Health Care Coverage for Refugees and Immigrants

In This Section

Refugees and immigrants who are admitted to the United States have access to health insurance through Medicaid, the Children’s Health Insurance Program (CHIP), Refugee Medical Assistance (RMA), or the Health Insurance Marketplace. In general, Medicaid, CHIP, and RMA are managed by state Medicaid programs, and therefore physician offices and facilities should contact their state Medicaid program for answers to specific questions. For those refugees and immigrants who are not eligible for Medicaid and seek care using private insurance from the Marketplace, reach out to the health plan for questions.

On November 1, the Centers for Medicare & Medicaid Services (CMS) released guidance for Medicaid programs processing eligibility for Afghan refugees. All Afghan refugees, regardless of immigration category, are eligible for Medicaid or CHIP without a five-year waiting period as long as they meet the eligibility requirements summarized below, until at least March 31, 2023.

In order to submit a claim for reimbursement for refugees and immigrants covered by Medicaid, CHIP, or RMA, physicians and providers will need to be enrolled as a Medicaid provider. The state may decide to offer an exception for Afghan refugees. Contact the Medicaid Provider Enrollment office in your state for more information.

Read on for eligibility and resources for physician practices.

Information and Resources for Practices

Presumptive Eligibility

Presumptive eligibility allows Medicaid programs to cover services before the individual is deemed eligible for coverage. States may elect to include refugees, immigrants, pregnant persons, and children in their presumptive eligibility program. It is important to note that not all states offer presumptive eligibility.

States that provide presumptive eligibility typically require hospitals, facilities, or practices to complete an application and training program including guidance on how to determine presumptive eligibility.

Presumptive eligibility is typically 60 days from the day of determination and is only available one time in a 12-month period. Services that are benefits and performed in the 60-day time frame are covered regardless if the individual is determined ineligible for continued Medicaid or CHIP coverage.

If Medicaid coverage cannot be verified through the state eligibility verification system, physician offices should contact the hospital presumptive eligibility or medical assistance programs managed by the state Medicaid program. A referral to a recognized or certified presumptive eligibility provider may be necessary.

Medicaid or CHIP Eligibility

Medicaid and CHIP eligibility for refugees and immigrants is verified by the state Medicaid program’s policies. The eligibility is typically measured by:

Noncitizen Eligibility

The Medicaid program has access to the Federal Data Services Hub that collects data from the Departments of Homeland Security, Health and Human Services, Justice, the Internal Revenue Service, and any state records regarding residency. The hub informs the Medicaid program of the immigration category that determines the type and length of medical assistance.

Residency

Medicaid programs often require verification of residency in the state for Medicaid eligibility. Depending on the state, this can be an attestation by the individual of the intent to reside within the state and does not need to be supported by a fixed address. Few states may offer eligibility to nonresidents.

If an individual intends to move to another state, they do not need to wait to apply for Medicaid. The date of eligibility is the date they arrive in the state. An individual cannot receive benefits from two state Medicaid programs simultaneously.

Income

States are required to provide Medicaid to all children and pregnant individuals. The income eligibility varies by state and cannot be reduced to an income lower than 133% of the federal poverty level. Several states have higher limits for pregnant individuals and some also include a percentage of the federal poverty level for adult eligibility.

Refugees and immigrants who do not qualify for Medicaid based on income level may still qualify for coverage through the Health Insurance Marketplace and may seek medical care coverage using a commercial plan. Note that plans obtained through the Marketplace do not typically cross state lines; therefore, like Medicaid, a change in residency will require a new plan.

As with every patient visit, insurance coverage should be verified prior to the visit for the date of service.

Stopgap Coverage

In addition to coverage through presumptive eligibility, RMA offers up to eight months of coverage starting the day a person leaves a military base and enters a community. There are income requirements for RMA that are typically similar to those in the state Medicaid program and should be verified through the Medicaid program.

If the Medicaid program cannot verify immigration status promptly, the individual attests to eligible immigration status, and once the other Medicaid or CHIP eligibility requirements are met, the state must cover services for at least a 90-day period and must give a 10-day advance notice for cancellation of the Medicaid or CHIP benefit. This coverage should also be noted in the Medicaid coverage verification system.