Jane Dotson
Many immigrants face a five-year waiting period before they can enrol in Medicaid and CHIP, the Children's Health Insurance Program. This waiting period applies to lawfully present immigrants with qualified immigration status, including most lawful permanent residents or green card holders. The waiting period is intended to ensure that immigrants have a qualified status before becoming eligible for these health coverage programs. However, this exclusionary approach has negative consequences, with people avoiding seeking medical care due to fears of enrolling in government programs. To address this, some states have eliminated the waiting period for certain groups, such as children and pregnant people, and expanded access to affordable health coverage for immigrants.
| Characteristics | Values |
|---|---|
| Who does the 5-year waiting period apply to? | Lawfully present immigrants, including most lawful permanent residents or "green card" holders |
| Who is exempt from the 5-year waiting period? | Refugees, asylees, citizens of Compact of Free Association (COFA) nations, and LPRs who used to be refugees or asylees |
| What is the impact of the 5-year waiting period? | Immigrants face challenges accessing health coverage and affordable care, which can lead to worse health outcomes and financial difficulties |
| What are some solutions to the 5-year waiting period? | States can remove the waiting period for children and pregnant people, provide Medicaid look-alike programs, or offer ACA-compliant health plans for those ineligible for ACA marketplace coverage |
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What You'll Learn
Income-based eligibility
Income is a key factor in determining eligibility for health insurance for immigrants. Lawfully present immigrants may qualify for Medicaid and the Children's Health Insurance Program (CHIP), but their eligibility depends on their income and residency rules in their state. Federal poverty levels are used to determine eligibility for certain programs and benefits, including savings on Marketplace health insurance, and Medicaid and CHIP coverage.
Undocumented immigrants are not eligible for Marketplace health coverage. However, some states have expanded coverage to include income-eligible adults regardless of their immigration status. For example, in California, adults ages 26 to 49 will be allowed to qualify for Medi-Cal, regardless of their immigration status, as long as they meet the income limits.
Lawfully present immigrants with incomes below 100% FPL may receive tax credits if they are ineligible for Medicaid based on their immigration status. This includes those in the five-year waiting period or those without a "qualified" status.
Qualified non-citizens, such as lawful permanent residents or green card holders, typically face a five-year waiting period for Medicaid and CHIP coverage. During this time, they may qualify for Marketplace coverage and premium tax credits, depending on their income.
In conclusion, income plays a significant role in determining eligibility for health insurance among immigrants. While undocumented immigrants generally face more restrictions, some states have expanded coverage options for income-eligible individuals regardless of their immigration status. Lawfully present immigrants have more options but may still need to meet income requirements and wait periods for certain programs.
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State-specific variations
As of April 2025, 37 states, including the District of Columbia, have eliminated the five-year wait for lawfully residing children, and 31 states have done the same for pregnant individuals. These states recognize that children and pregnant individuals are "lawfully resident" if they are "lawfully present" and otherwise meet the eligibility criteria for Medicaid or CHIP.
Additionally, seven states, including California, Colorado, Illinois, Minnesota, New York, Oregon, and Washington, along with the District of Columbia, have expanded fully state-funded coverage to income-eligible adults, regardless of their immigration status. These states have addressed the healthcare needs of immigrants by providing them with access to health insurance.
Maryland plans to allow income-eligible individuals to purchase Marketplace coverage without subsidies, regardless of their immigration status, starting in November 2025. This move will further enhance healthcare access for immigrants in the state.
It is worth noting that certain states, such as Alabama, Arkansas, Florida, Idaho, Indiana, Iowa, Kansas, Kentucky, Missouri, Montana, Nebraska, New Hampshire, North Dakota, Ohio, South Carolina, South Dakota, Tennessee, Texas, and Virginia, have restricted access to Marketplace coverage for Deferred Action for Childhood Arrivals (DACA) recipients and certain other immigration statuses. These states have excluded specific immigrant groups from obtaining health insurance through the Marketplace, creating a disparity in access to healthcare.
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Exceptions for certain groups
In the United States, lawfully present immigrants with a "qualified" immigration status can get Marketplace coverage and may qualify for premium tax credits and savings on Marketplace plans. They may also be eligible for Medicaid and the Children's Health Insurance Program (CHIP) but must typically wait five years after obtaining qualified status before they can enrol.
However, there are exceptions to this five-year waiting period for certain groups. Refugees, asylees, and Lawful Permanent Residents (LPRs) who previously held these statuses are exempt from the five-year wait and can immediately enrol in Medicaid and CHIP upon obtaining qualified status. Victims of trafficking and their immediate family members, or individuals with a pending application for a victim of trafficking visa, are also exempt from the waiting period.
