Guidance On Medicaid And CHIP Coverage Of "Lawfully Residing" Children And Pregnant Women.pdf

Section 214 of CHIPRA permits States to cover certain children and pregnant women in both Medicaid and the Children's Health Insurance Program (CHIP) who are "lawfully residing in the United States" as described in section 1903(v)(4) and 2107(e)(1)(J) of the Social Security Act. This option may be applied to pregnant women in Medicaid and CHIP and/or to children up to age 19 for CHIP or up to age 21 for Medicaid.

The 5-year waiting period imposed by the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 limited Federal funding for health coverage of immigrant families. However, section 214 of CHIPRA amends section 2107 of the Act to grant States the option to provide Medicaid and CHIP coverage to all children and pregnant women who are lawfully residing in the United States and who are otherwise eligible for such assistance.

The phrase "lawfully residing in the United States" has been used in various contexts, such as by the United States Department of Agriculture (USDA) and the Social Security Administration (SSA). For purposes of determining eligibility, we will rely on existing immigration regulations for the purpose of defining lawful presence and longstanding Medicaid rules to establish residency.

Children and pregnant women that fall into one of the following categories will be considered lawfully present:

A qualified alien as defined in section 431 of PRWORA (8 U.S.C. §1641)
An alien in nonimmigrant status who has not violated the terms of the status under which he or she was admitted or to which he or she has changed after admission
An alien who has been paroled into the United States pursuant to section 212(d)(5) of the Immigration and Nationality Act (INA) (8 U.S.C. §1182(d)(5)) for less than 1 year
An alien who belongs to one of the following classes:
+ Aliens currently in temporary resident status pursuant to section 210 or 245A of the INA (8 U.S.C. §§1160 or 1255a, respectively)
+ Aliens currently under Temporary Protected Status (TPS) pursuant to section 244 of the INA (8 U.S.C. §1254a), and pending applicants for TPS who have been granted employment authorization
+ Aliens who have been granted employment authorization under 8 CFR 274a.12(c)(9), (10), (16), (18), (20), (22), or (24)
+ Family Unity beneficiaries pursuant to section 301 of Pub. L. 101-649, as amended
+ Aliens currently under Deferred Enforced Departure (DED) pursuant to a decision made by the President
+ Aliens currently in deferred action status
+ Aliens whose visa petition has been approved and who have a pending application for adjustment of status
A pending applicant for asylum under section 208(a) of the INA (8 U.S.C. § 1158) or for withholding of removal under section 241(b)(3) of the INA (8 U.S.C. § 1231) or under the Convention Against Torture who has been granted employment authorization, and such an applicant under the age of 14 who has had an application pending for at least 180 days
An alien who has been granted withholding of removal under the Convention Against Torture
A child who has a pending application for Special Immigrant Juvenile status as described in section 101(a)(27)(J) of the INA (8 U.S.C. § 1101(a)(27)(J))
An alien who is lawfully present in the Commonwealth of the Northern Mariana Islands under 48 U.S.C. § 1806(e)
* An alien who is lawfully present in American Samoa under the immigration laws of American Samoa

Under CHIPRA, a State electing to cover these groups must also extend the option to Medicaid.