5011-6        PROOF OF ALIEN STATUS

 

To be eligible for Medicaid, an alien must provide proof of his or her alien status.  

 

The following documents are acceptable for determining alien status and whether the alien is subject to the five-year bar.  Certain USCIS documents can be viewed online at http://www.ncosc.net/Foreign_Nationals/Travel_Doc_Identification.pdf.

 

IMMIGRATION STATUS

VERIFICATION DOCUMENT (USCIS U.S. Citizenship and Immigration Services FORMS)

Legal Permanent Resident

  • I-551 (referred to as "green card"), or
     

  • I-94 annotated with a temporary I-551 stamp (for recent arrivals or aliens who have applied for a replacement I-551)

Refugee

  • I-94 stamped showing admission under section 207 of the INA Immigration and Nationality Act and date of entry to the US, or
     

  • I-688B annotated 274a.12(a)(3), or
     

  • I-766 annotated "A3, or,
     

  • I-571
     

(Refugees usually adjust to LPR status after 12 months in the US, However, they are still considered refugee for eligibility purposes when they have a I-551 with a code of RE-6, RE-7, RE-8, or RE-9)

Asylee

  • I-94 stamped showing grant of asylum under section 208 and date of entry, or
     

  • A grant letter from the Asylum Office of the USCIS U.S. Citizenship and Immigration Services; or
     

  • I-688B annotated "274a.12(a)(5), or
     

  • I-766 annotated "A5", or
     

  • Court order of an immigration judge showing asylum granted under section 208.

Parolee

  • I-94 annotated with stamp showing grant of parole under 212(d)(5) and a date showing granting of parole for at least 1 year.

Deportation Withheld

  • Order of an immigration judge showing deportation withheld under section 243(h) and date of grant; or
     

  • I-688B annotated 274a.12(a)(10), or
     

  • I-766 annotated "A10"

Conditional Entrant

  • I-94 with stamp showing admission under 203(a)(7), refugee-conditional entry, or
     

  • I-688B annotated 274a.12(a)(3)
     

  • I-766 annotated "A3"

Battered Spouse or Child of U.S. Citizen or Permanent Legal Resident

  • Approved or pending I-130 or I-360 petition showing a prima facia case that he or she is protected under the Violence Against Women Act, and
     

  • Verification that the individual responsible for the battery or cruelty is no longer living in the household of the victim.
     

  • Cuban Or Haitian Entrant • I-94 with stamp showing parole as “Cuban/Haitian Entrant” under section 212(d)(5) of the INA Immigration and Nationality Act
     

  • Form I-551 with code CU6, CU7, or CH6
     

  • Foreign passport containing an unexpired temporary I-551 stamp with the code CU6 or CU7

U.S. Military Veteran, Active Duty Military

(includes spouse and unmarried dependent children under 21)

  • Green Form DD-2 marked "ACTIVE", or
     

  • A current order showing the individual is on full-time duty in the US Army, Navy, Air Force, Marine Corps, or Coast Guard (Reserves are not considered active duty).
     

  • DD-214 indicating honorable discharge, or
     

  • Discharge papers indicating honorable discharge

Victims Of Trafficking

(includes certain eligible immediate family members holding a derivative T-Visa)

  • Letter of certification from the Office of Refugee Resettlement (ORR Office of Refugee Resettlement).  The caseworker must verify the validity of this letter and notify ORR Office of Refugee Resettlement of the benefits for which the individual has applied by calling the toll-free trafficking verification line at 1-866-401-5510.  
     

  • Form I-797a indicating Class T-1 Visa.
     

  • Form I-797a indicating T-2 (spouse), T-3 (child), T-4 (parent) or T-5 (unmarried sibling under age18 years on the date such alien’s T visa application was filed), known as a “Derivative Visa”.

 

Note:

T status is valid for 3 years from date of approval and is not renewable. However, the individual may adjust to lawful permanent resident status within the 90-day period immediately preceding the expiration of T status.

 

American Indian Born In Canada

  • Birth or baptismal certificate issued on a reservation;
     

  • Tribal records;
     

  • Letter from the Canadian Department of Indian Affairs, or
     

  • School records

 

 

Note:  

If an applicant presents a receipt indicating that he or she has applied to USCIS U.S. Citizenship and Immigration Services for a replacement document for one of the documents identified above, contact the USCIS U.S. Citizenship and Immigration Services to verify status by filing a G-845 with the local USCIS U.S. Citizenship and Immigration Services district office and attach a copy of the receipt.

 

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MC #29 (12/04)