Model the CHIPRA §214 (ICHIA) lawfully-residing option for children and pregnant people in Medicaid and CHIP #9736

Problem

is_medicaid_immigration_status_eligible applies the federal five-year bar (8 USC 1613) to every lawful permanent resident, parolee and conditional entrant. It has no term for the state option in 42 USC 1396b(v)(4), the CHIPRA §214 or "ICHIA" option. Through that option, 37 states plus DC cover lawfully residing children in Medicaid without the bar, and 31 states plus DC cover lawfully residing pregnant people (CMS, April 2026). As a result:

• A permanent-resident child or pregnant person inside the bar wrongly fails Medicaid in states that elected the option. With today's years_since_us_entry default of 5 this is invisible, but it blocks PolicyEngine/microcosm#776 which would store real entry years. It also blocks #9732, which removes the default. Without the option, recent-LPR children in those states would drop out of baseline Medicaid, a regression against reported CPS receipt.
• Lawfully present people who are not qualified aliens, such as those with Temporary Protected Status (TPS), are covered under the option. Today the model covers TPS children and pregnant people only through California's state-funded list. For example, a TPS child in New York or Texas fails today.
• From October 1, 2026, H.R.1 §71109 removes FFP for refugees, asylees, parolees and others, and CMS confirms the option is untouched. After that date, children and pregnant people in those statuses stay covered in states that elected the option. The model's 2026-10-01 eligible_immigration_statuses list drops them everywhere.
• CHIP (is_chip_eligible_child, is_chip_eligible_standard_pregnant_person, ca_cchip_eligible) checks only ~(UNDOCUMENTED | DACA), so every state is treated as if it had elected the option for CHIP. The code has no five-year bar, no qualified-alien limit and no §71109 narrowing (#9346). In separate-CHIP states that did not elect the option (AL, AZ, ID, IN, KS, MO, MS, SD, TN), recent-LPR and TPS children wrongly qualify.

Law

42 USC 1396b(v)(4)(A), added by CHIPRA §214(a):

A State may elect (in a plan amendment under this subchapter) to provide medical assistance under this subchapter, notwithstanding sections 1611(a), 1612(b), 1613, and 1631 of title 8, to children and pregnant women who are lawfully residing in the United States (including battered individuals described in section 1641(c) of title 8) and who are otherwise eligible for such assistance, within either or both of the following eligibility categories:
(i) Pregnant women — Women during pregnancy (and during the 60-day period beginning on the last day of the pregnancy).
(ii) Children — Individuals under 21 years of age, including optional targeted low-income children described in section 1396d(u)(2)(B) of this title.

The option waives the qualified-alien limit (1611(a)), the state Medicaid restrictions (1612(b)), the five-year bar (1613) and sponsor deeming (1631).

42 USC 1397gg(e)(1)(Q) applies it to CHIP. It was (P) before P.L. 119-21 redesignated it.

Paragraph (4) of section 1396b(v) of this title (relating to optional coverage of categories of lawfully residing immigrant children or pregnant women), but only if the State has elected to apply such paragraph with respect to such category of children or pregnant women under subchapter XIX.

CMS guidance:

• SHO #10-006, p. 1 sets the ages: "children up to age 19 for CHIP or up to age 21 for Medicaid".
• p. 2 bars CHIP-only elections.
• p. 3 defines "lawfully present". The list covers qualified aliens, valid nonimmigrants, parolees under one year, TPS, deferred action, DED, pending asylum applicants with work authorization, and others.
• p. 4 says a state "must offer coverage to all such individuals who meet this definition".
• SHO #12-002 excludes DACA: "individuals with deferred action under the DACA process shall not be eligible for Medicaid and CHIP under the CHIPRA state option". The current state plan template has the same exception (NH-24-0003, p. 10).
• That template also offers child age caps of 21, 20 or 19 (p. 9).
• SHO #21-007, Q11: pregnant people covered under the option get the 12-month extended postpartum period where the state elected it.
• 42 CFR 435.4 defines "qualified noncitizen" and "pregnant woman" but has never defined "lawfully present". The operative definition is SHO Implement policy parameter for SNAP maximum amount #10-006 as narrowed by Policy parameter for % of net income SNAP eligibility threshold  #12-002.

