Revision 17-4; Effective December 1, 2017

MEPD provides full Medicaid and/or MSP to qualified aliens whose eligibility is mandatory under federal requirements. Mandatory qualified aliens fall into three categories.  Refer to the following sections for information about the three categories of qualified aliens potentially eligible for full Medicaid and/or MSP:

• Section D-8310, Qualified Aliens Subject to a Seven-Year Limited Period
• Section D-8320, Qualified Aliens Not Subject to a Waiting Period or Limited Period
• Section D-8330, Qualified Aliens with a Five-Year Waiting Period

 

D-8310 Qualified Aliens Subject to a Seven-Year Limited Period

Revision 14-4; Effective December 1, 2014

The following qualified aliens are immediately eligible for full Medicaid and/or MSP benefits, provided they meet other program requirements, but are limited to seven years of eligibility:

• Refugees under Section 207 of the Immigration and Nationality Act (INA).
• Asylees under Section 208 of the INA.
• Aliens whose deportation is being withheld under Section 243(h) of the INA or whose removal has been withheld under Section 241(b)(3) of the INA.
• Cuban/Haitian entrants under one of the categories in Section 501(e) of the Refugee Education and Assistance Act of 1980, or aliens in a status that is to be treated as a "Cuban/Haitian entrant" for Medicaid purposes.
• Amerasian immigrants under Section 584 of the Foreign Operations, Export Financing, and Related Programs Appropriations Act of 1988. "Amerasian immigrants" are by definition lawfully admitted for permanent residence (LAPR), thus they are qualified aliens. If a person is an "Amerasian immigrant" and meets no other condition permitting eligibility, then the person is potentially eligible for Medicaid for seven years beginning with the date "Amerasian immigrant" status was granted.

Note: Amerasians who enter as legal nonimmigrants as defined in Section D-8610, Ineligible Aliens, (for example, foreign students pursuing studies in the U.S.) cannot be qualified aliens unless their classification changes.

• Afghan and Iraqi special immigrants eligible for resettlement assistance, federal benefits and entitlements. When determining eligibility for full Medicaid and/or MSP, treat these aliens as refugees according to provisions of the Department of Defense Appropriations Act for fiscal year 2010, signed by the president on Dec. 19, 2009.

Under federal law, a qualified alien in this category is limited to seven years of potential eligibility for full Medicaid and/or MSP unless the qualified alien fits into another category or becomes a naturalized citizen.

Start the Clock — The clock on the seven years begins to run from the date the person obtains a qualified alien classification, not from the date the person becomes eligible for full Medicaid and/or MSP.

Stop the Clock — The clock on the seven years stops with the beginning of the first month after the seventh anniversary of the date the person obtained qualified alien classification. Once the seven-year period ends, in order to remain eligible for full Medicaid and/or MSP, the alien described in this section must either:

• become a naturalized citizen or meet citizenship status; or
• be eligible for full Medicaid and/or MSP in the same manner as qualified aliens in Section D-8320, Qualified Aliens Not Subject to a Waiting Period or Limited Period.

Consider Medicaid for the treatment of an emergency medical condition when the seven-year period expires and the person does not meet either of the above.

 

D-8320 Qualified Aliens Not Subject to a Waiting Period or Limited Period

Revision 21-3; Effective September 1, 2021
 
Certain aliens are exempt from both the five-year waiting period and the seven-year limited period when they meet certain criteria.

The following aliens are eligible for full Medicaid and or MSP if they meet all other eligibility criteria:

• honorably discharged veterans or active duty members of the U.S. armed forces;
• spouses, unmarried surviving spouses or minor unmarried children of honorably discharged veterans or active duty members;
• Canadian born American Indians;
• members of federally recognized Indian tribes;
• aliens receiving SSI and or Medicaid on Aug. 22, 1996, and lawfully residing in the U.S. on or before Aug. 22, 1996;
• LPRs admitted for permanent residence prior to Aug. 22, 1996, and credited with 40 qualifying quarters of Social Security coverage;
• LPRs lawfully admitted on or after Aug. 22, 1996 and five years have passed since their legal date of entry, and have 40 qualifying quarters of Social Security coverage; and
• Compact of Free Association (COFA) citizens residing in the U.S.

