Clarifying information
A person's citizenship or immigration status must be determined as part of the eligibility determination for health care coverage under Apple Health (which includes both Classic Medicaid program and MAGI-based Medicaid programs). Everyone falls into one of the following four citizenship/immigration status groups for purposes of determining Apple Health eligibility:
- Lawfully Present Qualified Immigrant;
- Lawfully Present Nonqualified Immigrant;
- Not Lawfully Present (Undocumented) Immigrant; or
- Citizen or U.S. National.
Lawfully present
A lawfully present immigrant refers to any noncitizen or immigrant presently permitted to remain in the United States. Lawfully present means that USCIS has actively granted these immigrants permission to remain in the U.S. and has issued documentation of their lawfully present status that is currently valid. A lawfully present immigrant must still meet state residency requirements in WAC 182-503-0520 in order to qualify for health care coverage.
For a list of typical citizenship/immigration documents see the:
Qualified immigrant/nonqualified immigrant terms
Qualified immigrant and nonqualified immigrant are terms used in federal immigration law and do not by themselves indicate whether an immigrant is eligible for Apple Health coverage benefits. Both qualified immigrants and nonqualified immigrants may be eligible for health care coverage.
Note: If there is uncertainty about whether a particular individual has met the conditions for citizenship or immigration status, legal assistance is available at the Northwest Immigrant Rights Project in Western Washington at 206-587-4009 or in Eastern Washington at 509-854-2100.
Qualified immigrants
A qualified immigrant who is exempt from, or who has met, the 5-year bar is potentially eligible for federally-funded Apple Health (Medicaid) programs.
A qualified immigrant who is not exempt or has not yet met the 5-year bar is potentially eligible for state-funded Apple Health programs if they are a child, pregnant, or they have a qualifying medical emergency under the Alien Emergency Medical (AEM) program as described under WAC 182-507-0110.
Immigrants included in the qualified immigrant category can be found at Citizenship and Immigration Status Guide.
5-year bar
Federal law requires many qualified immigrants to wait five years before becoming eligible for Apple Health (Medicaid). This 5-year waiting period is commonly referred to as the 5-year bar. Unless exempt, the 5-year waiting period usually begins when the person receives their qualifying immigration status, not when they entered the U.S.
Note: The five-year bar does not apply to individuals that have obtained a qualified immigration status within the last 5 years, if they entered the U.S. prior to August 8, 1996, and have continuously lived in the U.S. since August 22, 1996.
Note: The category code on the I-551 Permanent Resident Card (green card) indicates how an LPR entered the U.S. If an individual entered the U.S. under a status that is exempt from the 5-year bar.
For more information on the 5-year bar see the Citizenship and Immigration Status Guide.
The following immigrant categories are exempt from the 5-year bar:
Refugee
An immigrant outside their own country of origin who is unable or unwilling to return to their country of origin because of persecution or on account of race, religion, nationality, membership in a particular social group, or political opinion as defined in sec. 101 (a)(42) of the INA, who are admitted under section 207 of the INA.
Asylee
A non-citizen in the U.S. or at a port of entry found to be unable or unwilling to return to their country or nationality, or to seek protection of that country because of persecution or well-founded fear of persecution.
Withholding of removal
Non-citizens in removal proceedings are granted withholding of removal when they can establish that it is more likely than not that their life or freedom would be threatened on account of race, religion, nationality, membership in a particular social group, or political opinion if returned to their native country. Only a judge can grant withholding of removal.
Amerasian
Amerasians who were born to U.S. citizen armed services member in Korea, Vietnam, Laos, Kambuchea, or Thailand, after December 31, 1950, but before October 22, 1982, who were admitted to the U.S. as immigrants pursuant to Section 584 of the Foreign Operation, Export Financing, and Related Programs Appropriations Act.
Hmong or Highland Laotian tribe members
Hmong (or Highland Laotian) tribe members born before May 8, 1975, whose tribe assisted the U.S. military during Vietnam era (August 5, 1964 to May 7, 1975) are “qualified immigrants” and potentially eligible for Apple Health (Medicaid) without having to meet the 5-year bar. The tribe member's spouse and unmarried dependent children under age 19 automatically qualify.
If the applicant does not have USCIS documentation of this status, he or she may submit the following statement under penalty of perjury: I was a Hmong (or Highland Laotian) tribe member when the tribe assisted the U.S. military during Vietnam era (August 5,1964 to May 7, 1975).
