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Congressional Research Service
Inforrning the legislative debate since 1914
Updated March 10, 2025
Noncitizen Eligibility for Medicaid and CHIP
Medicaid and the State Children's Health Insurance
Program (CHIP) provide a health care safety net for low-
income populations. Noncitizen (i.e., alien in immigration
law) eligibility for these programs depends on the
noncitizen's immigration status and certain other factors.
According to KFF, eligible noncitizens represented 6% of
Medicaid enrollees under age 65 in 2023. This In Focus
provides an overview of Medicaid/CHIP eligibility rules for
noncitizens.
Medicaid and CHIP Background
Medicaid, authorized in Title XIX of the Social Security
Act (SSA), is a joint federal-state program that finances the
delivery of primary and acute medical services-as well as
long-term services and supports-to a diverse, low-income
population, including children, pregnant women, adults,
individuals with disabilities, and people aged 65 and older.
CHIP, authorized in SSA Title XXI, provides health
insurance coverage to low-income, uninsured children in
families with incomes above applicable Medicaid income
standards, as well as to certain pregnant women.
Participation in both programs is voluntary for states,
though all states, the District of Columbia (DC), and the
U.S. territories (i.e., American Samoa, the Commonwealth
of the Northern Mariana Islands [CNMI], Guam, Puerto
Rico, and the U.S. Virgin Islands) choose to participate.
States must follow broad federal rules to receive federal
matching funds, but they have flexibility to design their
own versions of Medicaid and CHIP within the federal
statute's basic framework. The U.S. territories operate their
Medicaid and CHIP programs under rules that differ from
those applicable to the 50 states and DC (e.g., capped
Medicaid funding, eligibility flexibilities). Both programs
include several statutory waiver and demonstration
authorities that allow states to operate their programs
outside of certain federal rules. This flexibility results in
variability across state Medicaid and CHIP programs in
factors such as eligibility and covered benefits.
Medicaid and CHIP Eligibility
There are a number of eligibility pathways through which
individuals may qualify for Medicaid. (An eligibility
pathway is the specific federal statutory reference[s] that
extends Medicaid coverage to certain groups of
individuals.) Often, an enrollee's eligibility pathway
dictates the Medicaid state plan services they are entitled to.
In general, individuals must meet both categorical (e.g.,
children, pregnant women) and financial (i.e., income and
sometimes asset limits) criteria. Some eligibility pathways
are mandatory, meaning that all states with a Medicaid
program must cover them; others are optional. Subject to
federal minimum standards, states have discretion in
determining certain eligibility criteria for both mandatory
and optional eligibility groups, which results in substantial
variability across states. Under CHIP, states have broad
discretion in setting their income eligibility standards, and
eligibility varies by state.
Medicaid and CHIP applicants must also meet federal and
state requirements regarding
* State Residency: SSA §§1902(a)(16), 1902(a),
1902(b)(2), and 2102(b)(1)(A) [42 U.S.C.
§§1396a(a)(16), 1396a(a), 1396a(b)(2), and
1397bb(b)(1)(A)];
* Documentation of U.S. Citizenship: SSA
§§1137(d)(2), 1902(a)(46), 1902(ee), 1903(x), and
2105(c)(9)(A) [42 U.S.C. §§1320b-7(d)(2),
1396a(a)(46), 1396a(ee), 1396b(x), and
1397ee(c)(9)(A)]; and
* Immigration Status: SSA §§1902(b)(3) and
2105(a)(3)(F) [42 U.S.C. §§1396a(b)(3) and
1397ee(a)(3)(F)]; and Personal Responsibility and Work
Opportunity Reconciliation Act of 1996 (PRWORA;
P.L. 104-193), as amended, §§401, 402, 403, 421, and
431 [8 U.S.C. §§1611, 1612, 1613, 1631, and 1641].
While most Medicaid and CHIP eligibility rules reside
within SSA Titles XIX and XXI, noncitizen eligibility for
these programs is largely governed by provisions within (1)
SSA Title XI and (2) PRWORA, as amended. The
intersection of these laws establishes the rules for
noncitizen eligibility under Medicaid and CHIP, as
summarized below.
Medicaid and CHIP Noncitizen Eligibility
Rules
Noncitizens' eligibility for Medicaid and CHIP largely
depends on (1) applicants' immigration status; (2) whether
they arrived in the United States (or were enrolled in
Medicaid) before August 22, 1996 (the date PRWORA was
enacted); and (3) how long they have lived and worked in
the United States. In addition, alien applicants must meet
the programs' other eligibility requirements (e.g., financial,
categorical, state residency).
Qualified and Nonqualified Aliens
In general, with respect to an applicant's immigration
status, noncitizen eligibility for most federal public
benefits-including Medicaid and CHIP-is governed by
the term qualified alien (8 U.S.C. §1641), which was
created in PRWORA, as amended. Qualified aliens include
lawful permanent residents (LPRs), refugees, aliens granted
parole for at least one year, aliens granted asylum or related
relief, certain abused spouses and children, Cuban-Haitian
entrants, and Citizens of the Freely Associated States (FAS)
residing in the U.S. states and territories (see text box
https://crsreports.congress.gov](ViewImageLocal?handle=hein.crs/ncznegly0001&div=1&collection=&method=preview&ext=.png&size=3)