Medicaid for Immigrants who are Not Permanent Residents (Do Not have "Green Cards")-- PRUCOL Status and Procedure

2018 ALERT -   As of  Sept. 21, 2018, the Trump Administration has not changed the law on immigrant eligibility for Medicaid or other public benefits and has not changed the rules on when someone who receives Medicaid or other government benefits is considered a "public charge" or is  at risk of removal or being denied admission to the U.S. However, a leaked draft of an Executive Order has raised some concerns.  See this Fact Sheet by The National Immigrant Law Center, "The Trump Administration’s “Public Charge” Attack on Immigrant Families INFORMATION ABOUT AN UPCOMING PROPOSED RULE."  Also see:

Current Medicaid Rules For People Permanently Residing Under Color of Law but Who Do Not Have "Green Cards"

Many people mistakenly think an immigrant must have a "green card" (formally called a "lawful permanent resident" ) or be a refugee,  in order to be eligible for Medicaid.   This is not true, at least not in New York State.  Thanks to the New York State Constitution and a 2001 decision of New York's highest court in a case called Aliessa v. Novello,  many (but not all)  immigrants who do not have "green cards" are eligible for Medicaid in New York State.  Their Medicaid is paid for by the State exclusively, without any federal contribution -- but that does not affect the immigrant.  The Medicaid they have is the same. 

For a full explanation, see the   Immigrant Eligibility Handbook.   Immigrants who do not have a green card (permanent resident alien formally known as  the "qualified alien category")  but who are permanently residing under color of law (PRUCOL) are eligible for full Medicaid in New York State.    (see also 

New York’s Exchange Portal: A Gateway to Coverage for Immigrants, published 9/14/15, by Empire Justice Center reviews current rules on eligibility and describes how immigrants can access health care through NYSof Health portal, including for emergency care for those who are undocumented and not PRUCOL.   

Current NYS DOH policy defining the PRUCOL category can be found at:

Immigrants should be classified as PRUCOL by the social services district if :

  1. They can provide evidence that the USCIS or ICE (the main federal immigration agencies within the Dept. of Homeland Security) knows that they are here (see more below on what evidence is needed) and

  2. The immigration agencies are not contemplating enforcing their departure.  This is indicated either because:

These factors are described more below. 

1.  What is evidence that Immigration agencies know that the client is here in the U.S.?

The client is PRUCOL as long as the application is pending, and in some circumstances PRUCOL status may continue after the application is denied.  For example,  a notice denying a deferred action application states, “Denial of a request for deferred action does not necessarily mean that USCIS intends affirmatively to pursue your client’s removal.”   Some Fair Hearing decisions state that while the application may have been  denied, the facts and circumstances of the case indicate that the federal government does not intend to affirmatively enforce the person's removal.  See, e.g. Fair Hearing No. 6805696N (NYC 10/17/14),  Fair Hearing No. 6901593N (NYC 3/24/15), and Fair Hearing No.6417893Q (Dutchess Co. 1/17/2014). 

2.  WHAT PROOF IS NEEDED THAT AN IMMIGRATION AGENCY IS NOT ENFORCING THEIR DEPARTURE? 

      Either A or B:

A.   USCIS (or ICE) has expressly given them permission to remain in the U.S. , by granting:

 B.    The Immigration agency has not acted on an application or a letter, of the types described in #1 above.

  1. FORMAL APPLICATION to adjust status, etc.  - if Immigration service has not acted on a FORMAL APPLICATION, applicant is PRUCOL as long as the application is pending, no matter how long, until it is actually DENIED or there is some other indication that his her departure is being enforced.

  2. REQUEST BY LETTER FOR RELIEF from deportation -- Merely showing proof that the letter was sent is not enough.   The immigration agency must have been afforded "reasonable time" to consider the request, which the State Dept. of Health has said is six months from mailing the initial letter.  See 08 OHIP/INF-4 p. 6.   But the immigrant must ALSO show that the request was made in good faith by showing that s/he or her representative made at least one follow-up  inquiry about the status of the request with the Immigration agency during that six months.  

    • So - you must wait six months before filing a Medicaid application based on PRUCOL status, if the PRUCOL status is based on a letter, rather than a formal application to adjust status, and you must enclose proof that both the letter AND a follow-up letter were mailed to the immigration agency.    

  3. Requests for Deferred Action for Childhood Arrivals (DACA) (began 8/2012). The Dept. of Homeland Security (DHS) has decided to focus its attention on the removal of individuals who pose a danger to national security or a risk to public safety, including aliens convicted of crimes, with emphasis on violent criminals, felons and repeat offenders. The DHS will exercise prosecutorial discretion to ensure that enforcement resources are not expended on low priority cases, such as individuals who were brought to this country through no fault of their own as children. To be eligible for DACA, these individuals cannot have been convicted of a felony offense, a significant misdemeanor or multiple misdemeanor offenses. In New York State, these individuals will be PRUCOL, but are not eligible for FFP. See NYS GIS 13-MA-011 (May 7, 2013)

WHO IS NOT ELIGIBLE for PRUCOL status? 

The individuals in these "non-immigrant" categories are eligible only for "Emergency Medicaid,"  which may include some forms of cancer treatment, and pregnant women through 60-days post-partum.  ("Pre-Natal Care Assistance Program"= PCAP).    They may also seek health care options for the uninsured

IMMIGRATION RULES ARE VERY COMPLICATED.



Article ID: 33
Last updated: 21 Sep, 2018
Revision: 16
Medicaid -> Immigrant Access -> Medicaid for Immigrants who are Not Permanent Residents (Do Not have "Green Cards")-- PRUCOL Status and Procedure
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