DEPARTMENT OF HEALTH & HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop S2-26-12 
Baltimore, Maryland   21244-1850 
 
SHO # 19-004 
 
Re: Sponsor Deeming and Repayment for 
Certain Immigrants 
 
August 23, 2019 
 
Dear State Health Official:  
 
The purpose of this letter is to provide guidance, following issuance of the May 23, 2019 
Presidential Memorandum, Memorandum on Enforcing the Legal Responsibilities of Sponsors 
of Aliens,1 on requirements related to determining eligibility for certain sponsored immigrants 
who seek coverage under Medicaid and the Childrens Health Insurance Program (CHIP).  The 
Presidential Memorandum directs the Secretary of Health and Human Services to take steps 
necessary to ensure compliance with requirements under the Immigration and Nationality Act 
(INA) and other applicable federal law, including that the income and resources of sponsors of 
certain immigrants must be deemed (i.e., counted) to the sponsored immigrants in determining 
eligibility for federal means-tested public benefits, including Medicaid and CHIP.  Under the 
INA, sponsors of these immigrants also are responsible for reimbursing the state benefit-granting 
agency for the cost of most means-tested public benefits provided to the sponsored immigrant 
upon the state agencys request for reimbursement. 
 
The issues addressed in this letter include: 
  Application of the sponsor deeming requirements; 
  Methodologies for deeming a sponsors income and resources; 
  Reimbursement obligations of, and recovery of costs from, a sponsor;  
  Data collection and reporting on sponsor recovery; and  
  Other operational considerations. 
 
Generally, the sponsor deeming requirements and this guidance apply equally to Medicaid and 
CHIP.  Where there are differences, those differences will be specified.   
 
Background 
Title 8 U.S.C.  1182(a)(4)(C) and (D) require some immigrants who seek Lawful Permanent 
Resident (LPR) status to provide an Affidavit of Support Under Section 213A of the INA (Form 
I-864), referred to hereinafter as Form I-864 Affidavit of Support, executed by a qualified 
sponsor or sponsors.  As discussed in detail below, section 213A of the INA, 8 U.S.C. 1183a, 
provides details on the applicability and enforcement of the Form I-864 Affidavit of Support.  A 
sponsor must demonstrate that he or she can provide support to maintain the intending immigrant 
at an income of no less than 125 percent of the Federal Poverty Guidelines calculated based on 
the sponsors household size during the period in which the Form I-864 Affidavit of Support is 
enforceable.2  Sponsors must sign the legally enforceable Form I-864 Affidavit of Support, under 
which the sponsor agrees to assume financial support for the sponsored immigrant as well as 
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liability for the cost of any means-tested public benefits provided to the sponsored immigrant.  
Sponsors can also include spouses or other eligible adult members of the household of the 
individual providing the Form I-864 Affidavit of Support, if they execute a Contract Between 
Sponsor and Household Member (Form I-864A) (Form I-864A Contract).3  In family-based 
cases, if the sponsor dies after approval of the immigrant petition, a substitute sponsor may sign a 
Form I-864 Affidavit of Support if the substitute sponsor meets all of the requirements that 
applied to the original sponsor.   
 
In determining a sponsored immigrants eligibility for, and the amount of, any federal means-
tested public benefits, the income and resources of the sponsor and the sponsors spouse (if the 
sponsors spouse also signed a Form I-864 Affidavit of Support or a Form I-864A Contract) 
must be counted notwithstanding any other provision of law, in accordance with 8 U.S.C.  
1631(a).  Medicaid, other than services necessary to treat an emergency medical condition, and 
CHIP both are considered federal means-tested public benefit programs.4,5  We refer to the 
counting of a sponsors income and resources in determining an immigrants eligibility as 
deeming  i.e., a sponsors income and resources are said to be deemed to the sponsored 
immigrant. 
 
