Qualified Non-Citizens / Medicaid for Non-Citizens 510-03-35-58

(Revised 10/1/2026 Release 26.4)

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(N.D.A.C. Section 75-02-02.1-18)

 

For purposes of the information in this policy section, there is a difference between a lawfully present non-citizen and a Lawful Permanent Resident (LPR). A lawfully present non-citizen is someone who lawfully or legally entered the U.S. A Lawful Permanent Resident is an immigrant who lawfully or legally entered the U.S. and later applied for and was approved as a Lawful Permanent Resident. Undocumented non-citizens are individuals who did not enter the U.S. legally. These individuals are not lawfully present.

1. Non-citizens who have the immigration statuses listed below may be eligible for Medicaid if they meet all other Medicaid requirements.

   1. Lawful Permanent Residents who have met the five-year waiting period and the 40 quarters of work requirement or they meet an exception (see #2 below).

   2. Cuban and Haitian Entrants whose immigration status has not yet changed to Lawful Permanent Resident.

   3. Individuals from the Federated States of Micronesia (FSM), Republic of Marshall Islands (RMI), or Republic of Palau (PAL) (referred to as COFA) whose immigration status has not yet changed to Lawful Permanent Resident.

2. Non-citizens with the immigration statuses below are not eligible for Medicaid. Once they change to a Lawful Permanent Resident, they could meet an exception that allows them to be eligible for Medicaid without meeting the five-year waiting period and the 40 work quarters requirement. To meet an exception, they must have one of the acceptable Class of Admission (COA) codes listed below:

   1. Amerasian Immigrants: AM1, AM2, AM3, AM6, AM7, AM8, B2-1, B2-3, B2-6, B2-8.

   2. American Indians born in Canada (50%+): 513, S13.

   3. Asylees: AS6, AS7, AS8, AS9, GA6, GA7, GA8.

   4. Deportation Withheld: 243(h), 241(b)(3), 274a.12(a)(10), A10.

   5. Refugees: RE6, RE7, RE8, RE9, A3.

   6. LPR / U.S. Armed Forces: Active-duty member and their non-citizen spouse and unmarried child, honorably discharged veteran and their spouse and unmarried child, and the widow of an honorably discharged veteran who is not married.

      1. Verification of active-duty status or military discharge such as a DD214.

      2. Verification of relationships of family members.

   Note: Cuban/Haitian Entrants can be eligible for Medicaid before they change to a Lawful Permanent Resident (see #1 above). Once they change to a Lawful Permanent Resident, they may qualify for an exception and would not have to meet the five-year waiting period and the 40 work quarters requirement to continue to be eligible for Medicaid if they have one of the following codes: CU6, CU7, OOE, CH, CP, HF, HR, HT, HQRAP, PARCIS, EQ1, AM2, AM3, CH6, CH7, CNP, CU0, CU6, CU7, CU8, CU9, CUP, HA6, HA7, HA8, HA9, HB6, HB7, HB8, HB9, HD6, HD7, HD8, HD9, HE6, HE-7, HE8, HE9, NC6, NC7, NC8, NC9, A04, A12, C08, C10, C11.

3. Non-citizens who entered the U.S. before August 22, 1996 and are now a Lawful Permanent Resident do not have to meet the five-year waiting period and 40 work quarters requirement regardless of their immigration status at the time they entered the U.S.

   1. These individuals have Forms I-551 or I-151 (Permanent Resident Cards) or a foreign passport stamped LPR or I-551.

   2. Systematic Alien Verification for Entitlements (SAVE) does not update immigration status for clients who entered the U.S. before August 22, 1996 if their immigration status has expired.

4. Non-citizens with one of the immigration statuses below are not eligible for Medicaid. Once they change to a Lawful Permanent Resident, they must meet the five-year waiting period and the 40 work quarters requirement.

   1. Afghani Special Immigrant.

   2. Battered spouse or child.

   3. Conditional Entry.

   4. Iraqi Special Immigrant.

   5. Parolee.

   6. Victims of Trafficking.

   Note: Individuals from the Federated States of Micronesia (FSM), Republic of Marshall Islands (RMI), or Republic of Palau (PAL) (referred to as COFA) can be eligible for Medicaid before they change to a Lawful Permanent Resident (see #1 above). Once their immigration status changes to LPR, they must meet the five-year waiting period and 40 work quarters requirement.