Related Policy

Compact of Free Association (COFA) Citizens, D-5220
Qualified Aliens with a Five-Year Waiting Period, D-8330
Veterans, Armed Forces Active Duty and Dependents, D-8410
American Indians Born Outside the U.S., D-8420
LPR Residing in the U.S. on Aug. 22, 1996, D-8430

 

D-8330 Qualified Aliens with a Five-Year Waiting Period

Revision 14-4; Effective December 1, 2014

Aliens lawfully admitted for permanent residence on or after Aug. 22, 1996, are not eligible for full Medicaid and/or MSP benefits for a period of five years from the date they enter the U.S. or obtain a qualified alien classification, whichever is later, unless they meet:

• certain classifications described in Section D-8310, Qualified Aliens Subject to a Seven-Year Limited Period; or
• one of the LAPR conditions in Section D-8320, Qualified Aliens Not Subject to a Waiting Period or Limited Period.

Start the Clock — The clock on the five-year waiting period begins to run from the date the person:

• enters the U.S. with the qualified alien classification; or
• obtains the qualified alien classification.

Stop the Clock — The clock stops:

• with the beginning of the first month after the fifth anniversary of the date the person obtains the qualified alien classification, or
• earlier than the fifth anniversary if:
  • the alien classification changes and the alien meets criteria in Section D-8310, or
  • the alien meets one of the LAPR conditions in Section D-8320.

Once the five-year period ends, a qualified alien with a five-year waiting period who meets all other eligibility criteria must do one of the following to be eligible for full Medicaid and/or MSP:

• Become a naturalized citizen or meet citizenship status.
• Be credited with 40 qualifying quarters of Social Security coverage.
• Meet an alien classification criterion in Section D-8310 if the clock for the seven years has not ended.
• Meet one of the LAPR conditions in Section D-8320.

Consider Medicaid for the treatment of an emergency medical condition if the person does not meet one of the above or is still within the five-year waiting period.

 

D-8340 Establishing Qualifying Quarters of Social Security Coverage

Revision 14-4; Effective December 1, 2014

The Social Security Administration (SSA) defines a quarter as a period of three calendar months.

• Quarter 1: January, February, March
• Quarter 2: April, May, June
• Quarter 3: July, August, September
• Quarter 4: October, November, December

A quarter of coverage is credit for a requisite (necessary) amount of covered earnings assigned to a calendar quarter on a worker's earnings record.

A qualifying quarter is credit for a requisite (necessary) amount of covered earnings and/or non-covered earnings assigned to a calendar quarter for determining eligibility of an LAPR alien.

Individuals can get up to four qualifying quarters of credit each calendar year based on their own earnings. Individuals also can be credited with additional quarters in a calendar year based on the earnings of a parent or spouse.

To be potentially eligible for full Medicaid and/or MSP, an LAPR alien must be credited with 40 qualifying quarters, either from the alien’s own record, or combined with the quarters earned by a spouse or parent.

Note: The 40-qualifying-quarter requirement does not exempt the individual from the five-year waiting period (bar).

See the policy that follows to determine if the LAPR alien meets the 40-qualifying-quarter requirement.

 

D-8341 Combining Qualifying Quarters of Spouse/Parent

Revision 12-4; Effective December 1, 2012

Quarters from a spouse — Aliens can count their spouse's quarters earned during the marriage in addition to their own quarters to meet the 40 qualifying quarter requirement. For example, if each spouse has 20 quarters, the quarters are added and both spouses are credited with 40 quarters.

