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State of Wisconsin |
HISTORY |
The policy on this page is from a previous version of the handbook.
“Immigrants” refers to all people who reside in the U.S., but are not U.S. citizens or nationals. Immigrants may be eligible for Medicaid and other categories of health care benefits if they meet all eligibility requirements and, in addition, declare that they have a satisfactory immigration status (see Section 7.3.1), and they are:
Immigrants who do not meet these additional requirements may still be eligible for the BadgerCare Plus Prenatal Program or Emergency Services.
Before health care benefits may be issued to immigrants, their immigration status must be verified with the Department of Homeland Security through the Federal Data Sources Hub or SAVE (See Section 7.3.2). Prior to verification of immigration status, benefits may also be issued for a temporary period under a Reasonable Opportunity Period (see Section 7.3.2.2).
To qualify for health care benefits, persons who are not U.S. citizens or nationals must declare (or have an adult member of their household declare on his or her behalf) a satisfactory immigration status, except for:
This declaration is normally provided as part of a signed application for health care that provides some basic information regarding the immigration status of household members. However, in some cases, a person may only indicate on his or paper or ACCESS application that he or she is not a U.S. citizen and not provide any information about his or her immigration status. In such a situation, it is not known whether the person is telling us that he or she is lawfully present in the U.S. (i.e., that they have a satisfactory immigration status) or that they are undocumented.
Federal law requires that agencies obtain a declaration of satisfactory immigration status before taking any action to verify a person’s immigration status, including granting eligibility during a reasonable opportunity period (see 7.3.2.2 Reasonable Opportunity Period). To meet this declaration requirement, everyone who indicates that he or she is not a U.S. citizen or national must provide one of the following:
Anyone who is required to and fails to provide immigration information or a declaration (or have an adult in the household provide it on his or her behalf) within standard verification timeframes must be denied health care benefits and must not be granted a reasonable opportunity period.
Primary verification of immigration status is done through the Department of Homeland Security (DHS) by use of the Federal Data Services Hub (FDSH) or SAVE, which is an automated telephone and computer database system. A worker processing an application can simply enter the immigrant’s alien number and immigration document type into CWW. That information, along with demographic information of the individual, is sent in real time to the FDSH. The FDSH will immediately return verification of the immigrant’s status, date of entry, and the date the status was granted if it’s available from the Department of Homeland Security, along with other information. If the FDSH cannot provide verification of the immigration status, workers are directed to seek secondary verification though SAVE or take other action.
The verification query via the FDSH or SAVE most likely results in returning the latest date of any qualified alien status update for an individual, not his or her original date of arrival. The only way to obtain an accurate date of arrival for those who do not meet an exemption category and who report a date of arrival prior to August 22, 1996, is through the secondary verification procedure. The FDSH or SAVE will describe the immigrant’s current status which may have changed from the original status. In some situations described later workers will need to maintain the original status in CARES.
It may be necessary to complete a secondary or third level verification procedure with the U.S. Citizenship and Immigration Services (USCIS), including confirming the date of arrival, in the following situations:
An Immigration Status Verifier at DHS will research the alien's records and complete the response portion of the verification request.
Consult the SAVE manual for more information.
Additional verifications from sources other than the Department of Homeland Security are sometimes required as well. For example, persons who are in an immigration status subject to the 5-year bar and who indicate that they, their spouse or parent is in the military service or is a veteran, that military status must also be verified.
The following documents are considered valid verification of military service:
Immigration statuses for most immigrants are permanent and most often change when the immigrant become a U.S. citizen. For this reason, immigration status for most members should only be verified once, unless the status for an individual is questionable or it’s a status subject to reverification (see Section 7.3.2.1). Even if an immigrant loses health care eligibility for a period of time, his or her immigration status does not need to be re-verified unless the status is subject to reverification.
See Process Help, Section 44.3.9 Immigrant/Refugee Information Page for additional information on using the FDSH or the procedures in the SAVE Manual.
