Medicaid for Immigrants who are Not Permanent Residents (Do Not have "Green Cards")-- PRUCOL and Temporary Non-Immigrant Eligibility

New York State Medicaid covers many immigrants not covered by federal law. Since 1996, federal Medicaid limits Medicaid eligibility  to US citizens and “Qualified Aliens,” which include:

  1. Lawful Permanent Residents (LPR or “green card”) – under federal law, all but pregnant women & children have a 5 year waiting period, AND 

  2. Humanitarian immigrants - Refugees & Asylees, battered persons & trafficking victims, people in armed services, people granted withholding of deportation, and immigrants from certain countries granted  relief at different times, like Haitans, Cuban entrants, etc.

See Empire Justice Center & NY Immigration Coalition's  Immigrant Eligibility for Public Benefits in NYS  (Jan-2025).   Documentation of the above "Qualified Non-Citizen" categories listed in OHIP-0046 - Documentation Guide to Citizen and Non-Citizen Eligibility for Health Insurance Coverage in New York State (6/2024). pp. 7-14. 

New York State, fortunately, is more liberal. 

IN THIS ARTICLE: 

I.  What is Permanently Residing Under Color Of Law (PRUCOL)?

  1. Immigration agency has given express permission to remain in US?
  2. Agency has not acted on the request

  3. Revised procedure to determine PRUCOL status where USCIS has denied an application per GIS 24 MA/06

II.  Temporary non-immigrants who are lawfully present" in the U.S. and residents of New York State are eligible for full Medicaid,

III.  Immigrants Age 65 + Who are Undocumented - Eligible for Full Medicaid through Managed Care Starting Jan. 1, 2024

Public Charge - How Will Receipt of Medicaid affect Immigration Status?  

I.  IMMIGRANTS PERMANENTLY RESIDING UNDER COLOR OF LAW (PRUCOL)

Immigrants who do not have a green card (permanent resident alien or in another federally "qualified alien category" described above)  but who are permanently residing under color of law (PRUCOL) are eligible for full Medicaid in New York State.    (see also  Immigrant Eligibility for Public Benefits in NYS  (Jan -2025).   This is ​​​​​thanks to the New York State Constitution and a 2001 decision of New York's highest court in a case called Aliessa v. Novello,  many (but not all)  immigrants are eligible for Medicaid in New York State.  Their Medicaid is paid for by the State exclusively, without any federal contribution -- but that does not affect the immigrant.  The Medicaid they have is the same. 

State regulation definition of PRUCOL at 18 NYCRR §360-3.2(j)(1)(ii).

Immigrants should be classified as PRUCOL by the social services district or NYSoH if :

  1. They can provide evidence that the USCIS or ICE (the main federal immigration agencies within the Dept. of Homeland Security) knows that they are here (see more below on what evidence is needed) and

  2. The immigration agencies are not contemplating enforcing their departure.  This is indicated either because:

These factors are described more below. 

STATE POLICY DIRECTIVES  defining the PRUCOL category:

Per the GIS, the updates include:

1.  What is evidence that Immigration agencies know that the client is here in the U.S.?

The client is PRUCOL as long as the written application is pending, and in some circumstances PRUCOL status may continue after the application is denied.  For example,  a notice denying a deferred action application states, “Denial of a request for deferred action does not necessarily mean that USCIS intends affirmatively to pursue your client’s removal.”   Some Fair Hearing decisions state that while the application may have been  denied, the facts and circumstances of the case indicate that the federal government does not intend to affirmatively enforce the person's removal.  See, e.g. Fair Hearing No. 6805696N (NYC 10/17/14),  Fair Hearing No. 6901593N (NYC 3/24/15), and Fair Hearing No.6417893Q (Dutchess Co. 1/17/2014). 

2.  WHAT PROOF IS NEEDED THAT AN IMMIGRATION AGENCY IS NOT ENFORCING THEIR DEPARTURE? 

GIS 24 MA/06  states, "An alien will be considered as one whose departure the Federal Immigration Agency does not contemplate enforcing if, based on all the facts and circumstances in a particular case, it appears that the Federal Immigration Agency is  otherwise permitting the alien to reside in the United States indefinitely or it is the policy or practice of such agency not to enforce the departure of aliens in a particular category.  The interpretation of the PRUCOL designation is meant to be fluid, to allow for adaptation as needed. For example, changes and patterns seen in immigration agencies at the federal level may require re-interpretation of PRUCOL by the state. Changes made to the policy on PRUCOL designation over the last two decades reflects this adaptation...".

