5101:1-38-02.3 Medicaid: qualified aliens.

(A) The purpose of this rule is to define the criteria qualified aliens shall meet in order to have potential eligibility for medicaid.

(B) Definitions.

(1) "A-number" means the alien registration number, which is issued to the alien by the United States citizenship and immigration service (USCIS) or, in limited circumstances, by the United States department of state.

(2) "Active duty" means full-time employment in the military service, and does not include reserve or guard duty. The service member shall serve a minimum of twenty-four months or the period for which the person was called to military service in order to be eligible for benefits that are based on the length of active duty service.

(3) "Amerasian" means an alien born in Cambodia, Korea, Laos, Thailand, or Vietnam after December 31, 1950, and before October 22, 1982, and who was fathered by a U.S. citizen.

(4) "Asylee" means a person who has been granted asylum.

(5) "Federal means-tested public benefit" means a benefit in which eligibility for the benefit or the amount of the benefit, or both, is determined on the basis of income or resources of the individual seeking the benefit. Medicaid is a federal means-tested public benefit, but certain other benefits listed in 8 U.S.C. 1613(c) (as in effect on September 1, 2009) are not considered means-tested.

(6) "Immigrant" means a person who comes to the United States with plans to live here permanently. This term includes refugees, asylees, parolees, and other entrants, both legal and illegal.

(7) "Indefinite detainee" means a non-citizen who has served time for a criminal conviction and has received a final order of removal, but remains indefinitely in the United States because neither his or her home country nor any other country will accept the individual. Being an indefinite detainee does not confer medicaid eligibility upon an individual nor does it serve as an exemption to either the five-year bar described in paragraph (D) of this rule or the seven-year limit on eligibility described in paragraph (E)(1) of this rule.

(8) "Lawful permanent resident" (LPR) means an individual who has been granted the privilege of living permanently in the United States as an immigrant.

(9) "Parolee" means a person who has been given permission by the United States department of justice or the United States department of homeland security to enter the United States in an emergency or because it serves an overriding public interest. Parolees are granted temporary residence and are not on a predetermined path to permanent resident status.

(10) "Qualified alien" means an alien whose immigration status is one of the following at the time he or she applies for, receives, or attempts to receive medicaid:

(a) Lawful permanent resident; or

(b) Granted asylum under section 208 of the Immigration and Nationality Act

(INA) (as in effect on September 1, 2009); or

(c) A refugee who is admitted to the United States under section 207 of the INA (as in effect on September 1, 2009); or

(d) A parolee allowed into the United States under section 212(d)(5) of the INA (as in effect on September 1, 2009) for a period of at least one year; or

(e) An alien whose deportation is being withheld under section 243(h) or 241(b)(3) of the INA (as in effect on September 1, 2009); or

(f) Granted conditional entry pursuant to section 203(a)(7) of the INA as in effect prior to April 1, 1980; or

(g) A Cuban or Haitian entrant as defined in section 501(e) of the Refugee Education Assistance Act of 1980; or

(h) An Amerasian immigrant; or

(i) An alien or alien's child who has been battered or subjected to extreme cruelty, as defined in 8 U.S.C. 1641(c) (as in effect on September 1, 2009).

(j) An Afghan or Iraqi alien granted special immigrant visa status under section 101(a)(27) of the INA in accordance with the Consolidated Appropriations Act of 2008 and the National Defense Authorization Act for Fiscal Year 2008.

(11) "Quarter of coverage" is the basic unit for determining whether a worker is insured under the social security program. The amount of wages and self-employment income which an individual shall have in order to be credited with a quarter of coverage is defined in 42 U.S.C. 413(d) (as in effect on September 1, 2009), and is published annually in the Federal Register.

(12) "Refugee" means a person who flees his or her country due to persecution or a well-founded fear of persecution because of race, religion, nationality, political opinion, or membership in a social group.

(13) "Veteran" means an individual who served in the active military service and who was discharged or released from duty under honorable conditions. This term includes military personnel who die during active duty service, as defined in 38 U.S.C. 1101 (as in effect on September 1, 2009), and Filipinos described in 38 U.S.C. 107 (as in effect on September 1, 2009). These are individuals who served in the Philippine Commonwealth army during World War II or as Philippine scouts following the war.

(14) "Victim of trafficking."