The following persons with a Registration Status Code of 20 – Lawfully Residing are required to verify their immigration status at application and renewal, even if they have previously verified their immigration status:
Typically, these persons will be labelled with a “Non-immigrant” status by the United States Citizenship and Immigration Services. Reverifications are not to be done for children and pregnant women with other Registration Status Codes, as those statuses are permanent. The reverification requirement is only to be applied at the time of subsequent applications, renewals, or when an agency receives information indicating that the member may no longer be lawfully residing in the U.S. For pregnant women, the reverification is not to occur until the renewal is done to determine the woman’s eligibility after the end of the 60-day postpartum period.
Applicants who have declared that they are in a satisfactory immigration status, are otherwise eligible and are only pending for verification of immigration status must be certified for health care benefits within the normal application processing timeframe (30 days from the filing date). They are to continue receiving health care benefits for which they are eligible, while the IM agency waits for immigration status verification. Applicants who are otherwise eligible and are only pending for verification of immigration will have 90 days after receiving a request for immigration verification to provide the requested documentation. This 90-day period is called the Reasonable Opportunity Period (ROP). The 90-day ROP starts on the date after the member receives the notice informing the member of the need for the member to provide immigration verification by the end of the reasonable opportunity period. Federal regulations require that we assume a minimum five-day time frame for applicants to receive notices. For this reason, we must set the end of the ROP no less than 95 days after the date on the notice, even when the member receives the notice in less than 5 days. It also means that if a member shows that a notice was received more than 5 days after the date on the notice, we must extend the deadline to 90 days after the date the member received the notice.
The 90-day ROP applies when immigration verification is needed from a person at any time: applications, renewals and when a person is newly requesting benefits on an existing case.
Applicants are eligible for benefits beginning with the first of the month of application or request. However, they are not eligible for backdated health care benefits while waiting for verification of their immigration status. Once verification of an eligible immigration status is provided, the applicant’s eligibility must then be determined for backdated health care benefits if they have been requested.
When requested verification is not provided by the end of the ROP, the worker must take action within 30 days to terminate eligibility, unless one of the following situations occurs where the worker is allowed to extend the reasonable opportunity period:
Applicants who fail to provide verification of immigration status and later reapply for health care benefits are not eligible for another ROP. If verification of immigration status is still needed, eligibility may not be granted until verification is provided. The regular verification deadlines apply.
Persons whose health care benefits were terminated for failure to provide verification of immigration status by the end of the ROP are not eligible to have their benefits continued if they request a fair hearing.
A person may receive a reasonable opportunity period more than once in a lifetime in the following situations:
| Example 1: |
Vladimir is a 12-year-old lawfully present in the United States on a visa applying for health care benefits with his parents. When verification is attempted through the FDSH, the response requires the worker to submit a secondary verification request to SAVE. Vladimir is otherwise eligible for Medicaid, so the worker confirms Medicaid eligibility and sends the ROP notice to the family while waiting for the SAVE response. A week later, SAVE verifies the child is lawfully present in the U.S. under a Temporary Protected Status and the reasonable opportunity period ends. A year later, the case is up for renewal. Since Vladimir has a Registration Status Code of 20 – Lawfully Residing, his immigration status must be verified again. Once more, the FDSH informs the worker that verification of the child’s status must be done through SAVE. If Vladimir is otherwise eligible for Medicaid, the worker must again confirm eligibility without delay and send a new reasonable opportunity period notice to the family. Again, Vladimir may be eligible for up to 90 days after receiving the notice while the worker is waiting to verify his immigration status. |
Benefits issued during a reasonable opportunity period to a person otherwise eligible for BadgerCare Plus are not subject to recovery, even if the person turns out to have an immigration status that makes him or her ineligible for BadgerCare Plus benefits.
Immigrants may be eligible for Medicaid if they meet all other eligibility requirements and are either Qualifying Immigrants or are Lawfully Present as described below.
Immigrants of any age meeting the criteria listed below are considered Qualifying Immigrants.
*If these immigrants lawfully entered the U.S. on or after August 22, 1996, they must also meet one of the following criteria:
Children younger than 19 years old, adults younger than 21 years old who are residing in an IMD, and pregnant women do not have to wait five years to be eligible for full-benefit Medicaid and BadgerCare Plus if they meet one of the following criteria:
Women who have an immigration status requiring a five-year waiting period before being eligible for BadgerCare Plus will have the waiting period lifted when their pregnancy is reported to the agency. The lift on the five-year waiting period continues for an additional 60 days after the last day of pregnancy and through the end of the month in which the 60th day occurs.