H.R.1 / P.L. 119-21 §71109 (effective 2026-10-01)

§71109(a) adds 1396b(v)(5):

Notwithstanding the preceding paragraphs of this subsection, beginning on October 1, 2026, except as provided in paragraphs (2) and (4), in no event shall payment be made to a State under this section for medical assistance furnished to an individual unless such individual is— (A) a resident [...]; and (B) either— (i) a citizen or national of the United States; (ii) an alien lawfully admitted for permanent residence [...]; (iii) [...] Cuban and Haitian entrant [...]; or (iv) an individual who lawfully resides in the United States in accordance with a Compact of Free Association [...].

§71109(b) adds 1397gg(e)(1)(R), which applies (v)(5) to CHIP except for health services initiatives. §71109 does not narrow the option. SHO #26-001, p. 5: "section 1903(v)(5) of the Act did not make any changes [...] to coverage under the CHIPRA 214 option". Appendix A marks "FFP for Full Medicaid & CHIP Benefits under the CHIPRA 214 Option" YES for every status:

• LPRs inside the bar;
• refugees, asylees, parolees, withholding of deportation, conditional entrants, VAWA and trafficking cases, Afghan and Ukrainian parolees;
• "Other lawfully residing noncitizens".

SHO #26-001 also confirms the five-year bar still applies to CHIP (p. 3, fn 3; p. 6) and that 1612(b) does not apply to separate CHIP (p. 6, fn 22).

State elections

Primary source: CMS list, updated April 2, 2026. It matches SHO #26-001 fn 43, "39 states, the District of Columbia, and three territories". The CMS list is current-only; dated changes come from SPAs and state sources. KFF/CCF annual surveys corroborate the counts: Medicaid children/pregnant, including DC, were 35/26 in January 2023, 37/31 in May 2024, and 38/32 in January 2025 and January 2026.

"M-CHIP" means the state covers its option child population in Medicaid-expansion CHIP. The model treats them as Medicaid, so the CHIP election does not apply.

The ages come from the CMS footnote "* These states cover children in Medicaid up to age 19". Unmarked states use the statutory under 21; Michigan's bulletin confirms 21. No state is listed with the template's under-20 option. Territories (AS, CNMI, USVI) also elected but are out of scope.

Current code

• variables/gov/hhs/medicaid/eligibility/is_medicaid_immigration_status_eligible.py: citizen | (eligible_status & (bar_exempt | years_since_us_entry >= five_year_bar_years)) | undocumented_eligible | is_ca_medicaid_immigration_status_eligible. It has no lawfully-residing term.
• parameters/gov/hhs/medicaid/eligibility/eligible_immigration_statuses.yaml: qualified statuses; narrows to [CITIZEN, LEGAL_PERMANENT_RESIDENT, CUBAN_HAITIAN_ENTRANT] at 2026-10-01. COFA has no enum value (Add COFA immigration status for OBBBA SNAP, Medicaid, and ACA eligibility #8296). The formula is YEAR-period, so the narrowing reads from 2027 in annual runs.
• bar_exempt_immigration_statuses.yaml (REFUGEE, ASYLEE, CUBAN_HAITIAN_ENTRANT, DEPORTATION_WITHHELD), five_year_bar_years.yaml (5), undocumented_immigrant.yaml (DC, MA, NY, OR from 2023-07).
• is_ca_medicaid_immigration_status_eligible: state-funded coverage for UNDOCUMENTED, DACA and TPS only, so recent-LPR children in CA currently fail.
• Consumers of the Medicaid immigration variable: is_medicaid_eligible, is_emergency_medicaid_eligible, il_hbi_immigration_status_eligible, or_healthier_oregon_immigration_status_eligible, aca_ptc_below_fpl_immigration_exception, is_basic_health_program_eligible, ms_wd_eligible, is_medicaid_ineligible_due_to_work_requirement.
• CHIP: an inline ~(undocumented | daca) in is_chip_eligible_child, is_chip_eligible_standard_pregnant_person and ca_cchip_eligible. FCEP has no immigration test, correctly, because the unborn child is the beneficiary. The tests citing "CHIPRA" (is_chip_eligible_child.yaml Case 15 in TX, is_chip_eligible_standard_pregnant_person.yaml Case 7 in CO, ca_cchip_eligible.yaml) check only the DACA and undocumented exclusions in states that elected the CHIP option. None tests a recent LPR or TPS person in a state that did not elect it.

Proposed design

Immigration status mapping

Parameters

All are per-state breakdowns over the 50 states plus DC, with initial values from the CMS list and the dated changes in the table above. Earlier years extrapolate backward from the first value.

