Clarifying information

An individual'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 MAGI-based Medicaid programs). Everyone falls into one of the following four citizenship/immigration status groups for purposes of determining Apple Health eligibility:

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

Lawfully present

A lawfully present immigrant refers to any noncitizen or immigrant 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.

For a list of typical citizenship/immigration documents see the:

• National immigration Law Center (NILC) Guide in Appendix II; or
• Documents Typically Used by Lawfully Present Immigrants.

Qualified immigrant/nonqualified immigrant terms

Qualified immigrant and nonqualified immigrant are terms used in federal immigration law and do not by themselves indicate whether an immigrant is eligible for Apple Health coverage benefits. Both qualified immigrants and nonqualified immigrants may be eligible for health care coverage.

For an overview of citizenship and immigration status eligibility rules, see the Citizenship and Immigration Status Guide.

Qualified immigrants

Certain qualified immigrants who are exempt from, or who have met, the 5-year bar are potentially eligible for federally-funded Apple Health (Medicaid) programs.

A qualified immigrant who is not exempt or has not yet met the 5-year bar is potentially eligible for Apple Health for kids and pregnant individuals, after-pregnancy coverage, state-funded Apple Health Expansion, or if they have a qualifying medical emergency under the Emergency Medical (AEM) program as described under WAC 182-507-0110.

Immigrants included in the qualified immigrant category can be found at Citizenship and Immigration Status Guide.

5-year bar

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

For more information on the 5-year bar see the Citizenship and Immigration Status Guide.

The following immigrant categories are exempt from the 5-year bar:

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 immigrants" who are exempt from the 5-year bar.

Cuban/Haitian entrants include:

• Cuban and Haitian nationals who have current or expired parole;
• Cuban and Haitian nationals who are in pending removal proceedings;
• Cuban and Haitian nationals who have a pending application for asylum; or
• Have an I-94 stamped Cuban/Haitian Entrant pending.

Cuban-Haitian entrants who apply for asylum are exempt from the 5-year bar while their application is pending. Asylum applicants of other nationalities are non-qualified immigrants.

Cuban/Haitian entrants who are in removal proceedings remain exempt from the 5-year bar until a final, non-appealable, and legally enforceable order of removal, deportation, or exclusion has been issued. If a Cuban/Haitian Entrant is in removal proceedings, or is suspected of being in removal proceedings, or indicates a previous order is under appeal, call the Executive Office of Immigration Review (EOIR) at 1-800-898-7180 to confirm their current status.

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 immigrants exempt from the 5-year bar unless they have some other immigration status.

Armed Service Members or Veterans

Lawful Permanent Residents, parolees, or battered immigrants who are also an armed services member or veteran, or a family member of a veteran as described below:

• On active duty in the US military, other than active duty for training;
• An honorably discharged US veteran;
• The spouse, an un-remarried widow or widower; or Unmarried dependent child of a veteran or active-duty service member.

Other exemptions

The following categories are exempt from the 5-year bar if they have adjusted to lawful permanent residents:

• Refugee
• Asylee
• Amerasian
• Cuban/Haitian
• Victims of trafficking
• Immigrants from Iraq or Afghanistan granted the following:
  • Special immigrant status
  • Special immigrant conditional permanent resident
• Became a permanent resident and;
  • Has worked 40 qualifying quarters of coverage as defined under title II of the Social Security Act or can be credited with such qualifying quarters as provided under section 1645 of this title, and
  • In the case of any such qualifying quarter creditable for any period beginning after December 31, 1996, did not receive any Federal means-tested public benefit (as provided under section 1613 of this title) during any such period.

Nonqualified immigrants

Nonqualified immigrants may have permanent or temporary permission to stay in the U.S. and potentially qualify for Apple Health for kids, pregnancy, After-Pregnancy Coverage, Apple Health Expansion, or Emergency Medical (AEM) as described under WAC 182-507-0110.

Some lawfully present nonqualified individuals have temporary status or pending applications and consequently their status may expire when their documents expire or when a final denial of their application is issued.

Immigrants included in the non-qualified category can be found at the Citizenship and Immigration Status Guide.

Deferred Action Childhood Arrival (DACA or "Dream Act"), is technically considered a non-qualified status; however, they are not eligible for federally-funded Washington Apple Health. DACA individuals may be eligible for state-funded health care coverage, including Apple Health for kids, pregnancy, After-Pregnancy Coverage, Apple Health Expansion, or Emergency Medical (AEM).

Not lawfully present (undocumented)

Not lawfully present 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.

Citizens/U.S. nationals

U.S. citizens

U.S. citizens include the following:

• Individuals born in the U.S; or its territories - Guam, Puerto Rico, the U.S. Virgin Islands; and residents of the Northern Mariana Islands who chose to become U.S. citizens.
• Individuals who have become naturalized U.S. citizens.
• *Certain individuals born abroad to at least one U.S. citizen.

U.S. nationals

Individuals born in America Samoa or Swain Island and residents of the Mariana Islands who did not choose to become U.S. citizens.

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.

The Child Citizenship Act of 2000

Individuals born abroad to at least one U.S citizen parent depending on conditions at time of birth, per Title 8, Subchapter III, Section 1401 of the Unites States Code.

Individuals who turn 18 years of age on or after February 27, 2001, automatically become U.S citizens if the following conditions are met while the individual is under age eighteen per INA Section 320.

• The individual is granted lawful permanent resident (LPR) status.
• At least one of the individual’s parents is a U.S citizen by birth or naturalization, and the individual:
  • Resides in the U.S. in the legal and physical custody of the citizen parent; or
  • Was adopted according to the requirements of INA Section 101 and resides in the U.S. in the legal and physical custody of the citizen parent.

Individuals who turned 18 before February 27, 2001, would have automatically become U.S. citizen if, while the individual was still under eighteen became a permanent resident and both parents naturalized. Such individuals may have also derived citizenship when only one parent naturalized, if the other parent was dead or a U.S. citizen by birth, or the individual’s parents were separated and the naturalized parent had custody.

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

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

For individuals who automatically become citizens under the 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.

If unable to verify, refer individual to an immigration attorney at:

• Northwest Justice Project at 206-464-1519 or 1-888-201-1012
• Northwest Immigrant Rights Project - Seattle - 206-587-4009 or 1-800-445-5771
• Northwest Immigrant Rights Project - Tacoma - 253-383-0519 or 1-877-814-6444
• Northwest Immigrant Rights Project - Granger - 509-854-2100 or 1-888-756-3641; or
• Northwest Immigrant Rights Project - Wenatchee - 509-570-0054 or 1-866-271-2084

Reasonable opportunity period

Individuals otherwise eligible for Apple Health are conditionally approved and granted a reasonable opportunity period (ROP) of up to 90 days to obtain and provide verification of their citizenship or immigration status. The ROP may extend beyond 90 days if the individual requests additional time, and they are making a good faith effort to obtain the necessary documentation.

Examples of good faith effort includes:

• Up-to-date documents showing immigration status is pending with DHS/United States Citizenship and Immigration Services (USCIS).
• Other verification that reasonably verifies that a good faith effort is being made.

When the individual's citizenship or immigration status has not been verified by the end of the ROP, coverage may end.

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 immigration 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 immigration 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 immigrant 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 immigrant category and Order of Supervision which is a nonqualified immigrant category.

Form I-589

Application for Asylum (nonqualified immigrant) 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.

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.

For a list of typical citizenship/immigration documents see the:

• National Immigration Law Center (NILC) Guide in Appendix II; or
• Documents Typically Used by Lawfully Present Immigrants.