Children younger than 19 years old, young adults younger than 21 years old who are residing in an IMD, and pregnant women may qualify for BadgerCare Plus or Medicaid if they are lawfully present in the U.S. under many of the immigrant and non-immigrant statuses. For those who are not in a qualifying Immigrant category, but are lawfully present, use the Registration Status Code of 20. Please see Process Help, Section 82.6 VIS SAVE Verification Responses Table for a list of SAVE Responses and the appropriate Registration Status Code in CWW to apply.
Immigrants who are not a qualifying immigrant nor lawfully present (for example, someone with a status of DACA) and who apply for Medicaid and meet all eligibility requirements, except for citizenship and immigration status, are entitled to receive Medicaid Emergency Services only (see Chapter 34 Emergency Services).
Pregnant immigrants who are not a qualifying immigrant nor lawfully present and who apply for the BadgerCare Plus Prenatal Program and meet the eligibility requirements except for citizenship and immigration status, are entitled to receive BadgerCare Plus Prenatal Program benefits and/or BadgerCare Plus Emergency Services (see BadgerCare Plus Eligibility Handbook, Chapter 41 BadgerCare Plus Prenatal Program and Chapter 39 Emergency Services).
Immigration status is an individual eligibility requirement. An individual’s immigration status does not affect the eligibility of the Medicaid Group. The citizen spouse or child of an ineligible immigrant may still be eligible even though the immigrant is not.
Special Immigrants from Iraq or Afghanistan (Class of Admission Codes SI-1, 2, 3, 6, 7, and 8) are to be treated like they are refugees when determining their eligibility for Medicaid for as long as they have this Special Immigrant status. This policy applies to these immigrants regardless of when they received this status.
| Class of Admission Code | Description | CARES Alien Registration Status Code |
| SI1 | Nationals of Iraq or Afghanistan serving as interpreters with the U.S. Armed Forces | Code 04 |
| SI2 | Spouses of an SI1 | Code 04 |
| SI3 | Children of an SI1 | Code 04 |
| SI6 | Nationals of Iraq or Afghanistan serving as interpreters with the U.S. Armed Forces | Code 04 |
| SI7 | Spouses of an SI6 | Code 04 |
| SI8 | Children of an SI6 | Code 04 |
In addition, immigrant Afghan spouses and children of former Special Immigrants who have become United States citizens are also to be treated like they are refugees when determining their eligibility for Medicaid. This treatment is to continue for as long as they have a status of Special Immigrant Conditional Permanent Resident (SI CPR). The Class of Admission codes for SI CPRs are CQ1, CQ2 and CQ3.
Afghans and persons with no nationalities who were residing in Afghanistan and subsequently paroled into the United States on July 31, 2021 through September 30, 2023, are to be treated as refugees when determining their eligibility for Medicaid.
In addition, Afghans and persons with no nationalities who were residing in Afghanistan and subsequently paroled into the United States after September 30, 2022, are to be treated as refugees when determining their eligibility for Medicaid if they are one of the following:
All of the above persons are to continue to be treated as refugees until either March 31, 2023, or the date their parole status expires, whichever is later.
The table below shows the Class of Admission Codes that are used for these groups:
| Class of Admission Code | Description | CARES Alien Registration Status Code |
| SQ4, SQ5 | Special Immigrant Parolee (SI Parolee) | Code 04 |
| DT, OAR, OAW, PAR | Humanitarian Parolee | Code 04 |
Ukrainians and persons with no nationalities who were residing in Ukraine and subsequently paroled into the United States between February 24, 2022, and September 30, 2023, are to be treated as refugees when determining their eligibility for Medicaid.
In addition, Ukrainians and persons with no nationalities who were residing in Ukraine and subsequently paroled into the United States after September 30, 2023, are to be treated as refugees when determining their eligibility for Medicaid if they are one of the following:
The table below shows the Class of Admission Codes that are used for these groups:
| Class of Admission Code | Description | CARES Alien Registration Status Code |
| UHP, DT, PAR, or U4U | Humanitarian Parolee | Code 04 |
The term "Cuban-Haitian Entrant" (CHE) relates to benefit eligibility rather than an immigration status. Cuban-Haitian entrants are defined as certain nationals of Cuba or Haiti who have permission to reside in the U.S. based on humanitarian considerations or under Section 501(e) of the Refugee Education Assistance Act of 1980 (REAA). CHE are qualified immigrants with no waiting period.
