DEPARTMENT OF HEALTH AND HUMAN SERVICES   
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop S2-26-12 
Baltimore, MD 21244-1850 
 
Center for Medicaid & State Operations 
 
CMSO Informational Bulletin 
  
 
DATE:  January 27, 2010 
 
TO:  State Medicaid Agencies 
 
CC:  Associate Regional Administrators - Medicaid 
   
FROM:  Cindy Mann, Director 
  Centers for Medicaid and State Operations (CMSO) 
 
SUBJECT: Individuals arriving from Haiti for medical attention 
 
CMSO Contact:  Chris Gerhardt; 410-786-0693; Christine.gerhardt@cms.hhs.gov 
 
 
In response to the current earthquake disaster in Haiti we are providing the following information 
for you.  The following questions and answers apply exclusively to people arriving in the United 
States from Haiti as a result of the earthquake and subsequent humanitarian disaster. 
 
   
1.  Are the individuals who have arrived from Haiti all Haitian nationals? 
 
Many of individuals being brought to U.S. hospitals are U.S. citizens.  Some Haitian nationals 
have arrived, and may continue to arrive.  Some have been granted humanitarian parole status 
under the Cuban-Haitian Entrant program in order to receive necessary medical care while 
others have been granted visitors visas. (1/29/10) 
   
2.  Where are these individuals being transported? 
 
Individuals may arrive at any U.S. medical facility that has agreed to accept them, but several 
cities have been targeted to receive individuals from Haiti based on the medical facilities 
available and the presence of a substantial Haitian population that can provide community 
support to the evacuees.  These cities are: Miami, Orlando, Atlanta, the Washington DC metro 
area, New York, Philadelphia and Boston.  (1/29/10) 
 
3.  What if the U.S. citizens who arrive are unable to document their citizenship status? 
 
Individuals who declare U.S. citizenship must be provided with a reasonable opportunity to 
document their citizenship.  Eligibility for Medicaid may not be denied or delayed during the 
reasonable opportunity period for individuals who are otherwise eligible for Medicaid.  Please 
refer to the December 28, 2009 State Health Official Letter CHIPRA #11. (1/28/10) 
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4.  Are the U.S. citizens being transported to U.S. hospitals eligible for Medicaid? 
 
These persons may be eligible if they meet all factors of eligibility under the State Medicaid 
program.  These persons should apply for Medicaid in the State in which they reside, which 
generally would be the State in which they intend to stay.  (1/28/10) 
 
5.  May Haitian individuals admitted on humanitarian parole qualify for Medicaid? 
 
Yes.  Individuals granted humanitarian parole are ordinarily non-qualified aliens ineligible for 
any benefits as non-qualified aliens. However, the Refugee Education and Assistance Act of 
1980 permits Cubans and Haitians who have been granted humanitarian parole to be provided 
benefits as Cuban/Haitian Entrants.  Therefore, Haitians granted humanitarian parole because 
of the earthquake are qualified aliens exempt from the 5-year waiting period, and if otherwise 
eligible, may receive all Medicaid services available under the State plan.  The emergency 
services restriction affecting some non-citizens does not apply.  (1/28/10) 
 
6.  Are there any other Haitian nationals arriving who do not have humanitarian parole 
status? 
 
Yes. Children who are U.S. citizens or are being brought in as parolees may be accompanied 
by an adult who has been granted a B2 visitor visa.   
 
In addition, there is a possibility that Haitian nationals may arrive via private or commercial 
transportation.  The number of such individuals is unknown, and is expected to be small.  The 
immigration status of such individuals is also unknown.  (1/28/10) 
 
7.  Are people on B2 visitor visas eligible for Medicaid? 
 
Individuals admitted on B2 visas are not considered qualified aliens, nor are they considered 
lawfully residing in the U.S. under section 214 of CHIPRA due to the nature of their 
admission.  (1/28/10) 
 
8.  What if the eligible individual, either U.S. citizen or Haitian national, has a home in a 
U.S. State other than where the hospital is located? 
 
Although hospitalized in one State due to the emergency situation, a person may well intend to 
return to his or her home State where he or she maintains a residence or is part of a household 
where he or she previously resided.   In such cases, the person may be considered a resident of 
the home State and an application may be filed in the home State by a responsible party acting 
on behalf of the individual.  The individuals temporary absence from the home State for the 
purpose of receiving medical care should not affect Medicaid eligibility. (1/28/10) 
 
9.  Are individuals considered residents of the State where they are hospitalized? 
 
Possibly.  States are responsible for determining the residency of Medicaid applicants.  States 
may not impose any durational requirements on individuals in order to consider them State 
residents.  An address is not required to establish State residency.  (1/28/10) 
 
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  10. What other factors must be considered in establishing Medicaid eligibility for individuals 
evacuated from Haiti for medical care? 
 
All factors of eligibility must be met, including status as a child, pregnant woman, parent, a 
person over 65 years old or a disabled person.  (1/28/10) 
 
11. How may States expedite eligibility determinations for applicants who claim disability as 
a basis for eligibility? 
If a determination of disability is required to determine eligibility for Medicaid, States must 
follow the regulation at 42 CFR 435.540 defining disability and the regulation at 42 CFR 
435.541 providing procedures for determining disability. In most cases, the definition of 
disability will be the same as that used in the Supplemental Security Income (SS) program.  In 
circumstances in which States make disability determinations based on the requirements of the 
SSI program there are some provisions that could be the basis for finding that the individual is 
presumptively disabled (20 CFR 416.934). These impairments include the following: 
  Amputation of a leg at the hip; 
  Allegation of total deafness; 
  Allegation of total blindness. 
In other circumstances, the State may also make a presumptive disability finding based on the 
criteria in 20 CFR 416.933.   In this case, the finding is made by the State entity responsible for 
determining disability for Medicaid purposes, based on medical evidence in the States 
possession, if it is expected that when the full evaluation of all evidence (including the 
vocational factors) is made disability will be found to exist.  Once a finding of presumptive 
disability is made, eligibility may be granted to those otherwise eligible pending the 
completion of the full disability determination. (1/28/10)  
 
12. What if a person is incapacitated and cannot apply for Medicaid?  
 
Someone acting responsibly on behalf of the individual may apply on the individuals behalf as 
per 42 CFR 435.907.  (1/28/10) 
 
13. For individuals who are eligible, will Medicaid cover all of these services? 
 
For adults, all medically necessary services available under the State plan or approved waivers 
are covered.  All of the States existing limitations on services and payment policies are 
applicable.  For individuals under the age of 21, all medically necessary services including 
Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services are coverable under 
the Medicaid program.  If the person is being treated in a State that is not their state of 
residence, the individuals home State would pay to the same extent that it would pay for 
services furnished within its boundaries if the conditions in 42 CFR 431.52 are met.  (1/28/10) 
 
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