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    v1.0.28
    OpenPayerPolicy UpdatesAdministrative/Operational PolicyIndiana Medicaid Immigrant Coverage Update | OpenP…
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    CurrentIndiana Department of InsurancePolicy 2402.20.49

    Iraqi and Afghani Special Immigrants

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    This policy governs Medicaid and CHIP eligibility, alternative coverage pathways, and verification requirements for Iraqi and Afghan nationals with special immigrant visas, SI/SQ parole, or humanitarian parole. It addresses when individuals must be denied Medicaid, subject to a five-year waiting period, or transitioned to Emergency Services Only Medicaid.

    Policy Summary
    PayerIndiana Department of Insurance
    PolicyIraqi and Afghani Special Immigrants
    Policy CodePolicy 2402.20.49
    Change TypeRevised eligibility rules
    Effective DateOctober 1, 2026
    Next Review DateN/A
    Key ActionVerify immigration classification and admission information using the passport, DHS Form I-551, or I-94 before determining eligibility.
    SourceLink
    POLICY UPDATE CHANGES

    Eligibility rules distinguish Afghan special immigrant visa holders and SI/SQ parolees from humanitarian non-SI/SQ parolees for Medicaid and CHIP purposes.

    The policy identifies additional Afghan parolee populations that are ineligible for Medicaid, including certain individuals paroled during specified periods and Afghan parolees eligible for Unaccompanied Refugee Minor services.

    5 yearsWaiting period for qualifying SIV holders and SI/SQ parolees
    >1 yearSI/SQ parole duration

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    3Afghan immigration categories addressed
    ESOFallback Medicaid coverage
    7 SI / 7 SQImmigrant visa categories for verification

    Eligibility by Immigration Classification

    Alternative Marketplace and Refugee Medical Assistance

    Individuals who cannot receive Medicaid or CHIP because of income or lack of other coverage may qualify for an alternative coverage pathway.

    Alternative Marketplace and Refugee Medical Assistance pathway

    • The individual is an Afghan SI/SQ parolee

      • The individual was granted SI/SQ parole, including parole granted for more than one year.

    • Medicaid or CHIP is unavailable for one of the following reasons

      • The individual is over the applicable Medicaid or CHIP income limits.
      • The individual does not have other coverage, such as employer-sponsored insurance.
    • The individual may be eligible for Marketplace coverage with financial assistance through Refugee Medical Assistance (RMA).

      Marketplace and RMA eligibility remains subject to the applicable program requirements.

    Key Eligibility Timeframes

    Five-year waiting period
    Waiting period5 years
    Applies toQualifying Afghan Special Immigrant Visa holders and SI/SQ parolees, if otherwise eligible for Medicaid or CHIP
    Approved permanent resident statusApproved lawful permanent resident status is subject to the applicable five-year bar unless a federal exemption applies
    SI/SQ parole duration
    DurationMore than one year
    Status effectSI/SQ parole for more than one year places the individual in a qualified non-citizen status
    Coverage condition

    Verification and Eligibility Processing

    Documentation Required

    Verify special immigrant or parole status

    Before determining eligibility, verify the individual’s immigration classification and admission information using the required documentation.

    • Passport with an immigrant visa stamp showing SI1, SI2, SI3, SI6, SI7, SI8, SQ1, SQ2, SQ3, SQ6, SQ7, or SQ8 classification, plus a DHS stamp or notation showing the admission date.
    • DHS Form I-551 (green card) with the applicable immigrant visa category code.
    • I-94 noting SQ or SI parole.
    Denial Risk

    Apply immigration eligibility rules

    Apply the applicable qualified-non-citizen, five-year waiting-period, income, other-coverage, and federal-exemption rules when determining Medicaid or CHIP eligibility.

    • SIV holders and SI/SQ parolees granted parole for more than one year may qualify as qualified non-citizens, subject to the five-year waiting period and other eligibility requirements.

    Immigration and Coverage Terms

    Afghan Special Immigrant Visa holder
    Primary classificationAn Afghan granted a Special Immigrant Visa based on affiliation with the U.S. mission in Afghanistan, such as a translator or interpreter
    Qualifying family membersThe spouse or an unmarried child under age 21 of a qualifying Afghan may also be included
    Immigration statusSpecial Immigrant Visa holders are lawful permanent residents, also known as green card holders
    SI/SQ Parolee
    DefinitionAn Afghan eligible for a Special Immigrant Visa who was evacuated to the United States before completing the process to receive the visa
    Parole classificationThe individual was granted SI/SQ parole
    Policy Summary
    PayerIndiana Department of Insurance
    PolicyIraqi and Afghani Special Immigrants
    Policy CodePolicy 2402.20.49
    Change TypeRevised eligibility rules
    Effective DateOctober 1, 2026
    Next Review DateN/A
    Key ActionVerify immigration classification and admission information using the passport, DHS Form I-551, or I-94 before determining eligibility.
    SourceLink
    On This Page
    Eligibility by Immigration ClassificationKey Eligibility TimeframesVerification and Eligibility ProcessingImmigration and Coverage Terms
    Medicaid or CHIP may be available after the five-year waiting period if the individual is otherwise eligible
    Humanitarian parole period referenced
    Period coveredJuly 31, 2021 through September 30, 2022
    Later paroleesSpecified spouses or children of parolees, and parents or legal guardians of unaccompanied children paroled after September 30, 2022, are also addressed
    Eligibility conditionIndividuals in these categories who have not transitioned to approved lawful permanent resident status or met the five-year waiting period are not eligible for Medicaid
  1. Humanitarian non-SI/SQ parolees are ineligible unless they transition to an approved LPR status subject to the five-year bar or receive a federal exemption.
  2. Consider Marketplace coverage or Refugee Medical Assistance when an otherwise eligible individual is ineligible for Medicaid or CHIP because of income or lack of other coverage.
    3. Documentation Required

    Process incomplete status verification

    If the individual is otherwise eligible for Medicaid but citizenship or qualified immigration status cannot be verified, determine eligibility in accordance with the referenced processing guideline.

    • The individual must meet all other Medicaid verification requirements.
    • Refer to 2035.40.05 for the processing guideline.
    Denial Risk

    Transition nonqualified individuals to ESO

    Transition individuals who fail to attain or adjust to a federally qualified immigration status to Emergency Services Only Medicaid coverage (ESO).

    • Apply this when the individual does not attain or adjust to a federally qualified status.
    • Refer to 2402.20.50 for ESO procedures.
    Qualified status conditionSI/SQ parole for more than one year is a qualified non-citizen status for Medicaid and CHIP purposes
    Humanitarian non-SI/SQ Parolee
    DefinitionAn Afghan evacuated for urgent humanitarian reasons and paroled into the United States without being granted a Special Immigrant Visa
    SIV eligibilityThe individual may not be eligible for the Special Immigrant Visa program
    Medicaid statusHumanitarian non-SI/SQ parolees are generally ineligible for Medicaid unless they obtain approved lawful permanent resident status or a federal exemption
    Emergency Services Only Medicaid
    Coverage categoryEmergency Services Only Medicaid, or ESO
    Applies whenThe individual fails to attain or adjust to a federally qualified immigration status
    Required actionTransition the individual to ESO coverage when the applicable qualified status is not attained or adjusted