(a) Victims of trafficking and certain family members, as identified in the Trafficking Victims Protection Reauthorization Act of 2003 (TVPRA) ( Pub. L. No. 108-193 ), are eligible for federally funded or administered benefits to the same extent as refugees, per 22 U.S.C. 7105(b)(1)(A) (as in effect on September 1, 2009).

(b) Victims of trafficking are awarded a certification letter from the office of refugee resettlement (ORR) and are potentially eligible for medicaid. Certain family members are awarded "Derivative T" visas and are potentially eligible for medicaid.

(i) ORR makes the certification determinations and issues letters of certification for adult victims of trafficking.

(ii) Victims of trafficking who are younger than eighteen years of age do not need to be certified in order to receive benefits. Instead, ORR issues notarized letters similar to adult certification letters, stating the child is a victim of trafficking.

(c) A victim of trafficking is not required to provide any other documentation of immigration status to receive benefits, unless the victim's immigration status has changed.

(C) An alien who is lawfully residing in the United States as of August 22, 1996, shall continue to meet the citizenship requirements for medicaid. The alien:

(1) Does not have to meet the definition of a qualified alien; and

(2) Did not have to be receiving assistance prior to August 22, 1996.

(D) A qualified alien who enters the United States on or after August 22, 1996 does not meet the citizenship requirement for medicaid for a period of five years beginning on the date of the alien's entry into the United States with a status of "qualified alien."

(E) Exceptions to the five-year period of ineligibility for benefits as set forth in paragraph (D) of this rule are:

(1) An alien whose status meets any of the following criteria, as defined in paragraph (B)(10) of this rule, has potential eligibility for medicaid for seven years from the date status is granted:

(a) Refugee,

(b) Granted asylum,

(c) Deportation is being withheld,

(d) Cuban or Haitian entrant, or

(e) Amerasian immigrant.

(2) Victims of trafficking are potentially eligible for benefits and services to the same extent as an alien admitted to the United States as a refugee under Section 207 of the INA (as in effect on September 1, 2009).

(3) An alien who is an LPR and has forty quarters of coverage under Title II of the Social Security Act or can be credited with such quarters. In determining the number of quarters of coverage, an alien shall be credited as follows:

(a) All of the qualifying quarters of coverage worked by a natural or adoptive parent of such alien before the date the individual attains age eighteen can be credited; and

(b) All of the qualifying quarters worked by a spouse of such alien during their marriage can be credited so long as the alien remains married to such spouse or such spouse is deceased.

(c) A qualifying quarter does not include any quarter after December 31, 1996 in which the individual worked and also received a federal means-tested public benefit.

(d) A parent or spouse whose quarters are credited to the alien can be a U.S. citizen or an LPR.

(4) A veteran who is lawfully residing in Ohio and who received an honorable discharge, not a discharge on account of alienage as described in 8 U.S.C. 1426 (as in effect on September 1, 2009).

(5) A military service member who is lawfully residing in Ohio and who is on active duty (other than active duty for training) in the armed forces of the United States.

(6) A spouse or unmarried dependent child of a veteran or active duty service member as described in paragraph (E)(4) or (E)(5) of this rule.

(7) The surviving spouse of a deceased veteran or service member, provided the spouse has not remarried and the marriage fulfills the requirements of 38 U.S.C. 1304 (as in effect on September 1, 2009):

(a) Married for at least one year; or

(b) Married before the end of a fifteen-year time span following the end of the period of military service in which the injury or disease was incurred or aggravated; or

(c) Married for any period if a child was born of the marriage or was born before the marriage.

(8) An Afghan or Iraqi special immigrant, as defined in paragraph (B)(10) of this rule, has potential eligibility for medicaid to the same extent and for the same length of time as a refugee described in paragraph (E)(1) of this rule, in accordance with the Department of Defense Appropriations Act of 2010. Eligibility is calculated from the date special immigrant status is granted.

(9) With respect to eligibility for medicaid, paragraph (D) of this rule shall not apply to any individual:

(a) Who is an American Indian born in Canada to whom the provisions of 8 U.S.C. 1359 (as in effect on September 1, 2009) apply; or

(b) Who is a member of an Indian tribe, as defined in 25 U.S.C. 450B(e) (as in effect on September 1, 2009).