Applicability of Sponsor Deeming Rules 
Sponsor deeming requirements as set forth in 8 U.S.C.  1631(a) apply only to LPRs who have a 
sponsor who has executed a Form I-864 Affidavit of Support.6  With the exceptions noted below, 
this generally includes LPRs who applied for LPR status on or after December 19, 1997, and are: 
  Family-sponsored LPRs, including immediate relatives of U.S. citizens and other family-
sponsored immigrants; or  
  Employment-based LPRs, if a relative either (1) filed the employment-based immigrant 
petition, or (2) has an ownership interest of 5 percent or more in the petitioning entity.7 
 
The sponsor deeming rules cease to apply to a sponsored immigrant if: 
  The sponsored immigrant becomes a naturalized citizen; 
  The sponsored immigrant achieves 40 qualifying work quarters, as defined by the Social 
Security Act (the Act); or 
  The sponsor or the sponsored immigrant dies.8 
 
The following immigrants, even if they have sponsors who signed a Form I-864 Affidavit of 
Support, are not subject to the sponsor deeming requirements described at 8 U.S.C.  1631:  
  Sponsored immigrants for whom the state is determining eligibility for Medicaid 
coverage of services necessary for treatment of an emergency medical condition, in 
accordance with section 1903(v)(3) of the Act.  
  Children under 21 years of age or pregnant women (including women covered in the 60-
day post-partum period) who are lawfully residing in the U.S. and covered by Medicaid 
and/or CHIP, if the state has elected the option in accordance with sections 1903(v)(4)(A) 
and 2107(e)(1)(N) of the Act (often referred to as the CHIPRA 214 option, after the 
section of the Childrens Health Insurance Program Reauthorization Act of 2009, which 
added this option to titles XIX and XXI of the Act).    
 
 
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  Sponsored immigrants who have worked 40 qualifying quarters, as defined under title II 
of the Act, or can be credited with 40 qualifying quarters in accordance with 8 U.S.C.  
1631(b)(2) and 1645.  Some immigrants may have already been credited with 40 
qualifying quarters at the time they receive LPR status;9 others may accumulate 40 
qualifying quarters after becoming an LPR. 
 
Exemptions: The state agency has the responsibility to make determinations for two exemptions 
to the sponsor deeming requirements, in accordance with 8 U.S.C.  1631(e) and 1631(f).  The 
exemptions are for sponsored immigrants who are: 
  Victims who have been battered or subjected to extreme cruelty.  There are three 
categories of immigrants who can be covered under this exemption:   
  Immigrants who are victims of battery or extreme cruelty; 
o
  Immigrant parents of a battered child or a child who has been subject to extreme 
o
cruelty; or 
  Immigrant children of a battered parent or a parent who has been subject to 
o
extreme cruelty. 
 
The detail on the standard to be used to determine if an individual meets this exemption is 
in Appendix A.   
 
None of the sponsors income or resources are counted in determining the sponsored 
immigrants eligibility if this exemption applies; however, the sponsor may still be 
responsible for repayment for the cost of the benefits received by the sponsored 
immigrant in accordance with 8 U.S.C.  1183a.  Additional detail on repayment 
requirements of sponsors is provided below.  The initial exemption is in effect for 12 
months from the date the state makes the determination of abuse or cruelty.  The 
exemption can be extended, with respect to deeming the batterers income and resources 
only, if the battery or extreme cruelty is recognized by the Department of Justice, an 
Administrative Law Judge, or the U.S. Department of Homeland Security (DHS).   
 
  Determined by the state to be indigent.   
 
An indigent immigrant is defined as one who would, in the absence of the assistance 
provided by the agency, be unable to obtain food and shelter, taking into account the 
aliens income, plus cash, food, housing, or other assistance provided by other 
individuals, including the sponsor.  See 8 U.S.C.  1631(e). 
 
