing requirement (for instance, on grounds of divorce and /or domestic violence). Clients with this expired status must provide proof of a pending petition to remove the condition or of an application to waive the joint filing requirement.
  • Parolees: Their status expires after the expiration date. Parolees usually have an I-94 arrival/departure record stamped with an entry and expiration date. Some may have their expiration date stamped "waived" or "indefinite".

On the other hand, Nonqualified Alien status (including those in the U.S. on nonimmigrant visas) typically expires when their immigration documents expire.

Additional Information Regarding Specific Document Types and Status

Form I-797

Notice of Action may or may not have an expiration date. It is used to notify the individual that a fee was paid, an application was accepted, the case is pending, a step in the process is completed, or status is approved. Individuals with I-797s are undocumented unless it verifies that status has been approved.

Example: An example that a step in the process has been completed but status has not been approved is the Notice of Approval for Immigrant Petition for Relative. This is the initial step in the family-related immigrant application process. It solely establishes relationship. It does not establish status. If this is the only document provided, the individual is considered undocumented for purposes of benefits eligibility.

Example: An example that status is approved is the Approval Notice of an I-360 Self-Petition under the Violence Against Women Act (VAWA). In most cases a VAWA self-petitioner will first receive a Prima Facie notice, indicating that the petitioner has submitted evidence sufficient to establish a case. Both notices verify that the individual is a Qualified Alien and their status does not expire.

Order from Immigration Judge

An order is issued because the immigrant is or has been in removal proceedings. The Judge provides a decision notifying the individual whether the individual can remain in the country. The order does not have an expiration date.

Example: An example of a status granted by an "Order from Immigration Judge" are Granted Withholding of Deportation which is a qualified alien category and Order of Supervision which is a nonqualified alien category.

Form I-589

Application for Asylum (nonqualified alien) does not have an expiration date; however, USCIS is required to provide a decision within 180 days. Despite this requirement, some asylum applicants may not receive a decision within the 180 day deadline. If the document is more than 180 days old, staff will need to check USCIS website (see below) to determine if it is still pending a decision. If still pending a decision, the asylum applicant retains their nonqualified status.

Note: If an applicant for Asylum is a national of Cuba or Haiti they are Cuban/Haitian Entrants eligible for benefits to the same extent as refugees while their application is pending.

Form I-912

In cases with expired immigration documents, individuals should apply with USCIS for renewal and submit the Form I-912 (Request for Fee Waiver) at the same time. Individuals seeking or receiving public assistance, including Apple Health, are eligible for Fee Waivers with their application. Fee Waiver Guidance can be found at USCIS - Fee Waiver Guidance.

  • If USCIS denies the fee waiver request, they will notify the individual with a notice of rejection and an explanation why the fee waiver request was denied. In these cases, copy the notice of rejection into the individual’s file and offer help paying for the documents. If USCIS approves the fee waiver request, the individual will also be notified.
  • Staff can check the current case status of pending USCIS documents by entering the receipt number on the document at the USCIS website.

Note: If you are uncertain about someone’s eligibility for benefits after reviewing this clarifying page, please contact your area representative.

Worker Responsibilities

Classic Medicaid (in Washington Connection) Modified Adjusted Gross Income (MAGI) - Based Medicaid (in Healthplanfinder)
Applicants who have been granted DACA status should be coded CL in the INS Stat field on the ALAS screen Applicants who have been granted DACA status should be described as "Not Lawfully Present" in Healthplanfinder.
  • For all Apple Health applications, make sure you match names, dates of birth, and immigration document expiration dates with what is on the application.
  • If unable to verify that claim is still pending using the USCIS website, the individual will need to provide updated documentation from USCIS as to their current status.

ACES Procedures

Recording Citizenship / Alien Status

See Client Demographic 2 (DEM2) Screen

Completion of the (ALAS) Screen for Noncitizens

See Aliens, Students, and Medically Indigent (ALAS) Screen