(F) A qualified alien described in paragraph (D) of this rule who has been in the United States longer than five years shall either become a citizen or meet one or more of the exceptions set forth in paragraph (E) of this rule in order to be potentially eligible for medicaid.

(G) In order to continue being potentially eligible for medicaid , a qualified alien who has potential medicaid eligibility for seven years in accordance with paragraph (E)(1) of this rule and has now been in the United States longer than seven years shall either have become a citizen or meet one or more of the criteria set forth in paragraph (E)(3), (E)(4), (E)(5), (E)(6), or (E)(7) of this rule.

(H) Medicaid eligibility for an indefinite detainee will depend upon the individual's immigration status before the individual became an indefinite detainee.

(I) Individuals who are not qualified aliens, and individuals who are qualified aliens but are ineligible for benefits in accordance with paragraph (D) of this rule, have potential eligibility for alien emergency medical assistance (AEMA) as set forth in rule 5101:1-41-20 of the Administrative Code and are not required to verify alien status.

(J) Administrative agency responsibilities. The administrative agency shall:

(1) Verify the alien's immigration status. The following are acceptable verifications, and shall be original documents:

(a) I-94 (arrival/departure record).

(b) I-551 (permanent resident card).

(c) Visa in passport with a stamp from the appropriate issuing agency showing immigration status.

(d) Other documentation as prescribed or allowed by federal law.

(e) For victims of trafficking:

(i) The original certification letter or letter for children from ORR is to be used in place of immigration documentation from USCIS. Retain a copy in the case file. Victims of trafficking are not required to provide any other immigration documents to receive benefits.

(ii) The systematic alien verification for eligibility (SAVE) program does not contain information about victims of trafficking.

(f) An indefinite detainee most likely will not have documentation of original immigration status, and should instead present the following:

(i) I-220B (order of supervision), which should include the alien's A-number and notation concerning exclusion, deportation or removal; or

(ii) I-766, I-688A or I-688B (employment authorization documents), which should show either 8 C.F.R. 274a.12(c)(18) or 8 U.S.C. 1231(a)(7) (as in effect on September 1, 2009) as the provision of law authorizing employment.

(2) Verify the validity of the alien's original documents through the SAVE system maintained by USCIS. There are two methods of verifying the immigration documents provided by the alien:

(a) Primary verification through the SAVE system is an electronic verification of alien status provided within seconds of inquiry. This verification is used for most applicants.

(b) Secondary verification through the SAVE system is used when problems occur in the verification of alien status, and is required in any of the following situations:

(i) Documentation presented by the alien appears to be counterfeit or altered.

(ii) The individual presents unfamiliar USCIS documentation, or a document that indicates an immigration status but does not contain an A-number.

(iii) When an individual has no immigration documentation and is hospitalized, medically disabled or can otherwise show good cause for the inability to present documentation, and when securing such documentation would constitute an undue hardship.

(iv) When an individual presents a foreign passport or form I-94 and the "admission for permanent residence" endorsement is more than one year old.

(v) When an automated check of the SAVE system returns the response "institute additional verification" or when there is a material discrepancy between an alien's documentation and the information given by the SAVE system.

(vi) When an alien claims that he or she obtained lawful permanent (or conditional) resident status because he or she was a battered alien, the parent of a battered child, or the victim of domestic violence.

(3) Verify the veteran status of the applicant or the applicant's spouse or parent, as appropriate, when the applicant's eligibility is based upon the applicant's own, or another person's veteran status. Veteran status is verified by viewing an original or a certified copy of the DD Form 214 (undated).

(4) Verify with the social security administration, when applicable, whether an individual can be credited with forty qualifying quarters.

(5) Obtain the immigration status of an indefinite detainee by contacting ORR.

(6) Not deny or delay the alien's eligibility determination solely on the basis of the alien's immigration status:

(a) If verification cannot be obtained from the SAVE system; or

(b) Until a reasonable opportunity to submit immigration documentation has been provided.

Effective: 10/01/2010
R.C. 119.032 review dates: 10/01/2014
Promulgated Under: 111.15
Statutory Authority: 5111.01 , 5111.011
Rule Amplifies: 5111.01 , 5111.011
Prior Effective Dates: 6/1/93, 10/1/95, 7/1/98, 10/1/02, 4/1/03 (Emer.), 9/20/03, 10/8/09