Application For Retroactive Medicaid Coverage - Department Of Human Services - Case Records Management Unit Form Page 5

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Attachment B
Eligible Immigration Status
Eligible Immigration Status Chart
For all applicants, these are eligible
If the person is an individual under the age of 21 or a
immigration statuses:
pregnant woman, these are additional eligible immigration
statuses:
Lawful Permanent Resident (LPR,
Individual with Non-immigrant Status (includes worker visas,
or "Green card" holder)
student visas, and citizens of Micronesia, the Marshall Islands,
and Palau)
Asylee
Individual with Temporary Protected Status (TPS) or
Refugee
Applicant for Temporary Protected Status (TPS) (with
Cuban or Haitian entrant
Employment Authorization)
Individual paroled into the U.S. for
Individuals with Deferred Enforced Departure (DED)
at least one year
Family Unity beneficiary
Conditional entrant granted before
Individual with Deferred Action Status
1980
(Except Individual with Deferred Action for Childhood
Battered spouse, child and parent
Arrivals (DACA). DACA is not an eligible immigration
Victim of Trafficking and his/her
status)Applicant for Special Immigrant Juvenile Status
spouse, child, sibling or parent
Applicant for Adjustment to LPR Status
Individual granted Withholding of
Applicant for Asylum
Deportation or Withholding of
Removal
Applicant for Withholding of Deportation or Withholding of
Removal, under the immigration laws or under the Convention
Amerasian Immigrant
against Torture (CAT)
Iraqi and Afghan Special
Applicant who has filed for creation of record of lawful
Immigrants
admission for permanent residence (Registry Applicants) (with
Member of a federally-recognized
Employment Authorization)
Indian tribe or American Indian
Individual released on an order of Supervision (with
Born in Canada
Employment Authorization)
Veterans or individuals on active
Applicant for Cancellation of Removal or Suspension of
duty in the Armed Forces and their
Deportation (with Employment Authorization)
immediate family members
Applicant for Legalization under IRCA (with Employment
Authorization)
Legalization under the LIFE Act (with Employment
Authorization)
Individual Lawfully Admitted with Temporary Resident Status
Resident of American Samoa
Individual granted administrative order staying removal issued
by the Department of Homeland Security
5
D.C. Application for Retroactive Medicaid Coverage (3/2014)

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