Within these statutory parameters, states have discretion to adopt reasonable standards for 
making this determination.  For example, some means-tested public benefit programs 
have established policies that a sponsored immigrant is considered indigent if the sum 
of the immigrants own income and income provided by the sponsors and others to the 
immigrants household is less than the programs standard.  See Appendix B for 
examples of policies that the Centers for Medicare & Medicaid Services (CMS) believes 
are reasonable, including the indigence standards adopted by the Supplemental Nutrition 
Assistance Program (SNAP) and the Supplemental Security Income (SSI) programs. 
 
 
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If the state Medicaid agency determines that a sponsored immigrant is indigent, only the 
amount actually provided by the sponsor to the immigrant is counted for the 12-month 
period, beginning on the date the determination is made.  States may extend this 
exemption for additional 12-month periods, but must make a new determination that the 
states indigence standard is met for each such additional period. 
 
If the agency makes a finding that the individual is indigent, the agency must provide 
written notice to DHS/U.S. Citizenship and Immigration Services (DHS/USCIS) of this 
determination, including the name of the sponsor and the sponsored immigrant.  See 8 
U.S.C.  1631(e)(2); 8 CFR  213a.4(c)(2).  More detailed specifications about this 
notice (including where to send it) is provided at 8 CFR  213a.4(c)(2) and (c)(3).   
 
State agencies must notify the sponsored immigrant that a finding of indigence will be 
reported to DHS/USCIS so that sponsored applicants or beneficiaries can decide whether 
to request consideration for the indigence exemption or not.  Although not required, 
states are also encouraged to have the sponsored immigrants acknowledge (either through 
a check box on a form or in some other way) that they understand a finding of indigence 
will result in the agency notifying DHS of the sponsored immigrants name, sponsors 
name, and finding of indigence. 
 
Methodologies for Determining Sponsor Deeming 
Section 8 U.S.C.  1631 does not specify what methodology states should use in determining 
sponsors income and resources for purposes of the sponsor deeming requirements, and states 
have flexibility to determine a reasonable methodology for doing so.  Below we describe several 
approaches CMS believes are reasonable.  States may choose from the methodologies described 
or present an alternative methodology for CMS approval.  A number of the options described are 
not mutually exclusive, and states may elect to combine two or more options.  Note that any 
reference in the discussion below to a sponsors income or resources also includes the income or 
resources of any household member of the sponsor who signed a Form I-864A Contract.10  
 
Additionally, resources are only relevant under this guidance where a sponsored immigrants 
financial eligibility is subject to a resource test.  CMS does not interpret the reference in 8 U.S.C. 
 1631 to resources to impose a resource standard for sponsored immigrants whose Medicaid 
eligibility is not otherwise subject to a resource test.   
 
Approaches to sponsor deeming 
  Immigrants sponsored by a spouse or parent   
Many immigrants are sponsored by a parent or spouse such that the sponsors income 
and/or resources would be counted in determining the sponsored immigrants eligibility 
independent of the sponsor deeming provision.  In such circumstances, we believe states 
may comply with the sponsor deeming requirements by determining eligibility for the 
sponsored immigrant by following the methodologies described in the Medicaid and 
CHIP statutes and regulations, and the applicable state plan.   
 
 
 
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For example, if John is a sponsored immigrant and lives with Jane, who is both his wife 
and sponsor, and John applies for Medicaid, the state Medicaid agency could determine 
Johns eligibility in accordance with the applicable methodology described in 42 CFR  
435.601-603, including the Modified Adjusted Gross Income (MAGI)-based and 
supplemental security income (SSI)-based, depending on the eligibility group for which 
Johns eligibility is being determined.  If Johns eligibility determination is a MAGI-
based one, Jane would be included in Johns household pursuant to 42 CFR 
435.603(f)(4), and her income (as defined under 42 CFR  435.603(e)) would be included 
in Johns household income.  Assuming no other children or tax dependents, per section 
1902(e)(14)(I) of the Act and 42 CFR  435.603(d)(4), an amount equivalent to 5 
percentage points of the federal poverty level for a family of two would be deducted from 
Johns household income, and the remainder compared against the applicable income 
standard for a household of two.11  Similarly, if Johns eligibility is being determined 
using an SSI-based methodology, Janes income and resources would be counted 
applying the applicable SSI methodology, and any spousal-related income or resource 
disregards approved under the state plan pursuant to section 1902(r)(2) of the Act, would 
be applied to her income and resources in the same manner as those methods would be 
applied for a spouse who is not a sponsor.  
 