Additionally, 35 states, plus the District of Columbia and several US territories, have chosen to provide Medicaid coverage to lawfully residing children and/or pregnant people without the five-year waiting period. As of April 2025, 37 states plus D.C. have eliminated the wait for children, and 31 states plus D.C. have done so for pregnant individuals.
Furthermore, some states offer coverage to specific groups, such as lawfully present immigrants in the five-year waiting period for Medicaid. As of 2023, seven states and D.C. have expanded fully state-funded coverage to income-eligible adults regardless of immigration status. Maryland plans to follow suit starting in November 2025.
Undocumented immigrants, however, are generally unable to obtain Marketplace health coverage. Despite this, certain states, like California, have expanded coverage to low-income children regardless of immigration status, resulting in a decline in uninsurance rates.
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Impact on health outcomes
The impact of the five-year waiting period for medical insurance on immigrant health outcomes is significant. The exclusionary approach, where lawfully present immigrants are subject to a five-year waiting period for Medicaid and CHIP, has dire consequences. People with kidney failure, for instance, may wait until they are close to death to receive dialysis, and older adults' health may deteriorate due to preventable illnesses.
The waiting period also impacts pregnant people, who may avoid prenatal care due to fear of enrolling in government programs. This can lead to adverse health outcomes for both the parent and the child. The long-term health of children without insurance is also at risk, and they may experience reduced academic and career success.
The financial implications of the waiting period also contribute to the impact on health outcomes. Without insurance, immigrants face higher risks of medical debt and catastrophic healthcare costs, which can affect their financial well-being. This may further limit their access to healthcare services and impact their overall health.
However, some states have taken steps to mitigate these impacts. As of April 2025, 37 states, including Washington, D.C., have eliminated the five-year wait for children, and 31 states have done so for pregnant individuals. Additionally, seven states have expanded fully state-funded coverage to income-eligible adults, regardless of their immigration status. These expansions have been shown to improve health coverage and access to healthcare services for immigrants, ultimately improving their health outcomes.
The expansion of Medicaid eligibility to all adults with incomes up to 138% of the poverty level is also worth noting. While this policy does not directly address the five-year waiting period, it ensures that lawfully present immigrants with lower incomes have access to healthcare. This can help improve health outcomes and reduce financial burdens for those who have passed the waiting period or are exempt from it.
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Pathways to legal status
In the United States, there are various pathways to legal status for immigrants, and these pathways can lead to permanent residence and citizenship. While the process can be complex, there are a number of options available.
For those with close relatives who are U.S. citizens, there is a viable path to legal status. Immediate relatives, such as spouses, unmarried children under 21, and parents, can adjust their status to permanent residents without leaving the country. This is a pathway for those who entered the country legally and those who entered without authorization. The Provisional Unlawful Presence Waiver, or I-601A waiver, allows certain individuals to waive the 3 or 10-year re-entry bans. To qualify, applicants must demonstrate that their U.S. citizen relative would suffer extreme hardship if they were not granted the waiver.
Another pathway to legal status is through seeking asylum. Refugees and asylees can gain legal status and are exempt from the 5-year waiting period for Medicaid and CHIP coverage. Students and exchange programmes are another common route, with 21% of immigrants gaining legal status this way. Those who have overstayed their visas may also be able to adjust their status to lawful permanent residents, and some states have expanded coverage to include income-eligible adults, regardless of immigration status.
For undocumented immigrants, there are challenges, and the threat of deportation is very real. However, there are still smaller programs and laws that offer pathways to legal status. For example, military parole is an option for family members of U.S. service members. Furthermore, Congress is currently considering legislation that could provide citizenship pathways for essential workers, those who arrived as children, and those who have been in the U.S. for ten or more years.
The path to legal status for immigrants in the U.S. varies, and each individual's circumstances will determine their route. While there are many barriers, there are also opportunities, and a variety of ways to gain legal status and, ultimately, citizenship.
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Frequently asked questions
In the US, lawfully present immigrants with a "qualified" immigration status can get Marketplace coverage and may qualify for premium tax credits and other savings on Marketplace plans. However, many qualified non-citizens, including most lawful permanent residents or "green card" holders, have to wait five years after obtaining qualified status before they can enroll in Medicaid and CHIP coverage. This is known as the five-year waiting period.
Yes, there are some exceptions to the rule. Refugees, asylees, and Lawful Permanent Residents (LPRs) who previously held refugee or asylee status are exempt from the five-year wait. As of April 2025, 37 states and Washington D.C. have eliminated the wait for children, and 31 states and Washington D.C. have done the same for pregnant individuals.
The waiting period negatively affects the health and economic security of immigrants. They may delay treatment until their condition worsens, avoid prenatal care, or experience deteriorating health due to preventable illnesses. The waiting period also impacts their financial well-being, as they may accumulate medical debt and face higher risks of catastrophic healthcare costs.
