Lawful Permanent Residents: Eligibility For Medicaid Services

Lawful permanent residents, also known as LPRs or green card holders, can get Medicaid coverage, but they are subject to certain eligibility restrictions. To qualify for full Medicaid coverage, individuals must be citizens or nationals of the United States or qualified aliens. Many lawfully present immigrants are required to wait five years from the date they were granted their immigration status before they can qualify for full Medicaid coverage. However, there are exceptions to the five-year waiting period, such as for refugees, asylees, and citizens of Compact of Free Association (COFA) nations. Additionally, states have the option to remove the waiting period and cover lawfully residing children and/or pregnant women. Lawful permanent residents can also qualify for premium tax credits and other savings on Marketplace plans.

Lawful permanent residents are considered qualified non-citizens

Lawful permanent residents are considered "qualified non-citizens" and are generally eligible for Medicaid and the Children's Health Insurance Program (CHIP) if they meet state income and residency rules. However, there is usually a 5-year waiting period after obtaining "qualified" immigration status before they can receive Medicaid and CHIP coverage. This means that lawful permanent residents must wait 5 years from the date they were granted their immigration status before they can qualify for full benefits.

There are some exceptions to the 5-year waiting period. Refugees, asylees, and LPRs who previously held refugee or asylee status are exempt from the waiting period. Additionally, states have the option to waive the waiting period and provide immediate coverage to lawfully residing children and pregnant women under the Children's Health Insurance Program Reauthorization Act (CHIPRA) enacted in 2009. As of 2025, 29 states, the District of Columbia, and the Commonwealth of the Northern Mariana Islands have chosen to waive the waiting period.

It is important to note that applying for or receiving Medicaid or CHIP benefits does not impact an individual's ability to obtain lawful permanent resident status or U.S. citizenship. According to current rules, Medicaid and CHIP are not considered when determining whether an individual is likely to become primarily dependent on the federal government for financial support, also known as the "public charge" test.

Lawful permanent residents can also qualify for Marketplace coverage and may be eligible for lower costs on monthly premiums and additional savings on out-of-pocket expenses based on their income. They may also qualify for Medicare if they have sufficient work history.

There is a five-year waiting period for Medicaid coverage

Lawfully present immigrants may qualify for Medicaid and CHIP but are subject to certain eligibility restrictions. In general, lawfully present immigrants must have a "qualified" immigration status to be eligible for Medicaid or CHIP. Many Lawful Permanent Residents (LPRs) or "green card" holders are subject to a five-year waiting period, meaning they must wait five years after getting "qualified" immigration status before they can get full Medicaid and CHIP coverage.

There are, however, some exceptions to the five-year waiting period. Refugees, asylees, or LPRs who used to be refugees or asylees don't have to wait five years. In addition, citizens of Compact of Free Association (COFA) nations are also exempt from the waiting period. Furthermore, states can choose to eliminate the five-year waiting period and cover lawfully residing children and/or pregnant women in Medicaid or CHIP. As of January 2025, 35 states, plus the District of Columbia, the Commonwealth of the Northern Mariana Islands, American Samoa, and the U.S. Virgin Islands, have opted to do so.

Lawfully present immigrants who are otherwise eligible for Medicaid in their state but do not meet the citizenship and immigration status requirements may still be able to get Medicaid coverage for the treatment of an emergency medical condition. In addition, lawfully present immigrants can get Marketplace coverage and may qualify for premium tax credits and other savings on Marketplace plans. They may also qualify for Medicare, provided they have sufficient work history.

Refugees, asylees, and citizens of COFA nations are exempt from the waiting period

Refugees, asylees, and citizens of Compact of Free Association (COFA) nations are exempt from the five-year waiting period for Medicaid and CHIP coverage. This means that, unlike other qualified non-citizens, they do not have to wait five years after obtaining "qualified" immigration status before they can enrol in Medicaid and CHIP.

In December 2020, Congress restored Medicaid eligibility for citizens of COFA nations, and in March 2024, eligibility was further extended to other federally funded programs, including CHIP, the Supplemental Nutrition Assistance Program (SNAP), and Temporary Assistance for Needy Families (TANF). The U.S. government has COFA agreements with the Republic of the Marshall Islands, the Federated States of Micronesia, and the Republic of Palau. Certain citizens of these nations can lawfully work, study, and reside in the U.S., but they had been excluded from federally funded Medicaid since 1996 under the Personal Responsibility and Work Opportunity Reconciliation Act.

In 2020, Congress declared that, for Medicaid purposes only, citizens of Micronesia, Marshall Islands, and Palau who reside in the U.S. pursuant to a COFA would be considered "qualified" immigrants. In 2024, Congress further declared that COFA migrants are "qualified" immigrants for all federal public benefits programs and removed restrictions on their eligibility for federal means-tested public benefits.

Refugees and asylees are also exempt from the five-year waiting period for Medicaid and CHIP. In addition, certain individuals who were once refugees or asylees but have since become Lawful Permanent Residents (LPRs) or "green card" holders are also exempt from the waiting period.

Lawful permanent residents can get Marketplace coverage

Lawful permanent residents (LPRs) or green card holders can get Marketplace coverage. While they are generally eligible for coverage through Medicaid and the Children's Health Insurance Program (CHIP), there is usually a 5-year waiting period from the date they were granted their qualified immigration status before they can qualify for full coverage. This means that LPRs who haven't had their status for 5 years generally qualify for Marketplace coverage, if otherwise eligible.

There are some exceptions to the 5-year waiting period. Refugees, asylees, and LPRs who used to be refugees or asylees don't have to wait 5 years. Additionally, states can choose to remove the waiting period and cover lawfully residing children and/or pregnant women in Medicaid or CHIP. As of January 2025, DACA recipients in 19 states are unable to enrol in ACA Marketplace coverage.

Lawfully present immigrants who get Marketplace coverage may qualify for premium tax credits and other savings on Marketplace plans, such as lower costs on monthly premiums and extra savings on out-of-pocket costs based on their income. It's important to note that applying for or getting Medicaid, CHIP, or Marketplace coverage does not make someone a "public charge", and it won't affect their chances of becoming a Lawful Permanent Resident or U.S. citizen.

Medicaid eligibility won't affect chances of becoming a lawful permanent resident

Lawfully present immigrants in the U.S. may be eligible for Medicaid, but they are subject to certain eligibility restrictions. Generally, to qualify for the full range of benefits offered by Medicaid, individuals must be citizens or nationals of the U.S. or qualified aliens. Lawful Permanent Residents (LPRs), or green card holders, are considered "qualified non-citizens" and are therefore eligible for Medicaid and the Children's Health Insurance Program (CHIP) if they meet state income and residency rules. However, many LPRs have a 5-year waiting period after obtaining their "qualified" immigration status before they can receive Medicaid and CHIP coverage. This waiting period does not apply to refugees, asylees, or individuals with a pending application for a victim of trafficking visa.

It is important to note that applying for or receiving Medicaid benefits does not make one a "public charge," meaning it will not affect one's chances of becoming a Lawful Permanent Resident or U.S. citizen. The only exception to this is for people receiving long-term care in an institution at government expense, such as in a nursing facility, who may face barriers in obtaining a green card.

In addition to Medicaid and CHIP, lawfully present immigrants may also qualify for Marketplace coverage and may be eligible for lower costs on monthly premiums and extra savings on out-of-pocket costs based on their income. They may also qualify for Medicare if they have sufficient work history.

Frequently asked questions