  Deem all gross or countable income and resources   
Income and resources for purposes of the sponsor deeming statute could reasonably 
include all of a sponsors gross income and/or resources, or all of a sponsors income and 
resources that are otherwise countable under the financial eligibility methodologies 
applied to Medicaid or CHIP applicants and beneficiaries (countable income and 
resources).  In the case of Medicaid, a state could choose the methodology most closely 
aligned with the financial eligibility methodology applicable to the sponsored 
immigrants eligibility determination (i.e., MAGI or SSI-based methodologies), or apply 
either MAGI or SSI-based methodologies to all sponsored immigrants, regardless of 
which methodology is otherwise applied in determining a given sponsored immigrants 
eligibility.    
 
  Account for needs of the sponsor and/or sponsors dependents 
In determining the amount of a sponsors income available for the sponsored immigrant, 
states may account for the sponsors needs or the needs of sponsors dependents.  MAGI 
methodologies generally account for the needs of other family members by including 
them in the household size of the Medicaid applicant.  Under SSI methodologies, a 
deduction (called an allocation) is made from the income of a spouse or parent of an 
SSI applicant for each of their dependents in determining how much of the spouses or 
parents income to deem available to the SSI applicant.  States may adopt either the 
MAGI or SSI approach (i.e., a state could adopt the SSI approach even if determining the 
sponsored immigrants eligibility using MAGI-based methodologies, or vice versa) or, 
subject to CMS approval, develop another reasonable approach (e.g., deduct from the 
sponsors income a flat amount for the sponsor and each of the sponsors dependents or a 
flat amount for the sponsors household). 
 
 
 
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  Apply income and/or resource disregards adopted under the state plan 
States may apply income and/or resource disregards approved under section 1902(r)(2) of 
the Act to the sponsors income and/or resources to the extent that such disregards would 
be applied if the sponsor him or herself were applying for coverage.  For example, if a 
state applies a disregard in determining eligibility for a particular non-MAGI group (e.g., 
disregards an amount of earned income or the value of a retirement account), a state 
could apply the same disregards to the sponsors income and/or resources in determining 
the amount of sponsor income and/or resources to be deemed to the sponsored immigrant 
seeking coverage under that eligibility group.   
 
Subject to CMS approval, states also may propose other disregards to be applied 
specifically to a sponsors income and/or resources, where there is an identifiable and 
reasonable rationale to do so.  However, it would not be reasonable to use this option to 
categorically exclude all of a sponsors income and/or resources in determining the 
eligibility of the sponsored immigrant.    
 
Repayment from Sponsors 
Section 213A of the INA, 8 U.S.C  1183a, authorizes states to recover the costs of means-tested 
public benefits, including Medicaid or CHIP, provided to sponsored immigrants from sponsors 
who have signed a Form I-864 Affidavit of Support, or a Form I-864A Contract in support of a 
Form I-864 Affidavit of Support, during the time period that the Form I-864 Affidavit of Support 
is in effect.  Title 8 CFR  213a.4(a)(1) provides that states have the discretion to seek the 
repayment from the sponsor. 
 
In pursuing reimbursement of benefits from an immigrants sponsor, states must follow the 
process set out by DHS regulations at 8 CFR  213a.4.  When requesting reimbursement from a 
sponsor,12 the state agency must arrange for a written request for reimbursement to be provided 
to the sponsor through personal service.13  The request for reimbursement must contain specific 
information, including an itemized statement supporting the claim for reimbursement.  If there is 
no response to the reimbursement request within 45 days of the date of service indicating a 
willingness to commence repayment, the state agency may file a lawsuit against the sponsor to 
enforce the sponsors support obligation.  More detail on the recovery procedures is available in 
DHS regulations at 8 CFR  213a.4.  
 
