Agents frequently work with clients who are immigrants or have mixed-status households. Understanding the eligibility rules for Marketplace coverage, Medicaid, and CHIP for immigrant families helps agents guide clients to the right coverage options.
For a list of accepted immigration documents and how to handle verification issues on a Marketplace application, see Verifying Immigration Status for ACA Marketplace Eligibility — Frequently Asked Questions.
Eligibility for ACA Marketplace Coverage
To be eligible for ACA Marketplace coverage, an individual must be a U.S. citizen, U.S. national, or be lawfully present in the United States. Individuals who are not U.S. citizens or lawfully present are not eligible for Marketplace coverage.
Medicaid and CHIP Eligibility for Immigrants
Individuals may be eligible for Medicaid or CHIP if they are a U.S. citizen or have a "qualified" immigration status. However, many qualified immigrants must wait 5 years after receiving qualified immigration status before they can enroll in Medicaid or CHIP. In some states, lawfully present children and pregnant women may be eligible even without a "qualified" immigration status. State rules vary.
Marketplace Financial Assistance During the 5-Year Medicaid Wait
Clients who are in the 5-year waiting period for Medicaid or CHIP may still qualify for financial assistance for Marketplace coverage. The Marketplace application will determine whether the client qualifies for APTC and CSR based on income and household size.
Special Enrollment Period for Newly Lawfully Present Individuals
Clients who recently became lawfully present in the United States may qualify for a Special Enrollment Period (SEP) to enroll in Marketplace coverage outside of Open Enrollment.
Emergency Medicaid for Non-Eligible Individuals
Individuals who are not U.S. citizens or lawfully present may still be able to receive Medicaid coverage for emergency medical conditions, including labor and delivery.
Document Verification for Citizenship and Immigration Status
Clients may need to submit documents to the Marketplace to verify their citizenship or immigration status as part of the application process. The Marketplace states that this information will not be used for immigration enforcement purposes.
Additional Resources
HealthCare.gov/immigrants — Detailed information about Marketplace coverage for immigrants
Marketplace Call Center: 1-800-318-2596 (TTY: 1-855-889-4325)
For additional help please contact Producer Support, which is available by chat directly from your account, by phone at (866) 568-9649, or by email at [email protected].