Cuban/Haitian entrants
Individuals approved for the Haitian Family Reunification Parole (HFRP) program will enter the U.S. as Cuban/Haitian entrants under 501(e) of the Refugee Education Assistance Act of 1980 and are "qualified immigrants" who are exempt from the 5-year bar.
Cuban/Haitian entrants include:
- Cuban and Haitian nationals who have current or expired parole;
- Cuban and Haitian nationals who are in pending removal proceedings;
- Cuban and Haitian nationals who have a pending application for asylum; or
- Have an I-94 stamped Cuban/Haitian Entrant pending.
Cuban/Haitian entrants who apply for asylum are exempt from the 5-year bar while their application is pending. Asylum applicants of other nationalities are non-qualified immigrants.
Cuban/Haitian entrants who are in removal proceedings remain exempt from the 5-year bar until a final, non-appealable, and legally enforceable order of removal, deportation, or exclusion has been issued. If a Cuban/Haitian Entrant is in removal proceedings, or is suspected of being in removal proceedings, or indicates a previous order is under appeal, call the Executive Office of Immigration Review (EOIR) at 1-800-898-7180 to confirm their current status.
Victims of human trafficking
Per the Victims of Trafficking and Violence Protection Act of 2000, the U.S. Department of Health and Human Services (HHS) is the sole federal agency authorized to certify foreign adult victims of human trafficking. Victims of trafficking will be issued a certification letter from the Office on Trafficking in Persons (OTIP). If you have questions about the validity of an OTIP certification letter, call 1-866-401-5510. Derivative T-statuses (family members of the primary victim) do not receive a certification letter.
Iraqi or Afghan special immigrants
Immigrants from Iraq or Afghanistan who were granted Special Immigrant Status under section 101(a)(27) of the INA; or Special Immigrant Conditional Permanent Residence; or Paroled under section 602(b)(1) of the Afghan Allies Protection Act or section 1059(a) of the National Defense Authorization Act of 2006 are qualified immigrants and are eligible for federally-funded Washington Apple Health. Their eligibility period starts from their date of entry into the United States or, if occurred after the U.S. entry, the date Special Immigrant Status was granted. .
Afghans granted humanitarian parole
Under the Consolidated Appropriations Act of 2023, Afghans granted humanitarian parole between July 31, 2021, and September 30, 2023 and their spouses and children, and the parents and guardians of unaccompanied minors who are granted parole after September 30, 2022, are evaluated as qualified immigrants until March 31, 2023, or the end or their parole term, whichever is later.
Ukrainians granted humanitarian parole
Ukrainians (and non-Ukrainians who last habitually resided in Ukraine) granted humanitarian parole between February 24, 2022, and September 30, 2023 and their spouses and children, and the parents and guardians of unaccompanied minors who are granted parole after September 30, 2022, under Section 401 of the Additional Ukrainian Supplemental Appropriations Act of 2022 are evaluated as qualified immigrants.
Citizens of the Republic of the Marshall Islands, the Republic of Palau and the Federated States of Micronesia
Citizens of Marshall Islands, Micronesia or Palau may have a birth certificate, current or expired I94 arrival or departure record, current or expired passport or other document verifying they are citizens of one of these countries. These individuals have special rights under Compacts of Free Association and are lawfully allowed to enter, reside and work in the U.S., but are not U.S. nationals. They are considered lawfully present qualified immigrants exempt from the 5-year bar unless they have some other immigration status.
Armed Service Members or Veterans
Lawful Permanent Residents, parolees, or battered immigrants who are also an armed services member or veteran, or a family member of a veteran as described below:
- On active duty in the US military, other than active duty for training;
- An honorably discharged US veteran;
- A Veteran of the military of the Philippines who served prior to July 1, 1946;
- The spouse, an un-remarried widow or widower; or Unmarried dependent child of a veteran or active-duty service member.
Nonqualified immigrants
Nonqualified immigrants have temporary permission to stay in the U.S. and potentially qualify for Apple Health for children, pregnancy, or Alien Emergency Medical (AEM) as described under WAC 182-507-0110.
Some lawfully present nonqualified aliens have temporary status or pending applications and consequently their status may expire when their document is expired or when a final denial of their application is issued.