The requirement to repay cost of Medicaid and CHIP benefits pertains only to a sponsor who has 
signed a Form I-864 Affidavit of Support or a Form I-864A Contract.  The state agency may not 
seek repayment from the sponsored immigrant.14   
 
The recovery of the cost of such benefits also may not be sought from sponsors in the following 
circumstances:   
  The sponsored immigrant is a child or pregnant woman (including within the 60-day 
post-partum period) who is eligible for Medicaid or CHIP pursuant to the states election 
to cover lawfully residing children and pregnant women in the U.S. in Medicaid and/or 
CHIP under the CHIPRA 214 option;15  
 
 
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  The Medicaid benefits provided to the sponsored immigrant were necessary for the 
treatment of an emergency medical condition;16 or 
  The Form I-864 Affidavit of Support is no longer in effect, e.g., when the benefits are 
provided to a sponsored immigrant who has achieved 40 qualifying work quarters or has 
become a naturalized citizen. 
 
Pursuant to 8 U.S.C.  1183a, sponsors are liable for the cost of the Medicaid or CHIP benefits 
that a sponsored immigrant receives even if the state agency granted an exemption from the 
requirement to deem the sponsors income and/or resources to the sponsored immigrant on the 
basis that the immigrant is indigent or a victim of battery or extreme cruelty.  The state may seek 
repayment from the sponsor in these circumstances. 
 
Data Collection and Reporting Related to Sponsor Liability 
Section 5 of the Presidential Memorandum provides that the Departments of State, Homeland 
Security, Agriculture, Health and Human Services, and the Social Security Administration 
coordinate to establish and maintain records regarding each sponsors reimbursement obligations 
and status, as appropriate and consistent with law.  We are working with our federal partners to 
develop a coordinated process for states to share information relating to sponsor liability to the 
extent permitted under applicable laws, including the INA, the Illegal Immigration Reform and 
Immigrant Responsibility Act of 1996, and titles XIX and XXI of the Act.  We will provide 
additional information and guidance on this process as soon as it is available. 
 
Operational Considerations 
We understand that some states already have implemented sponsor deeming and/or repayment 
processes.  All states should review this guidance and ensure that their policies and procedures 
are consistent with all applicable requirements concerning sponsor deeming and/or repayment as 
soon as practicable for new applicants and current beneficiaries.  However, we understand that 
states will need time to fully incorporate this guidance into their eligibility processes, including 
policy manuals, notices, verification processes, eligibility systems, and staff training.  CMS 
believes it is reasonable for states to implement changes for current beneficiaries at their next 
scheduled renewal and/or as soon as practicable thereafter.  With respect to repayment, CMS 
believes it is reasonable for states to apply the sponsor repayment provision to benefits provided 
to sponsored beneficiaries after the issuance of this guidance and notice to the affected 
beneficiaries has been provided.   
 
Some households will include both individuals subject to sponsor deeming and repayment 
requirements and individuals who are not subject to such requirements.  As states implement the 
requirements described in this letter, states must (1) ensure that any changes to their eligibility 
determination processes do not discriminate against other members of sponsored immigrants 
families based on national origin, and (2) take appropriate steps to ensure that applicants, 
beneficiaries and the general public understand that the Medicaid and CHIP eligibility of other 
members of a sponsored immigrants family are not impacted unless they themselves are 
sponsored by an individual who signed a Form I-864 Affidavit of Support or a Form I-864A 
Contract. 
 
