17.02 General Rules

Health benefits, in general. Except as provided in paragraphs (b) through (d) of this subsection, as a condition of eligibility for health benefits, an individual must be a citizen or national of the United States and, for purposes of enrollment in a QHP, must reasonably expect to be a citizen or national for the entire period for which QHP enrollment is sought. Enrollment in Medicaid. An individual who is a non-citizen is eligible for Medicaid if the individual otherwise satisfies the eligibility requirements and is: (1) A qualified non-citizen who (i) Is subject to the five-year bar on Medicaid enrollment at § 17.03(a); and (ii) Has exceeded the five year waiting period; (2) A qualified non-citizen who is not subject to the five-year bar under § 17.03(b); or (3) A non-citizen who is not subject to the five-year bar under § 17.03(c), regardless of whether the individual is a qualified non-citizen. Enrollment in a QHP, with or without APTC or CSR. An individual who is a non-citizen who is lawfully present in the United States is eligible for enrollment in a QHP, with or without APTC or CSR, if the individual otherwise satisfies the eligibility requirements for a QHP and is reasonably expected to be a non-citizen who is lawfully present for the entire period for which QHP enrollment is sought. Emergency medical services.10 An individual who is ineligible for Medicaid solely because of immigration status is eligible for the treatment of emergency medical conditions if all of the following conditions are met: (1) The individual has, after sudden onset, a medical condition (including emergency labor and delivery) manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in serious: (i) Jeopardy to the individual’s health; (ii) Impairment of bodily functions; or 9 42 CFR § 435.4. 10 A legally-present individual who is enrolled in a QHP, with or without subsidies, is nevertheless eligible for emergency Medicaid. See CMS Response to Comment, 77 FR 17144, 17170. Nonfinancial eligibility requirements Part 3 – Page 8 (Sec.17.00, Sub.17.03) (iii) Dysfunction of any bodily organ or part. (2) The individual meets all eligibility requirements for Medicaid except that non-qualified non-citizens need not present a Social Security number or document immigration status. (3) Emergency medical services do not include organ transplant procedures or routine prenatal or post partum care. 17.03 Medicaid eligibility of non-citizens including the applicability of the five-year bar (01/01/2026, GCR 25-052) Qualified non-citizens subject to 5-year bar.11 Non-citizens who enter the United States on or after August 22, 1996 as qualified non-citizens, as defined at § 17.01(d), are not eligible to receive Medicaid for five years from the date they enter the country unless the five-year bar is inapplicable to them pursuant to paragraph (b) or (c) below. If they are not qualified non-citizens when they enter, the five-year bar begins the date they become a qualified non-citizen. The following qualified non-citizens are subject to the five-year bar unless it is inapplicable to them pursuant to paragraph (b) or (c) below: (1) Lawful permanent residents (LPRs) as defined at § 17.01(d)(1)(i); (2) Non-citizens granted parole in the United States for at least one year as defined at § 17.01(d)(1)(iv); (3) Non-citizens granted conditional entry12 as defined at § 17.01(d)(1)(vi); and (4) Battered non-citizens as defined at §§ 17.01(d)(1)(ix) through (xi). Qualified non-citizens not subject to 5-year bar.13 The following qualified non-citizens, as defined at § 17.01(d), are not subject to the five-year bar: (1) Refugees as defined at §17.01(d)(1)(iii) and non-citizens treated as refugees as defined at §17.01(d)(2); (2) Asylees as defined at §17.01(d)(1)(ii); (3) Cuban and Haitian Entrants as defined at § 17.01(d)(1)(vii); (4) An individual who has been granted nonimmigrant status under section 1101(a)(15)(T) of the Immigration and Nationality Act or who has a pending application that sets forth a prima facie case for eligibility for such nonimmigrant status as defined at § 17.01(d)(1)(xi); 11 42 CFR § 435.406(a)(2); 8 USC § 1613(a). 12 As a practical matter the five-year bar will never apply to such non-citizens, since, by definition, they entered the United States and obtained qualified non-citizen status prior to August 22, 1996. 13 42 CFR § 435.406(a)(2); 8 USC § 1613(b). Nonfinancial eligibility requirements Part 3 – Page 9 (Sec.17.00, Sub.17.03) (5) Non-citizens whose deportation is being withheld as defined at § 17.01(d)(1)(v); and (6) [Reserved] (7) [Reserved] (8) [Reserved] (9) [Reserved] (10) [Reserved] (11) Compact of Free Association migrants as defined at § 17.01(d)(1)(viii).14 Non-citizens not subject to 5-year bar regardless of whether they are qualified non-citizens. The five-year bar does not apply to the following groups of non-citizens regardless of whether they are qualified non-citizens: (1) Non-citizens who are applying for treatment of an emergency medical condition only15; (2) Non-citizens who entered the United States and became qualified non-citizens prior to August 22, 1996; (3) Non-citizens who entered prior to August 22, 1996, and remained “continuously present” in the United States until becoming a qualified non-citizen on or after that date. Any single absence of more than 30 consecutive days or a combined total absence of 90 days before obtaining qualified non-citizen status is considered to interrupt “continuous presence.” (i) Non-citizens who do not meet “continuous presence” are subject to the five-year bar beginning from the date they become a qualified non-citizen. (ii) Non-citizens do not have to remain continuously present in the United States after obtaining qualified non-citizen status. (4) Non-citizens who are American Indians who were born in Canada and who are of at least one-half American Indian blood or who are a member of a Federally-recognized Indian tribe16; (5) [Reserved] (6) Non-citizen children under 21 years of age and non-citizen women during pregnancy and their post partum period, who are lawfully residing in the United States and otherwise eligible.17 Lawfully residing 14 Consolidated Appropriations Act of 2021, § 208; 8 USC §§ 1612(b)(2)(G) and 1613(b)(3). 15 8 USC § 1613(c)(2)(A). 16 8 USC § 1612(b)(2)(E). Abenaki is not a Federally-recognized Indian tribe. 17 § 214, Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA). Nonfinancial eligibility requirements Part 3 – Page 10 (Sec.18.00, Sub.18.01) means an individual who is a non-citizen who is considered lawfully present pursuant to § 17.01(g) and is a Vermont resident. (7) Non-citizen children receiving foster care or adoption assistance under Title IV-E of the Social Security Act (Social Security Act § 402(a)(3))18; (8) Lawful permanent residents who first entered the United States under another exempt category (e.g., refugee, asylee, Cuban or Haitian entrant, non-citizen whose deportation was being withheld) and who later converted to the LPR status; and (9) Non-citizens who are lawfully residing and are19: (i) A veteran (as defined in section 101, 1101 or 1301, or as described in section 107 of title 38) with a discharge that is characterized as an honorable discharge and not on account of immigration status, and who fulfills minimum active duty service requirements of § 5303A(d) of title 38; and (ii) On active duty (other than active duty for training) in the U. S. military; or (iii) The spouse or unmarried dependent child of an individual described in (i) or (ii) or the unremarried surviving spouse of an individual described in (i) or (ii) who is deceased if the marriage fulfills the requirements of section 1304 of title 38. Assignment of rights and cooperation requirements for Medicaid (01/01/2026, GCR 25-052)