C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER C—MEDICAL ASSISTANCE PROGRAMS › PART 435—ELIGIBILITY IN THE STATES, DISTRICT OF COLUMBIA, THE NORTHERN MARIANA ISLANDS, AND AMERICAN SAMOA › Subpart E—General Eligibility Requirements

42 C.F.R. § 435.406

Citizenship and noncitizen eligibility

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(a) The agency must provide Medicaid to otherwise eligible individuals who are—

(1) Citizens and nationals of the United States, provided that—

(i) The individual has made a declaration of United States citizenship, as defined in § 435.4, or an individual described in paragraph (a)(3) of this section has made such declaration on the individual's behalf, and such status is verified in accordance with paragraph (c) of this section; and

(ii) For purposes of the declaration and citizenship verification requirements discussed in paragraphs (a)(1)(i) of this section, an individual includes applicants under a section 1115 demonstration (including a family planning demonstration project) for which a State receives Federal financial participation in its expenditures.

(iii) The following groups of individuals are exempt from the requirement to provide documentation to verify citizenship in paragraph (c) of this section:

(A) Individuals receiving SSI benefits under title XVI of the Act.

(B) Individuals entitled to or enrolled in any part of Medicare.

(C) Individuals receiving disability insurance benefits under section 223 of the Act or monthly benefits under section 202 of the Act, based on the individual's disability (as defined in section 223(d) of the Act).

(D) Individuals who are in foster care and who are assisted under Title IV-B of the Act, and individuals who are beneficiaries of foster care maintenance or adoption assistance payments under Title IV-E of the Act.

(E)(1) Individuals who are or were deemed eligible for Medicaid in the State under § 435.117 or § 457.360 of this chapter on or after July 1, 2006, based on being born to a pregnant woman eligible under the State's Medicaid or CHIP state plan or waiver of such plan;

(2) At State option, individuals who were deemed eligible for coverage under § 435.117 or § 457.360 of this chapter in another State on or after July 1, 2006, provided that the agency verifies such deemed eligibility.

(2)(i) Except as specified in 8 U.S.C. 1612(b)(1) (permitting States an option with respect to coverage of certain qualified noncitizens), qualified noncitizens as described in 42 CFR 435.4 (including qualified noncitizens subject to the 5-year bar) who have provided satisfactory documentary evidence of qualified noncitizen status, which status has been verified with the Department of Homeland Security (DHS) under a declaration required by section 1137(d) of the Act that the applicant or beneficiary is a noncitizen in a satisfactory immigration status.

(ii) The eligibility of qualified noncitizens who are subject to the 5-year bar in 8 U.S.C. 1613 is limited to the benefits described in paragraph (b) of this section.

(3) For purposes of paragraphs (a)(1) and (2), of this section, a declaration of citizenship or satisfactory immigration status may be provided, in writing and under penalty of perjury, by an adult member of the individual's household, an authorized representative, as defined in § 435.923, or if the applicant is a minor or incapacitated, someone acting responsibly for the applicant provided that such individual attests to having knowledge of the individual's status.

(b) The agency must provide payment for the services described in § 440.255(c) of this chapter to residents of the State who otherwise meet the eligibility requirements of the State plan (except for receipt of AFDC, SSI, or State Supplementary payments) who are qualified noncitizens subject to the 5-year bar or who are non-qualified noncitizens who meet all Medicaid eligibility criteria, except non-qualified noncitizens need not present a social security number or document immigration status.

(c) The agency must verify the declaration of citizenship or satisfactory immigration status under paragraph (a)(1) or (2) of this section in accordance with § 435.956.

[55 FR 36819, Sept. 7, 1990, as amended at 56 FR 10807, Mar. 14, 1991; 71 FR 39222, July 12, 2006; 72 FR 38691, July 13, 2007; 81 FR 86454, Nov. 30, 2016; 89 FR 39436, May 8, 2024]
Notes of Decisions
Cited in 9 cases (2 in the last 5 years), 1991–2025 · leading case: State of Texas v. United States, 50 F.4th 498 (5th Cir. 2022).
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State of Texas v. United States, 50 F.4th 498 (5th Cir. 2022). “109 See 42 C.F.R. § 435.406 (b) (2022) (emergency Medicaid); Plyler v.”
Soskin v. Reinertson, 353 F.3d 1242 (10th Cir. 2004). “See 42 C.F.R. § 435.406 (a) (1990). Now, the PRWORA requires states to provide Medicaid coverage only to “qualified aliens,” which it defines as lawful permanent residents, refugees, aliens granted asylum, and certain other specified categories of lawfully present aliens.”
Mercy Healthcare Arizona, Inc. v. Arizona Health Care Cost Containment Sys., 887 P.2d 625 (Ariz. Ct. App. 1994). “Undocumented aliens are those who do not meet the alienage requirements of the federal Medicaid program as implemented by 42 C.F.R. 435.406(a) under authority from 42 U.”
Szewczyk v. Dep't of Soc. Servs., 822 A.2d 957 (Conn. App. Ct. 2003). “§ 1396b (v) (1) (‘no payment may be made to a State under this section for medical assistance furnished to an alien who is not lawfully admitted for permanent residence or otherwise permanently residing in the United States under color of law’); 42 C.F.R. § 435.406 . The only…”
Chrisdiana v. Dep't of Cmty. Health, 754 N.W.2d 533 (Mich. Ct. App. 2008). · cites it 2× “Under 42 CFR 435.406(b), emergency Medicaid services must be provided "to residents of the State who .”
Okale v. North Carolina Dep't of Health & Human Servs., 570 S.E.2d 741 (N.C. Ct. App. 2002). “42 C.F.R. 435.406(b) (2001); 42 U.S.C. 1396b(v).”
Chiles v. United States, 874 F. Supp. 1334 (S.D. Fla. 1994). “§ 1396b and implemented under 42 C.F.R. §§ 435.406 and 435.408. AFDC is authorized under 42 U.”
Salem Hosp. v. Comm'r of Pub. Welfare, 574 N.E.2d 385 (Mass. 1991). “255 provides that “[ejffective January 1, 1987, aliens who are not lawfully admitted for permanent residence in the United States or permanently residing in the United States under the color of law” must be eligible to receive Medicaid for treatment of an emergency medical…”
State of Washington v. Trump (9th Cir. 2025). · cites it 3× “§§ 1611 (a)(c)(1)(B); 42 C.F.R. § 435.406 . Because current State systems rely on birth certificates, place of birth, or Social Security Numbers (SSNs) to determine eligibility, the States contend that they will need to create new systems to determine citizenship and maintain…”
— 42 C.F.R. § 435.406(a) — 1 case
Mercy Healthcare Arizona, Inc. v. Arizona Health Care Cost Containment Sys., 887 P.2d 625 (Ariz. Ct. App. 1994). “Undocumented aliens are those who do not meet the alienage requirements of the federal Medicaid program as implemented by 42 C.F.R. 435.406(a) under authority from 42 U.”
— 42 C.F.R. § 435.406(b) — 2 cases
Chrisdiana v. Dep't of Cmty. Health, 754 N.W.2d 533 (Mich. Ct. App. 2008). “Under 42 CFR 435.406(b), emergency Medicaid services must be provided "to residents of the State who .”
Okale v. North Carolina Dep't of Health & Human Servs., 570 S.E.2d 741 (N.C. Ct. App. 2002). “42 C.F.R. 435.406(b) (2001); 42 U.S.C. 1396b(v).”
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