Lawriter - OAC - 5160:1-2-12 Medicaid: non-citizens.

5160:1-2-12 Medicaid: non-citizens.

(A) This rule sets forth medicaid eligibility criteria for an individual who is not a U.S.citizen or national, acceptable documentary evidence of qualified non-citizen status, and the circumstances under which an individual who declares qualified non-citizen status, under penalty of perjury, may be given a reasonable opportunity to verify that status.

(B) Definitions. For the purposes of this rule:

(1) "A-number" means the alien registration number issued to a non-citizen 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, who was fathered by a U.S. citizen.

(4) "Asylee" means a person who has been granted asylum under section 208 of the Immigration and Nationality Act (INA) (as in effect on January 1, 2016).

(5) "Child" means an individual under the age of twenty-one.

(6) "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 the individual's 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 the five-year bar described in paragraph (C) of this rule.

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

(8) "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.

(9) "Qualified non-citizen" means:

(a) An LPR;

(b) An asylee;

(c) A refugee admitted to the United States under section 207 of the INA (as in effect on January 1, 2016);

(d) A parolee allowed into the United States under section 212(d)(5) of the INA (as in effect on January 1, 2016) for a period of at least one year;

(e) An alien whose deportation is being withheld under section 243(h) or 241(b)(3) of the INA (as in effect on January 1, 2016);

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

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

(h) An Amerasian immigrant;

(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 January 1, 2016); or

(j) An Afghan or Iraqi non-citizen 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.

(10) "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 January 1, 2016), and is published annually in the Federal Register.

(11) "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 as in effect on January 1, 2016), and Filipinos described in 38 U.S.C. 107 (as in effect on January 1, 2016). These are individuals who served in the Philippine Commonwealth army during World War II or as Philippine scouts following the war.

(12) "Victim of trafficking" refers to:

(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 ), who 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 January 1, 2016).

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

(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 individual who is not a U.S. citizen or national must be in a satisfactory immigration status to be eligible for medical assistance. An individual is considered to be in satisfactory immigration status if the individual is:

(1) A non-citizen who was lawfully residing in the United States as of August 22, 1996, and continues to be a lawful resident of the U.S.

(2) An indefinite detainee only if the individual was in a satisfactory immigration status when the individual became an indefinite detainee.

(3) A non-citizen who was granted qualified non-citizen status on or after August 22, 1996 does not have a satisfactory immigration status for medical assistance for a period of five years beginning on the date the status was granted, unless the individual is one of the following:

(a) An individual whose immigration status meets any of the following criteria:

(i) Refugee;

(ii) Asylee;

(iii) An alien whose deportation is being withheld under section 243(h) of the INA (as in effect on January 1, 2016);

(iv) Cuban or Haitian entrant;

(v) Amerasian immigrant;

(vi) Victim of trafficking; or

(vii) Afghan or Iraqi special immigrant.

(b) A lawfully residing pregnant woman.

(c) A lawfully residing child.

(d) An LPR who has forty quarters of coverage under Title II of the Social Security Act (as in effect on January 1, 2016) or can be credited with such quarters.

(i) 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;

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

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

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

(e) An individual who:

(i) Is a military member on active duty (other than active duty for training) in the armed forces of the United States; or

(ii) Is a veteran who received an honorable discharge, not a discharge on account of alienage as described in 8 U.S.C. 1426 (as in effect on January 1, 2016).

(f) A spouse or unmarried dependent child of a veteran or active duty service member as described in paragraph (C)(2)(e) of this rule.

(g) The surviving spouse of a deceased veteran or service member, provided the spouse has not remarried and the marriage fulfills the following requirements:

(i) Married for at least one year; or

(ii) 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

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

(h) An American Indian born in Canada to whom the provisions of 8 U.S.C. 1359 (as in effect on January 1, 2016) apply.

(i) A member of an Indian tribe, as defined in 25 U.S.C. 450B(e) (as in effect on January 1, 2016).

(D) An individual who is not a U.S. citizen or national and not in a satisfactory immigration status may be eligible for alien emergency medical assistance as described in rule 5160:1-5-06 of the Administrative Code, and is not required to verify alien status.

(E) Any individual applying for medical assistance and declaring a satisfactory immigration status shall bear the burden of proof of satisfactory immigration status.

(F) The process for establishing satisfactory immigration status shall include that:

(1) The administrative agency must attempt to verify an individual's immigrant status through the electronic eligibility system.

(2) If the individual's immigrant status cannot be verified through the electronic eligibility system, the individual must present documentary evidence of immigration status. The administrative agency is required to confirm the authenticity of the documentation provided by the individual through the automated systematic alien verification for entitlements (SAVE) system. Documentary evidence of immigration status refers to:

(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) 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 SAVE system does not contain information about victims of trafficking.

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

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

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

(ii) I-766 (employment authorization document) which must show 8 U.S.C. 1231(a)(7) (as in effect on January 1, 2016) as the provision of law authorizing employment.

(3) When the individual's eligibility is based upon the veteran status of the individual, the individual's parent, or the individual's spouse, veteran status is verified by viewing an original or a certified copy of the DD Form 214 (undated).

(G) Reasonable opportunity period for individuals who self-declare to be in satisfactory immigration status. If the administrative agency has been unable to verify satisfactory immigration status through the electronic eligibility system, and the individual has not provided verification as described in paragraph (E)(2) of this rule, the administrative agency shall give the individual reasonable opportunity to present verification of satisfactory immigration status.

(1) The administrative agency shall approve time-limited medical assistance, provided the individual satisfies all other conditions of eligibility outlined in rule 5160:1-2-10 of the Administrative Code.

(2) The reasonable opportunity period:

(a) Begins on the date of the individual's application.

(b) Ends ninety-five days after the administrative agency provides the individual (in person, electronically, or by mail) with the notice of the reasonable opportunity period.

(3) If, by the end of the reasonable opportunity period, the individual's immigration status has not been verified, the administrative agency must take action within thirty days to terminate eligibility.

Replaces: 5160:1-1- 58.3


Effective: 8/1/2016
Five Year Review (FYR) Dates: 08/01/2021
Promulgated Under: 111.15
Statutory Authority: 5162.03, 5163.02
Rule Amplifies: 5162.03, 5163.02
Prior Effective Dates: 10/1/13