Count the spouse's quarters earned during the marriage when the spouse is either a citizen or an alien and any of the following conditions apply:

• The couple is currently married.
• A spouse is deceased and the surviving spouse has not remarried.
• The couple is separated but not divorced.

When determining whether to credit a person's quarters to his spouse, count quarters earned beginning with the quarter from the date of marriage.

Do not count quarters earned by divorced spouses for either ex-spouses.

Note: Aliens who divorce after certification retain their eligible alien status through the end of the current certification period. This also applies to stepchildren.

Quarters from a parent – Aliens also can count the quarters earned by a living or deceased parent in addition to their own quarters to meet the 40 qualifying quarter requirement. In this instance, a parent means the natural or adoptive parent or the stepparent.

Count the parent's quarters when the parent is either a citizen or an alien and the quarters were earned before the child turned 18, including quarters earned before the child was born.

Death of a stepparent does not end the relationship. However, if the parent and stepparent are divorced, the stepparent's quarters are not counted.

Note: Quarters earned by a child are not counted toward the eligibility of a parent.

 

D-8342 Qualifying Quarters Earned on or After Jan. 1, 1997

Revision 12-4; Effective December 1, 2012

Federal law requires that quarters earned on or after Jan. 1, 1997, cannot be credited if the person who earned the quarters received means-tested public benefits.

When determining the total amount of qualifying quarters earned, do not allow any quarters earned on or after Jan. 1, 1997, if the person received TANF, SNAP, Medicaid or SSI benefits in that quarter.

The Wire Third Party Query (WTPY) system response does not reflect receipt of these benefits. Staff should verify if federal means-tested benefits were received by any person contributing quarters so that applicable quarters are deducted before determining the number of qualifying quarters.

Example: An LAPR alien files an application for benefits on Oct. 10, 2012. He has never worked and has no qualifying quarters of his own. He has been married for 30 years and his spouse, who is a U.S. citizen and who has been working since they were married, earned her 40th qualifying quarter in March 2012.

Spouse received SNAP in January 2012 and February 2012; however, she has not been certified to receive SNAP or to be eligible for any other federal means-tested public benefit since February 2012.

Result: As the 40th qualifying quarter was earned while receiving SNAP, it cannot be allowed. Since the spouse continues working, the 40th qualifying quarter is earned in the quarter ending June 2012. Since all 40 qualifying quarters were earned during their marriage, the LAPR alien meets the 40 qualifying quarter determination.

 

D-8343 Non-Covered Wages

Revision 14-4; Effective December 1, 2014

Non-covered wages are those earned by a person whose employer was not required to pay into the Social Security system (such as certain city, federal, school or religious organization employees).

If the alien cannot meet the 40-qualifying-quarter requirement using covered or non-covered earnings verified by the SSA, then obtain sufficient income verification from the employer to determine if the alien earned quarters for the period in question using non-covered earned wages.

If the alien reports self-employment with non-covered earned wages, obtain sufficient information about this employment to verify that the alien:

• was engaged in a trade or business, and
• had net earnings from self-employment.

Acceptable documents include, but are not limited to, pay stubs, employer statements, W-2s, and income tax forms including all applicable schedules. If HHSC already has verification of the income, do not request additional information.

Use the chart below to determine if the person earned sufficient non-covered wages to earn a quarter.

Year	Amount Required for a Quarter	Amount Required for 4 Quarters
2014	$1,200	$4,800
2013	$1,160	$4,640
2012	$1,130	$4,520
2010–2011	$1,120	$4,480
2009	$1,090	$4,360
2008	$1,050	$4,200
2007	$1,000	$4,000
2006	$970	$3,880
2005	$920	$3,680
2004	$900	$3,600
2003	$890	$3,560
2002	$870	$3,480
2001	$830	$3,320
2000	$780	$3,120
1999	$740	$2,960
1998	$700	$2,800
1997	$670	$2,680
1996	$640	$2,560
1995	$630	$2.520
1994	$620	$2,480
1993	$590	$2,360
1992	$570	$2,280
1991	$540	$2,160
1990	$520	$2,080
1989	$500	$2,000
1988	$470	$1,880
1987	$460	$1,840
1986	$440	$1,760
1985	$410	$1,640
1984	$390	$1,560
1983	$370	$1,480
1982	$340	$1,360
1981	$310	$1,240
1980	$290	$1,160
1979	$260	$1,040
1978	$250	$1,000