Immigrants included in the non-qualified category can be found at the Citizenship and Immigration Status Guide.
Deferred Action Childhood Arrival (DACA or "Dream Act"), is technically considered a non-qualified status; however, they are not eligible for federally-funded Washington Apple Health. DACA persons may be eligible for state-funded health care coverage, including Apple Health for children, pregnancy, or Alien Emergency Medical (AEM).
Undocumented individuals
Undocumented individuals are individuals who are not lawfully present. This includes both individuals who entered the U.S. without document inspection and individuals whose lawful presence status has expired.
An individual whose lawful presence has expired may be in the process of pursuing an extension or change of status. Without evidence of actively pursuing an extension or change of status, an individual whose lawful presence status has expired will be considered an undocumented individual.
Citizens/U.S. nationals/qualifying American Indians born abroad
U.S. citizens
U.S. citizens include the following:
- Individuals born in the U.S; or its territories - Guam, Puerto Rico, the U.S. Virgin Islands; and residents of the Northern Mariana Islands who chose to become U.S. citizens.
- Individuals who have become naturalized U.S. citizens.
- *Certain individuals born abroad to at least one U.S. citizen.
U.S. nationals
Individuals born in America Samoa or Swain Island and residents of the Mariana Islands who did not choose to become U.S. citizens.
American Indians/Alaska Natives
The term American Indian refers to members of federally recognized (and in some cases, state-recognized) tribes in the U.S. The term Alaska Native refers to members of Alaska Native Villages and of Alaska Native Corporations under the Alaska Native Corporation Settlement Act.
American Indians and Alaska Natives born outside the United States are eligible for federal benefits to the same extent as American Indians and Alaska Natives born in the U.S. if they are:
Note: Noncitizen American Indians have the same eligibility for health care coverage as U.S. Citizens, but citizen documentation requirements do not apply. Instead they will need to provide tribal verification.
Example: A member of a federally recognized tribe (e.g., Pueblo) who is a Mexican citizen gives birth to a child outside of the U.S. The child qualifies as a member of the tribe but is not a citizen. That child is potentially eligible for Washington Apple Health as long as the child can establish that he or she is a member of the federal tribe.
Qualifying American Indians born abroad
- Individuals born in Canada who have at least fifty percent American blood, regardless of tribal membership; or
- Individuals born outside of the United States who are:
- Members of a federally recognized tribe; or
- Alaska Natives enrolled by the Secretary of the Interior under the Alaska Native Claims Settlement Act.
Qualifying American Indians born abroad have the same eligibility requirements as U.S. citizens; however, citizenship and identity requirements do not apply. They will need to provide the following verification as appropriate:
- Canadian birth certificate;
- Tribal affiliation; and/or
- Blood quantum
The Child Citizenship Act of 2000
For children born outside the U.S. to acquire citizenship under the Child Citizenship Act of 2000, they must meet all the conditions in WAC 182-503-0530 on or after February 27, 2001. The Act applies to children related to the citizen parent by birth or adoption only - stepchildren are not included unless also adopted. Citizenship for these children can depend on:
- Which parent is a U.S. citizen;
- How long the citizen parent resided in the U.S.; and
- Whether the parents were married at the time.
Once a child becomes a citizen under the Act, subsequent changes in the parents' marital status, such as separation or divorce, have no bearing on the child's citizenship. Nor does it matter whether the parent in question became a U.S. citizen after entering the U.S.
If a child is 18 years or older when the parent becomes a citizen, child citizenship laws do not apply, and he/she must independently apply for naturalization.
For individuals who automatically become citizens under terms of the Child Citizenship Act of 2000 or previous legislation, USCIS issues no documentation unless requested. Individuals themselves may not be aware that they or their children are already citizens.
If unable to verify, refer individual to an immigration attorney at:
- Northwest Justice Project at 206-464-1519 or 888-201-1012
- Northwest Immigrant Rights Project - Seattle - 206-587-4009 or 800-445-5771
- Northwest Immigrant Rights Project - Tacoma - 253-383-0519 or 877-814-6444
- Northwest Immigrant Rights Project - Granger - 509-854-2100 or 888-756-3641; or
- Northwest Immigrant Rights Project - Wenatchee - 509-570-0054 or 866-271-2084
Reasonable opportunity period
Individuals otherwise eligible for Apple Health are conditionally approved and granted a reasonable opportunity period (ROP) of up to 90 days to obtain and provide verification of their citizenship or immigration status. The ROP may extend beyond 90 days if the individual requests additional time, and they are making a good faith effort to obtain the necessary documentation.