      Either A or B or C:

A.   USCIS (or ICE) has expressly given them permission to remain in the U.S. , by granting:

 B.    The Immigration agency has not acted on an application or a letter, of the types described in #1 above.

  1. FORMAL APPLICATION to adjust status, etc.  - if Immigration service has not acted on a FORMAL APPLICATION, applicant is PRUCOL as long as the application is pending, no matter how long, until it is actually DENIED or there is some other indication that his her departure is being enforced.

  2. REQUEST BY LETTER FOR RELIEF from deportation -- Merely showing proof that the letter was sent is not enough.   The immigration agency must have been afforded "reasonable time" to consider the request, which the State Dept. of Health has said is 15 days from mailing the initial letter.  See GIS 23 MA/16.  The non-citizen must provide proof the request was sent to and received by the federal immigration agency, such as return receipt from the U.S. Postal Service or a private carrier. 

  3. Requests for Deferred Action for Childhood Arrivals (DACA) (began 8/2012). The Dept. of Homeland Security (DHS) has decided to focus its attention on the removal of individuals who pose a danger to national security or a risk to public safety, including aliens convicted of crimes, with emphasis on violent criminals, felons and repeat offenders. The DHS will exercise prosecutorial discretion to ensure that enforcement resources are not expended on low priority cases, such as individuals who were brought to this country through no fault of their own as children. To be eligible for DACA, these individuals cannot have been convicted of a felony offense, a significant misdemeanor or multiple misdemeanor offenses. In New York State, these individuals will be PRUCOL, but are not eligible for FFP. See NYS GIS 13-MA-011 (May 7, 2013)

C. The Immigration agency denied the non-citizen's request for adjustment or relief, but has taken no action to enforce the individual's departure. 

1. In cases where  a federal immigration agency has DENIED an application or request for immigration relief, this alone is not enough to deny PRUCOL status.   GIS 24 MA/06 sets forth the following procedure:

2.  In cases where an individual has had an encounter with federal immigration agencies but has not been placed in removal proceedings GIS 24 MA/06 sets forth the following procedure:

WHO IS NOT ELIGIBLE for PRUCOL status? 

II.   Temporary Non-immigrants who are "lawfully present" in the U.S. and residents of New York State

Temporary non-immigrants are individuals who are allowed to enter the United States temporarily for a specific purpose and for a specific period of time. They are commonly referred to as short-term visa holders. There are more than two dozen temporary non-immigrant categories. A few of the more common temporary non-immigrant categories are tourists, students and visitors for business.  See list at Temporary Non-Immigrant Document Types and Visa Codes, which is page 30 of OHIP-0046 - Documentation Guide to Citizen and Non-Citizen Eligibility for Health Insurance Coverage in New York State (6/2024).     This  list also includes  examples of the types of documentation that temporary non-immigrants will typically possess.

A 2016 GIS extended eligibility to this category:  GIS 16 MA/002 - Changes in Medicaid Coverage for Temporary Non-Immigrants  (PDF

Under the 2016  GIS, the individual must not have violated the terms of the status under which he or she was admitted to the U.S. (i.e., the individual must not have overstayed his or her visa.

Before this GIS was issued in 2016, temporary non-immigrants were only eligible for Emergency Medicaid, unless they were pregnant women or children.  NYS is exercising an option afforded to states to cover all temporary non-immigrants if they are "lawfully present" in the U.S., are state residents, and meet all other Medicaid eligibility requirements. This option is granted under the  Children's Health Insurance Program Reauthorization Act of 2009, as interpreted in guidance issued by CMS in 2010.  See GIS. 

To determine if they are state residents, the "Residency Review Worksheet" (Spanish version) must be given to all temporary non-immigrants applying for Medicaid.   The applicant must answer YES to one of the questions to qualify as a resident.  See the GIS for more information.  If they do not qualify as a resident, they are only eligible for Emergency Medicaid -- again, unless they are pregnant women or children. 

The 2016 GIS and all of its attachments can be found here

III. Undocumented Immigrants Age 65+ eligible for FULL MEDICAID - starting Jan. 1, 2024

See  here

WARNING:  Public Charge --and IMMIGRATION RULES ARE VERY COMPLICATED.



Article ID: 33
Last updated: 12 Mar, 2025
Revision: 21
Medicaid -> Immigrant Access -> Medicaid for Immigrants who are Not Permanent Residents (Do Not have "Green Cards")-- PRUCOL and Temporary Non-Immigrant Eligibility
http://health.wnylc.com/health/entry/33/