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Page 10 – CMCS Informational Bulletin Section 71109. Alien Medicaid Eligibility Under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) (Public Law 104-193), certain “qualified aliens,” also referred to as “qualified noncitizens,”17 (e.g., lawful permanent residents (LPRs)/“green card holders,” refugees, and asylees) are eligible for federal public benefits, including full Medicaid and CHIP coverage, if they meet all other eligibility requirements in the state (e.g., residency, income). Other federal statutes require other categories of individuals – including certain victims of human trafficking18 and certain Afghan19 and Ukrainian20 parolees – to be treated as “refugees” and therefore they are considered eligible for full Medicaid or CHIP coverage, if they meet all other eligibility requirements in the state. In accordance with PRWORA, many qualified noncitizens are subject to a five-year waiting period before becoming eligible for full Medicaid benefits or CHIP coverage, but some noncitizens are exempted from the five-year waiting period in Medicaid and CHIP (e.g., refugees and asylees).21 The Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) (Public Law 111-3) authorized an option for states to provide full Medicaid and CHIP coverage to children up to age 21 (up to age 19 for CHIP) and pregnant women who are lawfully residing in the U.S., without having to meet the five-year waiting period if otherwise applicable (often referred to as the “CHIPRA 214 option”). Section 71109 amends sections 1903(v) and 2107(e)(1) of the Act to restrict, with limited exceptions, federal financial participation (FFP) for medical assistance (Medicaid) and child or pregnancy-related health assistance (CHIP) to the following groups beginning October 1, 2026: 17 “Qualified noncitizen” is defined at 42 CFR § 435.4 for Medicaid and cross referenced at 42 CFR § 457.320(c) for CHIP, and includes: 1) noncitizens who are considered “qualified aliens” under 8 U.S.C. § 1641(b) and (c); and 2) noncitizens who are treated as refugees under other Federal statutes. 18 22 U.S.C. § 7105(b)(1)(C), or who are classified as nonimmigrants under § 101(a)(15)(T)(ii) of the Immigration and Nationality Act (8 U.S.C. § 1101(a)(15)(T)(ii)), pursuant to 22 U.S.C. § 7105(b)(1)(A). See also 8 U.S.C. § 1641(c)(4). 19 Section 2502 of the Extending Government Funding and Delivering Emergency Assistance Act (Public Law 117- 43 as amended, enacted September 30, 2021) and Section 1501 of the Consolidated Appropriations Act, 2023, Public Law 117-328. 20 Section 401 of the Additional Ukraine Supplemental Appropriations Act (Public Law 117-128 as amended, enacted May 21, 2022; Title III, Section 301 of Public Law 118-50, which amends Section 401(a)(1)(A) of the Additional Ukraine Supplemental Appropriations Act, 2022. 21 8 U.S.C. § 1613(b).