• gov/hhs/medicaid/eligibility/lawfully_residing/immigration_statuses.yaml: the list above (unit: list).
• gov/hhs/medicaid/eligibility/lawfully_residing/child.yaml (bool): the state elected 1396b(v)(4)(A)(ii) for children.
• gov/hhs/medicaid/eligibility/lawfully_residing/child_age_limit.yaml (year): 19 or 21 for elected states, and 21 (the statutory ceiling, unused) elsewhere.
• gov/hhs/medicaid/eligibility/lawfully_residing/pregnant.yaml (bool): the state elected 1396b(v)(4)(A)(i) for pregnant people.
• gov/hhs/chip/lawfully_residing/child.yaml and pregnant.yaml (bool): the state applies 1397gg(e)(1)(Q) in its separate CHIP. "M-CHIP" states are false.

References: the statute, SHO #10-006 and the CMS list, plus the SPA or bulletin for each dated change.

Variables

Medicaid part (unblocks microcosm#776):

class is_medicaid_lawfully_residing_option_eligible(Variable):
    value_type = bool
    entity = Person
    definition_period = YEAR
    label = "Eligible for Medicaid under the lawfully residing children and pregnant people option"
    reference = (
        "https://www.law.cornell.edu/uscode/text/42/1396b#v_4_A",
        "https://downloads.cms.gov/cmsgov/archived-downloads/smdl/downloads/sho10006.pdf#page=3",
        "https://www.medicaid.gov/federal-policy-guidance/downloads/sho26001.pdf#page=5",
    )

    def formula(person, period, parameters):
        p = parameters(period).gov.hhs.medicaid.eligibility.lawfully_residing
        status = person("immigration_status", period).decode_to_str()
        lawfully_residing = np.isin(status, p.immigration_statuses)
        state = person.household("state_code_str", period)
        age = person("age", period)
        child = p.child[state] & (age < p.child_age_limit[state])
        # Pregnancy plus the state's postpartum period (42 CFR 435.4; SHO #21-007 Q11).
        pregnant = p.pregnant[state] & person("is_pregnant_for_medicaid_nfc", period)
        return lawfully_residing & (child | pregnant)

Then OR it into is_medicaid_immigration_status_eligible. The test is age-based, not category-based: per SHO #10-006, 19- and 20-year-olds in under-21 states are covered in whatever group they otherwise qualify for.

CHIP part (closes #9346): add is_chip_immigration_status_eligible, defined as citizen | (qualified & (bar_exempt | past_bar)) | is_chip_lawfully_residing_option_eligible. It reuses the dated Medicaid status and bar parameters, citing 8 USC 1611(a) and 1613, 1397gg(e)(1)(R) and SHO #26-001 p. 6. The option term requires chip.<category>[state] & medicaid.<category>[state] (1397gg(e)(1)(Q)) and age < gov.hhs.chip.child.max_age or is_pregnant. It replaces the inline checks in the three CHIP formulas and leaves FCEP unchanged.

Behavior

• Inert where years_since_us_entry ≥ 5 for LPRs, parolees and conditional entrants, because they already pass the bar.
• Not inert for TPS children and pregnant people in elected states, and, from 2027 in annual runs, for refugee, asylee, parolee, deportation-withheld and conditional-entrant children and pregnant people in elected states. The law requires both changes.
• Microsim: the default dataset has no TPS, refugee, asylee, parolee or conditional-entrant records, and LPRs default to 5 years (per Remove the years_since_us_entry default of 5 #9732). This change should therefore change no weighted enrollment today; verify. After microcosm#776 and Remove the years_since_us_entry default of 5 #9732, recent-LPR children and pregnant people keep Medicaid in elected states and lose it elsewhere.

Tests

New is_medicaid_lawfully_residing_option_eligible.yaml, plus cases in is_medicaid_immigration_status_eligible.yaml. Period 2025 unless noted:

1. CA, LPR, age 10, years_since_us_entry: 2 → true.
2. CA, LPR, age 20, years 2 → true (under 21). TX, LPR, age 20, years 2 → false. TX, age 18 → true (under 19).
3. TX, LPR, pregnant, age 30, years 2 → false (TX did not elect for pregnant people). WY, the same person → true. WY, LPR, age 10, years 2 → false.
4. AL, LPR, age 10, years 2 → false (no election).
5. NY, TPS, age 10 → true. NY, DACA, age 10 → false. FL, UNDOCUMENTED, age 10 → false.
6. CA, LPR, age 40, not pregnant, years 2 → false. CA, LPR, age 10, years 5 → true either way (inertness).
7. Postpartum: an LPR at years 2 with is_pregnant: false and count_days_postpartum: 90. In NJ → true, because the model's postpartum_coverage is 365 days there. In CA → false (60 days in the model). At count_days_postpartum: 30, CA → true. The model gives 46 states 60 days, which is stale against the 12-month extensions; that is a separate issue.
8. Effective dates: MI 2024 → false, 2025 → true. GA and NH 2023 → false, 2024 → true. ND pregnant 2023 → false, 2024 → true.
9. Post-§71109 (2027): NY, REFUGEE, age 10 → true. NY, REFUGEE, age 40 → false. AL, REFUGEE, age 10 → false. FL, REFUGEE, pregnant, age 30 → false.
10. Integration, TX 2025, LPR parent (age 35) and LPR child (age 8), both years 2, income in the TX child Medicaid range, both with has_emergency_medical_condition: true: is_medicaid_eligible: [false, true] and is_emergency_medicaid_eligible: [<per parent category>, false].

