Qualified Non-Citizens / Medicaid for Non-Citizens 510-05-35-58

(Revised 10/1/2026 Release 26.7)

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

 

For purposes of this policy, 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 and are not lawfully present.

  1. Non-citizens with the following immigration statuses 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 who meet an exception described below;

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

    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 based on that status. Once they change to Lawful Permanent Resident, they may meet an exception that allows Medicaid eligibility without meeting the five-year waiting period and 40 work-quarter requirements. To meet an exception, they must have an acceptable Class of Admission (COA) code listed below:

    1. Afghani Special Immigrant: CQ1, CQ2, CQ3, SQ1, SQ2, SQ3, SQ6, SQ7, SQ8, SQ9, SI6, SI7, SI9, SQ4, SQ5, SI1, SI2, SI3, OAR, PAR, DT

    2. Amerasian Immigrants: AM1, AM2, AM3, AM6, AM7, AM8.

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

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

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

    6. Iraqi Special Immigrant: CQ1, CQ2, CQ3, SQ1, SQ2, SQ3, SQ6, SQ7, SQ8, SQ9, SI6, SI7, SI9, SQ4, SQ5, SI1, SI2, SI3, OAR, PAR, DT

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

    8. 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 an unmarried widow or widower of an honorably discharged veteran. Verify active-duty status or military discharge (such as DD214) and the relationship of family members.

    Note: Cuban and Haitian Entrants may be eligible for Medicaid before becoming Lawful Permanent Residents. Once their status changes to Lawful Permanent Resident, they may qualify for an exception and continue eligibility without meeting the five-year waiting period and 40 work-quarter requirements if they have one of these codes: CU6, CU7, OOE, CH, CP, HF, HR, HT, HQRAP, PARCIS, EQ1, AM2, AM3, CH6, CH7, CNP, CU0, CU8, CU9, CUP, HA6-HA9, HB6-HB9, HD6-HD9, HE6-HE9, NC6-NC9, A04, A12, C08, C10, C11.

  3. Non-citizens who entered the U.S. before August 22, 1996 and are now Lawful Permanent Residents do not have to meet the five-year waiting period and 40 work-quarter requirements regardless of their immigration status at entry.

    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 based on that status. Once they become Lawful Permanent Residents, they must meet the five-year waiting period and 40 work-quarter requirements:

    1. Battered spouse or child;

    2. Conditional Entry;

    3. Parolee;

    4. Victim of Trafficking.

    Note: Individuals from FSM, RMI, or PAL (COFA) may be eligible for Medicaid before becoming Lawful Permanent Residents. Once their immigration status changes to LPR, they must meet the five-year waiting period and 40 work-quarter requirements.

  5. Pregnant Woman Coverage for non-citizens:

    1. Lawfully present non-citizen pregnant women who are not eligible for Medicaid due to immigration status may be eligible for Pregnant Woman coverage during pregnancy and the 12 months following the birth if they meet all other Medicaid requirements. After the 12-month period, they cannot continue Medicaid until they become Lawful Permanent Residents and either meet the five-year waiting period and 40 work-quarter requirements or qualify for an exception above.

    2. Lawful Permanent Resident pregnant women who are otherwise ineligible because they have not met the five-year waiting period and 40 work-quarter requirements may receive Pregnant Woman coverage during pregnancy and the 12 months following birth without meeting those requirements, if all other Medicaid requirements are met. After the 12-month period, they must meet the waiting-period/work-quarter requirements or an exception above.

    3. Undocumented non-citizens are not lawfully present and are not eligible for Pregnant Woman coverage, but they may be eligible for Emergency Services for the birth of a child if all other Medicaid requirements are met.

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

    1. Afghan Special Immigrants;

    2. Amerasian Immigrants;

    3. Asylees;

    4. Iraqi Special Immigrants;

    5. Refugees;

    6. Victims of Trafficking.

    Note: Cuban and Haitian Entrants who are not yet Lawful Permanent Residents may be eligible for regular Medicaid. If they are not eligible for Medicaid during any of their first eight months in the U.S. due to excess income, they may be eligible for RMA through their eighth month if they meet all other RMA requirements. After RMA ends, they may be eligible for regular Medicaid if they meet all other Medicaid requirements.

  7. Five-year waiting period: 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 qualifying work quarters based on quarters in which an individual paid for Social Security coverage. This information can be obtained using 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, verify the earnings.

    4. Count the individual’s work quarters.

    5. Count a spouse’s work quarters during the marriage. If divorced, count work quarters from the start through the end of the marriage. If separated but still married, continue to count work quarters. If the spouse died while still married, count work quarters earned before death.

    6. For a natural, adoptive, or stepparent, count applicable work quarters while the non-citizen child was under age 18. For adoptive parents, count beginning with the quarter of adoption. For stepparents, count beginning with the quarter of marriage to the child’s parent.

    7. Some earnings not counted by SSA, including certain federal, state/local government, farm, and domestic earnings, may be used as qualifying work quarters for Medicaid.

    8. Do not count work quarters from a parent whose parental rights were terminated.

    9. Do not count a work quarter in which an individual received TANF, SNAP, Medicaid, or SSI in at least one month of that quarter.