Examples of good faith effort includes:
- Up-to-date documents showing immigration status is pending with DHS/United States Citizenship and Immigration Services (USCIS).
- Other verification that reasonably verifies that a good faith effort is being made.
When the individual's citizenship or immigration status has not been verified by the end of the ROP, coverage may end.
Immigration documentation
Expired documents versus expired immigration status.
Many immigration documents have expiration dates; however, an expired immigration document does not necessarily mean the immigration status has expired. For instance, qualified immigration status does not expire even if the immigration documents expire, with the following exceptions:
- Lawful Permanent Residents with Conditions (2-year Conditional Residents): Conditional residents receive a 2-year LPR card, often based on a recent marriage to a U.S. citizen. At the end of the 2 years, they must either file a joint petition to remove the condition or a request for a waiver of the joint filing requirement (for instance, on grounds of divorce and /or domestic violence). Clients with this expired status must provide proof of a pending petition to remove the condition or of an application to waive the joint filing requirement.
- Parolees: Their status expires after the expiration date. Parolees usually have an I-94 arrival/departure record stamped with an entry and expiration date. Some may have their expiration date stamped "waived" or "indefinite".
On the other hand, nonqualified immigration status (including those in the U.S. on nonimmigrant visas) typically expires when their immigration documents expire.
Additional information regarding specific document types and status
Form I-797
Notice of Action may or may not have an expiration date. It is used to notify the individual that a fee was paid, an application was accepted, the case is pending, a step in the process is completed, or status is approved. Individuals with I-797s are undocumented unless it verifies that status has been approved.
Example: An example that a step in the process has been completed but status has not been approved is the Notice of Approval for Immigrant Petition for Relative. This is the initial step in the family-related immigrant application process. It solely establishes relationship. It does not establish status. If this is the only document provided, the individual is considered undocumented for purposes of benefits eligibility.
Example: An example that status is approved is the Approval Notice of an I-360 Self-Petition under the Violence Against Women Act (VAWA). In most cases a VAWA self-petitioner will first receive a Prima Facie notice, indicating that the petitioner has submitted evidence sufficient to establish a case. Both notices verify that the individual is a qualified immigrant and their status does not expire.
Order from Immigration Judge
An order is issued because the immigrant is or has been in removal proceedings. The Judge provides a decision notifying the individual whether the individual can remain in the country. The order does not have an expiration date.
Example: An example of a status granted by an Order from Immigration Judge are Granted Withholding of Deportation which is a qualified immigrant category and Order of Supervision which is a nonqualified immigrant category.
Form I-589
Application for Asylum (nonqualified immigrant) does not have an expiration date; however, USCIS is required to provide a decision within 180 days. Despite this requirement, some asylum applicants may not receive a decision within the 180 day deadline. If the document is more than 180 days old, staff will need to check USCIS website (see below) to determine if it is still pending a decision. If still pending a decision, the asylum applicant retains their nonqualified status.
Note: If an applicant for Asylum is a national of Cuba or Haiti, they are Cuban/Haitian Entrants eligible for benefits to the same extent as refugees while their application is pending.
Form I-912
In cases with expired immigration documents, individuals should apply with USCIS for renewal and submit the Form I-912 (Request for Fee Waiver) at the same time. Individuals seeking or receiving public assistance, including Apple Health, are eligible for Fee Waivers with their application. Fee Waiver Guidance can be found at USCIS - Fee Waiver Guidance.
- If USCIS denies the fee waiver request, they will notify the individual with a notice of rejection and an explanation why the fee waiver request was denied. In these cases, copy the notice of rejection into the individual’s file and offer help paying for the documents. If USCIS approves the fee waiver request, the individual will also be notified.
- Staff can check the current case status of pending USCIS documents by entering the receipt number on the document at the USCIS website.
Note: If you are uncertain about someone’s eligibility for benefits after reviewing this clarifying page, please contact your area representative.
For a list of typical citizenship/immigration documents see the:
- National Immigration Law Center (NILC) Guide in Appendix II; or
- Documents Typically Used by Lawfully Present Immigrants.
