General eligibility requirements that apply to all Apple Health programs

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Citizenship and immigration status general requirements

Revised Date: 
December 15, 2014

Purpose: To provide information on how an applicant's immigration status affects their eligibility for health care coverage, including nonemergency Medicaid and the state children’s health insurance program (CHIP).

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

All applicants for Apple Health programs must provide their citizenship/immigration status. Immigration status determines what program an applicant is eligible for, including whether the program is state-funded or federally-funded. See Definitions for more information on citizenship and the different immigration statuses. For some immigration statuses, the date of entry is an important factor in determining eligibility for Apple Health programs. See Date of Entry for more information.

All individuals fall into one of the following groups:

  • U.S. Citizens and U.S. Nationals
  • Lawfully Present Qualified Aliens
    • Must meet 5-year bar; or
    • Exempt from 5-year bar
  • Lawfully Present Nonqualified Aliens
  • Undocumented Individuals

See the Citizenship and Immigration Status Guide for detailed information on each of the groups.

Some noncitizens who served in the military may be considered a veteran when they meet the following conditions:

  1. Served in any branch of the U.S. armed services,
  2. Fulfilled the minimum active duty service requirements or 24 months of continuous active service, whichever is less, and
  3. Was honorably discharged or released.

Veterans also include individuals who died while on active duty or after being released from active duty. Surviving spouses who have not remarried and dependent children of veterans are treated as veterans for purposes of this rule.

Note: The 5-year bar does not apply to individuals that have obtained a “qualified alien” status within the last 5 years, if they entered the U.S. prior to 8/22/96 and have continuously lived in the U.S. since 8/22/96. See WAC 182-503-0535.

Note: The code on the green card indicates how an LPR entered the U.S. If an individual entered the U.S. under a status that is exempt from the 5-year bar and they have had LPR status for less than 5 years, they are still exempt from the 5-year bar.

Note: An Employment Authorization Document (EAD) does not in itself confer immigration status. EADs contain coded information that indicates an individual's immigration status. Immigrants with a variety of statuses may be issued an EAD. An expired EAD does not mean that a person's immigration status has expired and should not in itself be a reason to deny benefits.

Note: Examples of violation of status are persons who overstay their visa or work without permission from USCIS. If in violation of status and still in the U.S. without proof of pending status change or extension of status, these nonimmigrants are considered undocumented.

Example: An individual applying for benefits has an I-94 (Arrival/Departure Record) with a "B2" code that is not expired. According to the NILC Guide, "B2" signifies tourist status. A person with a tourist status is considered a lawfully present nonimmigrant and if otherwise eligible (including residency requirements) may qualify for Apple Health for Kids or Pregnant Women.

Example: A five-person family applies for benefits. The father has a Lawful Permanent Resident card (I-551) but the mother and three children only have Employment Authorization Documents (EADs). All four EADs are coded "A15". According to the NILC Guide, the "A-15" code indicates "V" status. These are spouses and children of lawful permanent residents whose visa petitions have been pending for at least three years. Immigrants with "V" status are lawfully present nonqualified aliens. These aliens may qualify for state benefits or federal Apple Health for Kids or Pregnant Women. The father may be eligible for federal benefits depending on other factors such as date of entry into the U.S.

Worker Responsibilities

  1. When working or reviewing an individual’s case, it is important to enter an applicant’s immigration status correctly. If you enter the immigration status incorrectly, it can improperly increase the agency’s costs.
    1. For example, if an applicant is a “Nonqualified Alien”, the applicant’s immigration status should never be entered as “Not Lawfully Present” (in Healthplanfinder) or “Undocumented” (in ACES).
  2. If working a Classic Medicaid case in ACES, gather all the information necessary to determine eligibility as described in WAC 182-503-0535. Document immigration status, date of entry, armed service/veteran status, work quarters (if applicable), and SSN information in the system. Inform any individual who is subject to the five-year bar of the expiration date of their five-year bar and of the need to inform the agency if family members become citizens (including parents who have children under 18). See ACES Manual for more information.
  3. For immigrants who have applied for Classic Medicaid and who have an Affidavit of Support form (I-864) filled out on their behalf, be sure to determine work quarters and immigration status. If the affidavit is still in effect:
    1. See WAC 182-512-0785 and WAC 182-512-0790 to determine if sponsor deeming applies; and
    2. See WAC 182-512-0795 for treatment of the sponsor's income.

Alien Emergency Medical

See Alien Emergency Medical Programs.