CHIP cases:

• AZ, LPR child, years 2, income between the Medicaid and CHIP limits → is_chip_eligible_child: false. Years 5 → true.
• AZ, TPS child → false. TX, TPS child → true.
• AZ, refugee child: 2025 → true, 2027 → false. TX, refugee child, 2027 → true.
• CO, LPR, pregnant, years 2, income between the Medicaid pregnant limit (200% FPL) and the CHIP limit (265%) → is_chip_eligible_standard_pregnant_person: true. MO, the same person → false; MO FCEP still applies, because FCEP has no immigration test.
• TX, DACA child → false.
• Existing Case 15 (TX) and Case 7 (CO) unchanged.

Re-run the affected suites:

• gov/hhs/medicaid, gov/hhs/chip and gov/aca (including the below-FPL exception);
• gov/states/il/hfs/hbi, gov/states/or/oha/healthier_oregon and gov/states/ca/dhcs/cchip;
• gov/states/wa/dshs/integration.yaml (Case 2 has a WA LPR child at years 2);
• the partner tests. A change there needs the partner gate.

Decisions (2026-10-01)

1. One PR covers both the Medicaid option and the CHIP side, and closes CHIP immigration eligibility does not encode H.R.1 §71109 narrowing (Medicaid side is encoded; CHIP check is only ~undocumented) #9346.
2. All lawfully residing statuses the law covers qualify through the option: LPR, refugee, asylee, deportation withheld, Cuban/Haitian entrant, conditional entrant, parolee and TPS. DACA and undocumented people do not qualify.
3. Age encoding: a per-state boolean plus child_age_limit (19 or 21).
4. CHIP reuses the Medicaid status and bar parameters (one source of truth).
5. To verify during implementation: the Rhode Island pregnant effective date; Oregon's 2026 move to M-CHIP; that each state's age cap has not changed over time.
6. Out of scope: residency (assumed), the COFA enum (Add COFA immigration status for OBBBA SNAP, Medicaid, and ACA eligibility #8296), the veteran exception (Federal noncitizen eligibility rules omit the veteran and active-duty exception (8 USC 1612(a)(2)(C), 1612(b)(2)(C), 1613(b)(2)) #9389), the territories, and the stale 60-day postpartum parameter.

Links

• US: store years_since_us_entry from PEINUSYR (blocked on engine ICHIA option) microcosm#776: US: store years_since_us_entry from PEINUSYR (blocked on engine ICHIA option) microcosm#776
• ACS local lane: immigration_status_str and ssn_card_type default-filled CITIZEN for all ACS persons; years_since_us_entry never populated microcosm#1020: ACS local lane: immigration_status_str and ssn_card_type default-filled CITIZEN for all ACS persons; years_since_us_entry never populated microcosm#1020
• Remove the years_since_us_entry default of 5 #9732: Remove the years_since_us_entry default of 5 #9732
• CHIP immigration eligibility does not encode H.R.1 §71109 narrowing (Medicaid side is encoded; CHIP check is only ~undocumented) #9346: CHIP immigration eligibility does not encode H.R.1 §71109 narrowing (Medicaid side is encoded; CHIP check is only ~undocumented) #9346
• CMS list: https://www.medicaid.gov/medicaid/enrollment-strategies/medicaid-and-chip-coverage-lawfully-residing-children-pregnant-individuals
• CMS SHO make a test for max snap benefit, add to existing tests #26-001: https://www.medicaid.gov/federal-policy-guidance/downloads/sho26001.pdf#page=1

Axiom parity: each implementing PR needs an axiom: line. It will likely queue a rulespec-us issue covering 42 USC 1396b(v)(4) and 1397gg(e)(1)(Q).

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