 
 
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Collection and Verification of Information Necessary to Conduct Eligibility Determinations 
  Identification of Sponsored Immigrants/Verification through SAVE and SSA 
States administering federal means-tested public benefits can verify whether a sponsored 
immigrant is subject to the sponsor deeming and repayment provisions by using DHSs 
Systematic Alien Verification for Entitlements (SAVE) program, either through the 
Federal Data Services Hub Verify Lawful Presence v37 service or through a direct 
connection with the web-based Graphic User Interface (GUI).  At all three steps of the 
SAVE program, SAVE can verify that an individual is an LPR who has a sponsor, joint 
sponsor, and/or substitute sponsor who signed the Form I-864 Affidavit of Support and 
provide each sponsors name, address, and Social Security Number.17  In order for the 
sponsor information to be provided by SAVE, the state must request the sponsor 
information.  In addition, states using the Federal Data Services Hub must have their 
systems configured to accept the data elements returned from SAVE.   
 
To verify that an individual should not be considered or is no longer a sponsored 
immigrant, DHSs SAVE program can verify citizenship for individuals who are 
naturalized U.S. citizens.  The Social Security Administration (SSA) can verify whether 
individuals have earned or can be credited with 40 qualifying work quarters, information 
which can be sought through the Federal Data Services Hub or a direct connection with 
SSA.   
 
Additional information on how to request information from SAVE is provided in 
Appendix C to this letter.   
 
  Obtaining and Verifying Sponsors Income and Resource Information  
States will need to be able to collect information about sponsor income and resources, as 
appropriate, in order to make accurate Medicaid and CHIP determinations.  Immigrants 
subject to the sponsor deeming requirements are responsible for obtaining the 
cooperation of the sponsor in providing information needed about the sponsors income 
and resources, as well as any needed documentation.  States will use their current 
verification policy and procedures, including obtaining verification from electronic 
sources whenever possible, to verify sponsor income and resources.  If either the 
sponsored immigrant or the sponsor fails to cooperate in providing information or 
documentation necessary to determine eligibility, the sponsored immigrants eligibility 
must be denied or terminated. 
 
The reasonable opportunity period (ROP) described in section 1137(d) of the Act and 42 
CFR  435.956(b) of the regulations, during which otherwise-eligible immigrants can 
receive benefits pending verification of their immigration status, does not apply in the 
case of sponsored immigrants pending verification of sponsor income and/or resources.  
The requirement to furnish benefits during an ROP only applies to non-citizens who 
otherwise meet the eligibility criteria for coverage under the state plan, including income 
and resource requirements, as applicable, pending verification of immigration status.  If 
verification of sponsor income or resources is pending, the state will be unable to 
 
 
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determine whether the individual meets the income/and or resources criteria for Medicaid 
or CHIP. 
 
  Application, Notices, and Related Changes 
Collecting the information necessary to determine eligibility may involve changes to 
applications and other forms, including the addition of new instructions or help text.  Any 
changes to the application should be directed only to those individuals for whom the 
information is necessary to make an eligibility determination in accordance with 42 CFR 
 435.907(e) and 42 CFR  457.330.  CMS is working on additional guidance regarding 
changes to the single streamlined application and we are available to provide technical 
assistance to states on identifying and implementing the necessary changes.   
 
States will need to revise current notices or develop new notices in accordance with 42 
CFR  435.917 and 42 CFR  457.340, to reflect the impact of the sponsor deeming 
requirements on sponsored immigrants and their sponsors.  Notices to the sponsored 
immigrant should include the following:   
1)  Clear information about the income and/or resource verification process, 
including what information and documentation regarding the sponsors 
income and/or resources (and the sponsors spouses income and resources, if 
the spouse signed a Form I-864 Affidavit of Support or a Form I-864A 
Contract) is necessary to determine the sponsored immigrants eligibility. 
2)  Clear information on when the sponsor deeming requirements apply, when the 
deeming requirements cease to apply, the availability of the exemptions for 
victims of battery or extreme cruelty and for indigent immigrants, and how to 
request an exemption. 
3)  A clear explanation that the state will notify USCIS if the sponsored 
immigrant is approved for an indigence exemption.  States are also 
encouraged to have the sponsored immigrant acknowledge they are aware that 
this notification will take place.    
4)  Clear information on the potential liability of the sponsor if the sponsored 
immigrant is determined eligible for Medicaid or CHIP and enrolls in a 
managed care plan or receives covered services, and explanation that the 
sponsor is responsible for paying back the cost of the benefits received, even 
if the state has granted an exemption from the sponsor deeming requirements 
because the sponsored immigrant is indigent or is a victim of battery or 
extreme cruelty.  
 
