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REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-003

USCIS Documents Issued by the Department of Homeland Security: Person Documents An alien lawfully admitted to the U.S. for permanent residence under the INA NFOCUS - select "Lawful Permanent Resident Form I-551, Alien Registration Receipt Card annotated with Section 101(a)(15), 101(a)(20), 212(b)(5), 245A, 245(b)(1), 249. A refugee admitted under the INA NFOCUS - select "Refugee- Section 207" Form I-94/I-94A, Arrival/Departure Record annotated with Section 207, Form I-688B annotated with Section 247A.(a)(3), which is valid until the refugee receives Form I-766, Employment Authorization Document (EAD) annotated with 271a12(a3). Asylum granted under the INA NFOCUS - Select "Asylee- Section 208" Form I-94/I-94A, annotated with Section 208, and/or a notation such as “asylum granted indefinitely.” Grant letter/Order from Asylum Office of USCIS; Form I-688B annotated 274a12(a)(5) or Form I-766 annotated 274a12(A5). Deportation is being withheld under the INA NFOCUS - Select "Deportation Withheld - Section 243(h)" Form I-94, annotated with Section 243(h), or 241(b)(3) of the INA. Order of an Immigration Judge showing deportation withheld under 243(h) or 241(b)(3) and date of the grant or Form I-688B annotated 274a12(c)(10) or Form I-766 annotated 274a12(A10). An alien granted parole for at least 1 year under INA NFOCUS - Select "Public Interest Parolee - Section 121(d)(5) Form I-94, annotated with Section 212(d)(5) and showing granting of parole for at least one year. Cuban or Haitian entrant NFOCUS - Select "Cuban- Haitian Entrant - Section 207" (207 will be corrected) Form I-94, annotated as "Cuban/Haitian Entrant CU6, CU7, CH6 Reviewable January 15, 1981." annotated 501(e). Form I-511 with coding CH6 or unexpired temporary card I-511. Form I-94 annotated 212(d)(5). Alien who has been battered or subjected to extreme cruelty NOCUS - Select "Worker determined Eligible" Letter stating approval of applicant's petition, Section 204(a)(1)(A)(iii) or Form I-511 "COA." Form I-797 indication that applicant has established prima facie case. Amerasian (Vietnam) NFOCUS - Select "Amerasian" Form I-94 annotated 204 or 584, Form I-511 annotated 204 or 584.