The following individuals meet the definition of Cuban-Haitian Entrant:
Public charge determinations are part of longstanding immigration policy that can impact a non-U.S. citizen’s ability to gain entry to the United States or obtain lawful permanent resident status (get a green card). A public charge is someone who the government believes is likely to rely on cash assistance or government-funded institutionalization for long-term care to survive.
Many non-U.S. citizens are exempt from public charge determinations. These include lawful permanent residents, also known as green card holders (unless they travel outside the U.S. for six months or more), asylees, refugees, special immigrant juveniles, survivors of trafficking, and other protected groups.
For non-U.S. citizens who are subject to public charge determinations, enrolling in Medicaid does not make them a public charge.
The only category of Medicaid-funded services considered in public charge determinations is long-term institutionalization paid for by Medicaid. The following institutionalization situations are not considered in public charge determinations:
Medicaid Home and Community Based Services (HCBS) is not considered in public charge determinations.
Do not refer an immigrant to INS unless information for administering the Medicaid program is needed. For example, if Medicaid needs to determine an individual’s location for repayment or fraud prosecution, or to determine his or her immigration status.
Certain non-citizens who arrived in the U.S. on or after August 22, 1996, are subject to a five-year ban on receiving federal benefits (including BadgerCare Plus and Medicaid), other than emergency services. For these immigrants, the five-year ban is calculated beginning on the day on which they gain qualified immigrant status. However, certain applicants who alleged an arrival date in the U.S. before August 22, 1996, and obtained legal qualified immigrant status after August 22, 1996, are not subject to the five-year ban and may be eligible to receive federal BadgerCare Plus enrollment. The immigrants described below, who apply for BadgerCare Plus and meet all eligibility requirements, are entitled to receive BadgerCare Plus benefits:
An individual meets the "continuous presence" test if he or she:
To establish continuous presence, require a signed statement from the applicant stating he or she was continuously present for the period of time in question. The signed statement will be sufficient unless a worker believes the information is fraudulent or further information received now indicates that it is questionable.
Below is one example of a signed statement:
I, first and last name, hereby declare that I have continuously resided in the United States between the day I arrived in the United States, date here, and the date I received qualified alien status, date here. I have not left the United States in that time for any single period of time longer than 30 days or for multiple periods totaling more than 90 days.
Applicant/authorized representative Signature, Date
In cases in which it is known that the applicant originally arrived in the U.S. in undocumented status, do not attempt to verify his or her status with the USCIS. Undocumented immigrants do not have any official documentation regarding their date of arrival. Therefore, if a worker needs to establish a date of arrival for a qualified immigrant who originally arrived as an undocumented immigrant prior to August 22, 1996, alternative methods need to be used. In such cases, the applicant must provide at least one piece of documentation that shows his or her presence in the U.S. prior to August 22, 1996. This may include pay stubs, a letter from an employer, lease or rent receipts, or a utility bill in the applicant's name.