Federally Facilitated Exchange   
The sponsor deeming requirements described in this letter have operational implications for the 
eligibility determination, verification, and account transfer (AT) processes of the Federally-
Facilitated Exchange (FFE).  CMS is evaluating potential changes to the FFE processes and AT 
payload.  Additional information on these operational issues will be released separately.  
 
 
 
 
 
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Eligibility Systems Upgrade Funding 
Enhanced Federal Financial Participation (FFP) is available at a 90 percent federal matching rate 
for the design and development of improvements to Medicaid eligibility determination systems, 
including changes related to determinations of eligibility to implement the sponsor deeming 
provisions, in accordance with applicable federal requirements.18  Seventy-five percent enhanced 
federal funding is also available for on-going maintenance and operations of such systems, in 
accordance with applicable federal requirements.  Receipt of these enhanced funds is conditioned 
on states meeting a series of standards and conditions to ensure investments are efficient and 
effective.  Other activities, such as sponsor deeming policy development and outreach, may be 
claimed under Medicaid at 50 percent administrative match, in accordance with regular 
eligibility and enrollment claiming policies for such administrative activities.  For states jointly 
administering Medicaid and a separate CHIP, cost-allocation methodologies set forth in 45 CFR 
part 75 apply.  For the CHIP portion of the cost, states can claim the states enhanced CHIP 
match available under title XXI of the Act.  CHIP administrative funding is limited to 10 percent 
of the states CHIP allotment. 
 
Closing 
CMS will soon release Medicaid and CHIP State Plan Amendment pages that will be required 
by states to document their sponsor deeming policies and procedures.  Additionally, CMS staff 
is available to provide technical assistance regarding the sponsor deeming and repayment 
provisions discussed in this letter.  Questions regarding the policies discussed in this letter may 
be directed to Stephanie Kaminsky, Director, Division of Medicaid Eligibility Policy, at (410) 
786-4653 or Stephanie.Kaminsky@cms.hhs.gov. 
 
Sincerely, 
 
 
 
            Calder Lynch 
            Acting Deputy Administrator and Director   
   
 
 
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Appendix A 
 Exemption for Immigrants who are Victims of Battery or Extreme Cruelty under 8 U.S.C. 
 1631(f) 
 
For an individual to be eligible for this exemption, the state must determine (1) that battery or 
extreme cruelty has occurred in the United States; (2) that the battery or cruelty was committed 
by the battered immigrants spouse, parent or a member of the spouse or parents family residing 
in the same household as the immigrant, and the spouse or parent consented to or acquiesced to 
such battery or cruelty; (3) that the battery or cruelty is substantially connected to the need for 
the benefits applied for; and (4) that the battered immigrant does not currently live with the 
batterer.  If these conditions are met, the exemption is available to the battered immigrant, the 
battered immigrants parent and/or the battered immigrants child.   
 