5. Pregnant Woman Coverage for non-citizens:

   1. Non-citizen pregnant women who are lawfully present in the U.S. and are not eligible for Medicaid due to their immigration status can be eligible for Pregnant Woman coverage during their pregnancy and the 12 months following the birth of their child if they meet all other Medicaid requirements. They cannot continue to be eligible for Medicaid after the 12 months until they change to a Lawful Permanent Resident and either meet the five-year waiting period and 40 work quarters requirement or qualify for one of the exceptions in #2 above.

   2. Non-citizen pregnant women who are Lawful Permanent Residents and are not eligible for Medicaid because they are required to meet but haven't yet met the five-year waiting period and the 40 work quarters requirement can be eligible for Pregnant Woman coverage during their pregnancy and the 12 months following the birth of their child without meeting the five-year waiting period and 40 work quarters requirement. They must meet all other Medicaid requirements. They cannot continue to be eligible for Medicaid after the 12 months until they meet the five-year waiting period and 40 work quarters requirement or they meet one of the exceptions in #2 above.

   3. Undocumented non-citizens are not considered lawfully present in the U.S. They are not eligible for Pregnant Woman coverage, but they could be eligible for Emergency Services for the birth of a child if they meet all other Medicaid requirements.

6. Non-citizens with the following immigration statuses are not eligible for Medicaid but they can be eligible for Refugee Medical Assistance (RMA) during their first eight months in the U.S. if they meet all the RMA requirements.

   1. Afghan Special Immigrants.

   2. Amerasian Immigrants.

   3. Asylees.

   4. Iraqi Special Immigrant.

   5. Refugee.

   6. Victims of Trafficking.

   Note: Cuban and Haitian Entrants who are not yet a Lawful Permanent Resident can be eligible for regular Medicaid but if they are not eligible for Medicaid during any of their first eight months in the U.S. due to excess income, they could be eligible for RMA through their eighth month in the U.S. if they meet all the other RMA requirements. At the end of their first eight months in the U.S., they could be eligible for regular Medicaid if they meet all the other Medicaid requirements after they are no longer eligible for RMA coverage.

7. Five-year waiting period:

   1. The five-year waiting period starts on the date an individual enters the U.S. with a qualifying immigration status.

8. Forty quarters of work:

   1. The Social Security Administration (SSA) determines an individual's qualifying work quarters based on the quarters in which an individual paid for Social Security coverage.

      1. This information can be obtained using the Verification Interfaces / 40 Quarters in the eligibility system.

      2. When the system shows 40 or more work quarters, no other verification is needed.

      3. If the system shows fewer than 40 work quarters but the individual claims to have 40 work quarters, their earnings must be verified.

   2. When determining the number of qualifying work quarters:

      1. Count the work quarters of the individual.

      2. Count the work quarters of a spouse:

         1. If still married, count all work quarters from the start of the marriage to the current date.

         2. If they are divorced, count all work quarters from the start of the marriage through the end of the marriage.

         3. If they are separated but still married, continue to count the work quarters through the end of the marriage.

         4. If the spouse died but they are still married at the time of death, count the work quarters the deceased spouse earned prior to the date of death.

      3. Count the work quarters of the natural, adoptive, or stepparents of a child:

         1. The work quarters of the parent can be counted for children who are under age 18. Once the child turns 18, they can still use their parents' work quarters from before they turned 18 but they cannot use any of the parents' work quarters earned after they turned 18.

         2. For adoptive parents, count their work quarters starting in the quarter they were adopted and through the month the child turns 18.

         3. For stepparents, count the work quarters starting in the quarter the parents were married and through the month the child turns 18.

      4. Some earnings are not counted by SSA. These could include earnings for federal workers who were hired before 1984, state and local government workers, and farm and domestic workers. The quarters not counted by SSA can be used as qualifying work quarters for Medicaid.

      5. Do not count the work quarters for any parents whose parental rights were terminated.

      6. Do not count any work quarters in which an individual received TANF, SNAP, Medicaid, or SSI in at least one month in that quarter.