| Example 2: | The legal status conferred on a non-citizen by immigration law—Toshi entered the U.S. February 2, 2004, with qualified immigrant status. She is applying for Medicaid in February 2008. The IM worker should first determine if she is in one of the immigrant categories exempt from the five-year ban. If Toshi is not exempt, then she must wait five years before qualifying for Medicaid. She can be enrolled in Medicaid after February 2, 2009 if she meets other financial and non-financial criteria. |
| Example 3: | Shariff arrived as a student in June 2002. On June 5, 2006 he was granted asylum. The five-year ban does not apply because asylees are exempt from the ban. Secondary verification is not necessary. Shariff is eligible to be enrolled in Medicaid if he meets other financial and non-financial criteria. |
| Example 4: | Katrin entered the U.S. March 3, 1995, and gained qualified immigrant status June 20, 1995. She is applying for Medicaid in February 2008. She is a qualified immigrant who entered the U.S. prior to August 22, 1996. There is no need to apply the five-year ban. She is eligible for Medicaid if she meets other financial and non-financial criteria. |
| Example 5: | Juan entered the U.S. as an undocumented immigrant on April 1, 1996. He applied for Medicaid on February 1, 2008. His immigration status changed to lawful permanent resident on March 3, 2005. He has signed a self-declaration stating he remained continuously present in the U.S. between April 1, 1996, and March 3, 2005. Additionally, Juan provided a copy of a lease showing a date prior to August 1996. He is eligible for Medicaid if he meets other financial and non-financial criteria. |
| Example 6: | Elena entered the U.S. on July 15, 1999, on a temporary work visa and obtained qualified immigration status on October 31, 2004. She applied for Medicaid February 1, 2008, and has been in the U.S. for over five years. Elena is not in one of the immigrant categories exempt from the five-year ban. Therefore, the five-year ban would have to be applied since Elena's original entry date is after August 22, 1996. The five-year clock starts from the date she obtained qualified immigration status, so she would be able to apply for Medicaid after October 31, 2009. |
| Example 7: | Tomas entered the U.S. on April 8, 1996, on a visitor’s visa. He obtained qualified alien status on September 22, 2003. Tomas applied for Medicaid on May 5, 2008. The IM worker completed primary verification and USCIS responded with the date of entry as September 22, 2003, since that was the last updated date on his status. The IM worker needs to confirm with the applicant that this is the original date he arrived in the U.S. Tomas explained that he arrived in 1996; therefore, the IM worker needs to conduct secondary verification. USCIS responds and confirms that the original date of arrival was April 8, 1996. Additionally, the IM worker needs to confirm that the applicant was continuously present between April 8, 1996, and September 22, 2003. Tomas signs a self-declaration confirming this and is found eligible. If the IM worker had used September 22, 2003, as the date of entry in CARES, Tomas would have been incorrectly subject to the five-year ban and not eligible until September 22, 2008. |
Please see Process Help, Section 82.6 VIS SAVE Verification Responses Table for a list of SAVE Responses and the appropriate Registration Status Code in CWW to apply.
| CARES Registration Status Code | Immigration Status | Arrived Before August 22, 1996 | Veteran* Arrived Before August 22, 1996 | Arrived On or After August 22, 1996 | Veteran* Arrived On or After August 22, 1996 | Children Under 19 and Pregnant Women; Arrived on or after August 22, 1996 |
| 01 | Lawfully admitted for permanent residence | Eligible | Eligible | Ineligible for 5 years | Eligible | Effective October 1, 2009 Eligible |
| 02 | Permanent resident under color of law (PRUCOL) | Ineligible | Ineligible | Ineligible | Ineligible | Ineligible |
| 03 | Lawfully present under Section 203(a)(7) | Eligible | Eligible | Ineligible for 5 years | Eligible | Effective October 1, 2009 Eligible |
| 04 | Lawfully present under Section 207(c) | Eligible | Eligible | Eligible | Eligible | Eligible |
| 05 | Lawfully present under Section 208 | Eligible | Eligible | Eligible | Eligible | Eligible |
| 06 | Lawfully present under Section 212(d)(5 | Eligible | Eligible | Ineligible for 5 years | Eligible | Effective October 1, 2009 Eligible |
| 07 | IRCA (No longer valid) | N/A | N/A | N/A | N/A | N/A |
| 08 | Lawfully admitted - temporary | Ineligible | Ineligible | Ineligible | Ineligible | Ineligible |
| 09 | Undocumented Immigrant | Ineligible | Ineligible | Ineligible | Ineligible | Ineligible |
| 10 | Illegal Immigrant | Ineligible | Ineligible | Ineligible | Ineligible | Ineligible |
| 11 | Cuban/Haitian Entrant | Eligible | Eligible | Eligible | Eligible | Eligible |
| 12 | Considered a Permanent Resident by USCIS | Ineligible | Ineligible | Ineligible | Ineligible | Eligible |
| 13 | Special agricultural worker under Section 210(A) | Ineligible | Ineligible | Ineligible | Ineligible | Eligible |
| 14 | Additional special agricultural worker under Section 210(A) | Ineligible | Ineligible | Ineligible | Ineligible | Eligible |
| 15 | Withheld deportation - Section 243(h) | Eligible | Eligible | Eligible | Eligible | Eligible |
| 16 | Battered Immigrant | Eligible | Eligible | Ineligible for 5 years | Eligible | Effective October 1, 2009 Eligible |
| 17 | Amerasian | Eligible | Eligible | Eligible | Eligible | Eligible |
| 18 | Foreign-Born Native American | Eligible | Eligible | Eligible | Eligible | Eligible |
| 19 | Victims of Trafficking** | Eligible | Eligible | Eligible | Eligible | Eligible |
| 20 | Lawfully Residing | Ineligible | Ineligible | Ineligible | Ineligible | Eligible |
| 21 | Victims of Trafficking Subject to 5 Year Bar | Eligible | Eligible | Ineligible for 5 years | Eligible | Eligible |
| 22 | Citizens of Compacts of Free Assoc (COFA) | Eligible | Eligible | Eligible | Eligible | Eligible |
* "Veteran" includes certain veterans and active duty servicemen and women, their spouses, dependent children, or certain surviving spouses.
