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Issue Alert - BEM 220 - Residency for Medicaid eligibility

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Jan 17, 2012

Program Area:

Medicaid BEM 220

Issue Summary:

Residency requirements for Medicaid eligibility now state that a child's residency status is the same as his/her parents, even if the child is a citizen and the parent has a different status, ie - work visa. See BEM 220.

Persons Affected:

Medicaid applicants

For More Information:

Lisa Ruby

Michigan Poverty Law Program

220 E. Huron #600A

Ann Arbor, MI 48104

(734)998-6100 ext. 117

Center for Civil Justice

320 S. Washington, 2nd Floor

Saginaw, MI 48607

(989) 755-3120


Fax: (989) 755-3558



U.S. Citizens and some qualified non-citizens or aliens who meet certain immigration status requirements receive the full package of Medicaid benefits if they meet the other financial and non-financial criteria for Medicaid. Other non-citizens, who do not meet the immigration status requirements for full Medicaid coverage, are eligible for Medicaid coverage of emergency services only (ESO). ESO coverage includes active labor and delivery for pregnant women, but not pre-natal care. See generally Department of Human Services (DHS) Bridges Eligibility Manual (BEM) Item 225.

Non-citizens cannot be denied Medicaid because they fail or refuse to provide verification of their immigration status, but they will be limited to ESO Medicaid. BEM 225 p. 15-16. Many groups of non-citizens who are in the U.S. legally, including Permanent Resident Aliens who entered the U.S. after August 22, 1996 and have not lived in the U.S. for at least 5 years do not meet the immigration status requirements.


An individual must be a Michigan resident in order to qualify for Michigan's Medicaid program. Under both federal and state law, residency may be established by either based on intent to stay, or based on entrance to the state with a job commitment or looking for work. The federal Medicaid regulation, 42 C.F.R. 435.403(i)(1), defines residence based on the state where the individual is "Living with the intention to remain there permanently or for an indefinite period... or (ii) Living and which the individual entered with a job commitment or seeking employment (whether or not currently employed)".

What's Happening?

The Department of Human Services (DHS) implements its residency policy through BEM 220. It states that "To be eligible, a person must be a Michigan resident." For Medicaid only (MA), it states that "an individual who claims that a member of the MA fiscal group has entered the state for employment purposes must verify that there is a job commitment or is seeking employment. If the official immigration documents indicate a status that does not permit the individual to work, the documents are verification that the individual did not enter Michigan for purposes of employment. When an adult in the MA fiscal group does not meet the residency requirement for eligibility, their children cannot meet the requirement either." emphasis added

An example of where this policy has been applied is to graduate students who enter the United States to attend school. The visas that they and their spouses and/or children have are defined as “non-immigrant visas” given to “exchange visitors,” or aliens with no intention of abandoning their foreign residences who are in the United States as students, scholars, teachers, or certain other kinds of visitors. The policy that has now been codified in BEM 220 is that the residency of a child follows the parent. When a parent is in Michigan on a time-limited visa, or for any other reason the parent does not meet the residency requirements for Medicaid, the child cannot meet residency requirements for Medicaid.

Residency is a separate element of Medicaid eligibility determinations, it is not related to the citizenship element for Medicaid eligibility. This can become very confusing, as you may have a citizen child who one would assume to be eligible for Medicaid. However, pursuant to this new language, U.S. citizen children will be denied Medicaid if they have parents who are here under a time-limited visa.

What Should Advocates Do?

If people overstay their visas, they and their dependents residing with them can establish state residency. They are no longer here pursuant to a time-limited visa and have no legal status, thereby making them eligible for emergency services-only Medicaid (ESO) and any citizen children would then become eligible for regular Medicaid. Also, if you can establish that a child should have a different residency status than the parents, for instance if the child is old enough and planning on staying in the U.S. when the parents leave, he/she may be eligible for Medicaid.

Finding Help

Most legal aid and legal services offices handle these types of cases, and they do not charge a fee. You can locate various sources of legal and related services, including the free legal aid office that serves your county, at You can also look in the yellow pages under "attorneys" or call the toll-free lawyer referral number, (800) 968-0738.