Page 17

MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL C-420 Division of Welfare and Supportive Services GENERAL ELIGIBILITY REQUIREMENTS Medical Assistance Manual NON-CITIZEN MEDICAL ASSISTANCE ELIGIBILITY CHART 21 Oct 01 MTL 04/21 Eligible only if: ●individual meets any of the criteria listed above authorization, and such an applicant under the age of 14 who has had an application pending for at least 180 days alien granted withholding of removal under the Convention Against Torture pending application for Special Immigrant Juvenile status alien who is lawfully present in the Commonwealth of the Northern Mariana islands alien who is lawfully present in American Samoa under the immigration laws of American Samoa. Emergency Medicaid Eligible if: ● does not meet any of the criteria listed above Eligible Medicare "Premium Free" Part A (hospitalization) (eligibility based on work history) Eligible Eligible Eligible only if: ●Lawfully present, and eligibility for assistance is based on authorized employment Premium "Buy-in" Medicare Eligible only if: ● Lawful permanent resident who has resided continuously in the U.S. for at least 5 years Eligible only if: ●Lawful permanent resident who has resided continuously in the U.S. for at least 5 years. Not Eligible Key – * Status as refugee, asylee, withholding of deportation/removal, Cuban/Haitian Entrant or Amerasian but only during the first 7 years after attaining status. Eligibility continues for these individuals after the first 7 years as they have now been in qualified non-citizen status for over 5 years and have met the 5-year bar.