Example: A person worked for the school district as a custodian from 2001 through 2011. The school district did not pay into the Social Security system. The specialist requested that the person provide verification of earnings for this particular period. (Note: If the State Online Query (SOLQ) shows an F on the 40-quarter record, SSA has verified those non-covered wages, and the specialist does not need to reverify them.)

The person brought a statement from the school district verifying the person’s wages. The person earned $9,000 for 2011. Using the chart above, the income required to earn a quarter for 2011 is $1,120. The person can be credited with four quarters for 2011 because the person earned more than the amount required ($1,120 x 4 = $4,480).

 

D-8344 Procedures for Verifying 40 Quarters

Revision 17-4; Effective December 1, 2017

Determine all persons whose quarters can be included in the quarter coverage count. See D-8341, Combining Qualifying Quarters of Spouse/Parent.

If the alien applicant/recipient and/or person whose quarters will be included did not sign the application form, obtain the person’s signature on Form SSA-3288, Social Security Administration Consent for Release of Information. When a completed and signed Form SSA-3288 cannot be obtained because the person refuses to complete it, SSA cannot release information about that individual.

If a person, other than the LPR applicant, refuses to sign the Form SSA-3288, do not request earnings history for that person. Determine eligibility based on the qualifying quarters of the LPR applicant/recipient. If the LPR applicant/recipient does not meet the qualifying quarter requirement, deny the case.

A signed Form SSA-3288 is not required when requesting information on:

• a deceased individual's Social Security number; or
• a spouse’s Social Security number when the couple is separated but not divorced.

Use the 40 Quarters Verification System in TIERS to request 40 quarters from SSA to determine how many countable quarters are in the LPR's SSA earnings records.

Note:  WTPY may still be used to obtain information on 40 Qualifying Quarters.

Run Inquiry to determine if any person whose quarters are being considered received SSI, SNAP, TANF or Medicaid in any month on or after January 1997. Record the eligibility dates for these benefits so that applicable quarters are deducted from the total before determining if the alien applicant/recipient meets the 40-qualifying-quarter requirement.

Note: Determine if it is possible for the alien to meet the 40-quarter requirement first by obtaining the number of years the alien and each person included in the quarter coverage calculation has lived in the U.S. If the combined number of years totals less than 10 years, the alien will not meet the requirement. (Must earn 4 quarters/year x 10 years = 40 quarters.)

 

D-8345 Response from WTPY

Revision 12-4; Effective December 1, 2012

SSA does not complete the posting of covered earnings quarters for any one year until the following year (around August). For instance, quarters earned in 2011 may not be posted on the WTPY system until August 2012. These quarters are referred to as Lag quarters.

The quarters of covered earnings are based on the calendar year's total earnings. Each year the amount of income needed to earn a quarter changes. State office advises staff of the change each year.

Example: In 2011, an individual must earn $1,120 to earn one quarter. If the individual earned at least $4,480 for 2011 ($1,120 x 4), the individual has four qualifying quarters for the year.

Do not allow credit for an incomplete or future quarter.

Example: The quarter of July-September 2011 cannot be counted until October 2011, even though the individual earned enough income by March 2011 to receive credit for three quarters in 2011.

Note: The WTPY response will not reflect receipt of federal means-tested benefits. Staff should conduct inquiry to verify if SSI, SNAP, TANF or Medicaid benefits were received by any person contributing quarters so that an accurate count of the qualifying quarters is made. See D-8342, Qualifying Quarters Earned on or After Jan. 1, 1997.