**Some victims of trafficking may need to provide certain verification to be exempt from the five-year bar. See Section 7.3.11 Victims of Trafficking for more information.
The federal Office of Refugee Resettlement (ORR) provides resources for refugees, asylum seekers, and other new arrivals to the U.S. to assist with their integration into their new community. Several benefit programs overseen by the ORR and operated by the Bureau of Refugee Programs in the Department of Children and Families are discussed here.
Refugee Cash Assistance (RCA) program payments are not counted as income for Medicaid. RCA is administered by Wisconsin Works (W-2) agencies and is made available for refugees who do not qualify for W-2.
Refugee "Reception and Placement" (R&P) payments are not counted as income for Medicaid. R & P payments are made to refugees during the first 30 days after their arrival in the U.S. R & P payments are made by voluntary resettlement agencies and may be a direct payment to the refugee individual/ family or to a vendor.
If an individual does not meet the other eligibility requirements for Medicaid, they may apply for Refugee Medical Assistance (RMA), which is not funded by Medicaid. Refugee Medical Assistance is considered a separate benefit from Medicaid but provides the same level of benefits. Refugee Medical Assistance is available only in the first 12 months after a special immigrant’s date of entry. If it is not applied for in that 12-month period, it cannot be applied for later.
While W-2 agencies have contractual responsibility for providing Refugee Medical Assistance, they need to coordinate with economic support agencies to ensure eligibility for all regular Medicaid subprograms is tested first.
More information about this program is in Wisconsin Works (W-2) Manual, Section 18.3 Refugee Medical Assistance.
| Note: | The federal Medicaid eligibility for all other refugees admitted under Registration Status Code 04 remains the same. |
Applicants with an immigration status that requires them to be in that immigration status for five years before being eligible for health care benefits are exempt from this five-year bar if they meet any of the following criteria related to military service:
Applicants claiming to be victims of trafficking (or have a Class of Admission (COA) code indicating that they are a victim – ST6 or T1), have not resided in the United States for at least five years, and are at least 18 years of age, must have a victim certification from the federal Office of Refugee Resettlement (ORR) in the Department of Health and Human Services to be treated like a refugee and be exempt from the five-year bar.
Persons with a COA code indicating they are a child, spouse, or parent of a trafficking victim (Codes ST0, ST1, ST7, ST8, ST9, T2, T3, T4, T5, or T6) are exempt from the five-year bar and do not need certification from the ORR. Victims of trafficking who are under 18 at the time they apply do not require a certification from the ORR. Victims of Trafficking who are 18 or older and do not have the certification will be subject to the five-year bar.
This page last updated in Release Number: 23-03
Release Date: 08/14/2023
Effective Date: 08/14/2023
The information concerning the Medicaid program provided in this handbook release is published in accordance with: Titles XI and XIX of the Social Security Act; Parts 430 through 481 of Title 42 of the Code of Federal Regulations; Chapters 46 and 49 of the Wisconsin Statutes; and Chapters HA 3, DHS 2, 10 and 101 through 109 of the Wisconsin Administrative Code.
Notice: The content within this manual is the sole responsibility of the State of Wisconsin's Department of Health Services (DHS). This site will link to sites outside of DHS where appropriate. DHS is in no way responsible for the content of sites outside of DHS.
Publication Number: P-10030