Are noncitizens in North Carolina eligible for Medicaid? Some are. Here are the rules.

In North Carolina, 7% of U.S.-born people do not have health insurance, while 12% of immigrant U.S. citizens and 47% of immigrant noncitizens are uninsured.

That’s according to a new Urban Institute and UNC-Chapel Hill report using census data on barriers immigrants face in accessing safety-net programs.

But Medicaid is set to expand in the state on Dec. 1, opening the door for hundreds of thousands of people In North Carolina to gain access, and that includes immigrants.

They may not always know it, but immigrants who are U.S. citizens, as well as some noncitizens, qualify for the federal-state health insurance program.

Here’s a guide to eligibility requirements.

Income requirements

North Carolina, until just recently, was one of just 11 states that had not expanded Medicaid, which meant that the income limit for eligibility under the program for a parent or caretaker in North Carolina was 41% of the federal poverty level, or just over $8,000 yearly for a family of three.

With the passage of Medicaid expansion into law this year, the program will now cover all adults up to 138% of the federal poverty line. This means single adults who make below about $20,120 a year can get access to health insurance. Family income thresholds will also be expanded.

Citizenship/residency requirements

To be eligible for Medicaid in North Carolina, you have to live in the state.

Under most circumstances, to qualify you have to be a citizen. But certain noncitizens are eligible. According to the state’s health and human services department, these are:

  • Lawful permanent residents (LPR/green card holder)

  • People granted asylum status

  • Refugees

  • Cuban/Haitian entrants

  • Those paroled into the U.S for at least one year

  • Conditional entrants with that status granted before 1980

  • Battered noncitizens, spouses, children or parents

  • Victims of trafficking (and certain family members of the victim) with a pending application for a victim trafficking visa

  • Those granted withholding of deportation

  • Members of a federally recognized Indian tribe or American Indian born in Canada

  • Citizens of the Marshall Islands, Micronesia and Palau who are living in one of the U.S states or territories.

According to DHHS, in most of the cases above, the noncitizen will need to wait five years after receiving a qualifying immigration status to be eligible to apply.

Some immigrants with a qualifying status, such as refugees and people granted asylum, do not have to wait five years. Immigrants in the country without legal authorization are not eligible to enroll in Medicaid or other federally funded coverage programs like the Health Insurance Marketplace.

To apply, you’ll need to provide your full legal name, date of birth, Social Security number (or immigration documents), proof of North Carolina residency and income information (such as pay stubs and tax returns).

People can apply through the state’s ePass Public Portal (available in English and Spanish), in person at a local Department of Social Services office or via mail using a paper application that must be sent to a local DSS office. Another alternative is to apply through the website or by calling 1-800-318-2596.

Barriers immigrants face

Beyond eligibility questions, immigrants, whether U.S. citizens or not, face additional barriers to accessing safety-net programs such as Medicaid and the Supplemental Nutrition Assistance Program (SNAP). According to the UNC and Urban institute report, these include:

  • A lack of language access (especially beyond Spanish)

  • Fears of immigration-related consequences and misinformation about public charges.

  • Complex immigrant eligibility rules and challenges providing employment and identification documentation

  • Discriminatory treatment from employees helping enroll in programs based on race, ethnicity, language and immigration status.

These barriers are on top of the universal structural barriers that many program applicants face, including complicated eligibility rules and burdensome enrollment processes, the report says.

The report found that community-based organizations and community health workers play a key role in supporting immigrants to gain access to safety-net programs, though these organizations face funding and capacity challenges.

Also key are state and local agencies, which need to address mistrust and immigration-relation concerns, simplify the processes for enrolling and reapplying, improve language accessibility and more, said the report.

Researchers conducted interviews with more than 40 people working at the state and county levels and held four multilingual focus groups with immigrants.

The study also released a new tool, using Census data, which maps the characteristics of immigrants across counties, such as the birth region and health-insurance status of immigrants.