Additionally, battered immigrants and the parents or children of battered immigrants may be 
considered qualified aliens under 8 U.S.C.  1641(c).  These non-citizens, who can file a petition 
under the INA, and often are referred to as Violence Against Women Act (VAWA) self-
petitioners, based on the statute which created this pathway to legal status for such immigrants.  
While the exemption for victims of battery or extreme cruelty from sponsor deeming 
requirements is distinct from the qualification of VAWA self-petitioners for qualified alien 
status, Interim Guidance issued by the Department of Justice on determining qualified alien 
status of VAWA self-petitioners will be useful to states in determining whether the exemption 
from sponsor deeming requirements under 8 U.S.C.  1631(f) applies.  The Interim Guidance, 
Interim Guidance on Verification of US Citizenship, Qualified Alien Status, and Eligibility Under 
Title IV of the Personal Responsibility Work and Opportunity Reconciliation Act, 62 Fed. Reg. 
61344 (Nov. 17, 1997) is available at https://www.govinfo.gov/content/pkg/FR-1997-11-
17/pdf/97-29851.pdf.    
 
Part II of Exhibit B to Attachment 5 of the Interim Guidance discusses the exemptions from 
sponsor deeming for victims of battery or extreme cruelty. For determining whether the 
exemption applies, states are referred back to the discussion of certain requirements which must 
be satisfied by VAWA self-petitioners, which is found in Part I of Attachment 5 of the Interim 
Guidance.  In particular, states are directed to the discussions of: 
  Requirement 2 (relating to the definition of battered and extreme cruelty) at 62 Fed. Reg. 
at 61369-70; 
  Requirement 3 (relating to whether a substantial connection between the battery and the 
need for benefits) at 62 Fed. Reg. at 61370; and 
  Requirement 4 (relating to whether the battered immigrant lives in the same household 
with batterer) at 62 Fed. Reg. at 61370.   
 
The initial exemption is in effect for 12 months from the date the state makes the determination 
of abuse or cruelty.  The exemption can be extended if the abuse or cruelty is recognized by the 
Department of Justice, an Administrative Law Judge, or DHS.   
 
Note that most VAWA self-petitioners determined by DHS to be considered a qualified alien 
under 8 U.S.C.  1641(c) have not adjusted to LPR status; thus the sponsor deeming 
 
 
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requirements would not be applicable.  Some VAWA self-petitioners do adjust to LPR status, but 
typically do not have a sponsor who has signed a Form I-864 Affidavit of Support; for these 
immigrants also, the sponsor deeming requirements would not be applicable.  Occasionally, a 
VAWA self-petitioner may adjust to LPR status with a sponsor who signed a Form I-864 
Affidavit of Support.  Since these individuals will have been previously adjudicated by DHS as 
being a victim of battery or extreme cruelty, states can rely on their former VAWA status for 
purposes of the sponsor deeming exemption.  SAVE provides Class of Admission response 
codes which can verify that an immigrant who is a LPR, was also a VAWA self-petitioner.   
   
 
 
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Appendix B   
Examples of Indigent Exemption Policies 
 
Both the Supplemental Nutrition Assistance Program (SNAP) and the Supplemental Security 
Income program (SSI) have published guidance on the indigence exemption from sponsor 
deeming provided under 8 U.S.C.  1631(f).  CMS believes both the SNAP and SSI policies 
represent reasonable approaches which state Medicaid and CHIP agencies may adopt.   
  
  SNAP: States consider a sponsored immigrant to be indigent when a sponsored 
immigrants own household income, plus any cash and the value of any in-kind 
contribution actually provided by the sponsor and others, does not exceed 130 percent of 
the federal poverty level of the household size.19   
 
  SSI: SSI treats sponsors who live in the home with the sponsored immigrant differently 
than sponsors who do not live with the sponsored immigrant.  The SSI program will not 
grant an indigent exemption if a sponsored immigrant is living with the sponsor, as it 
assumes the sponsor is providing food and shelter.  However, if the sponsored immigrant 
is not living with the sponsor and the total income (including all types of income, from all 
sources) the sponsored immigrant receives is less than the SSI federal benefit rate and 
resources available are under the applicable resource limit, the individual may be found 
to be indigent.20     
 
States may also adopt an alternative reasonable policy, subject to CMS approval: 
  Different Income Threshold: States could employ a different income threshold to define 
indigent that is closely related to the Medicaid or CHIP program.  For example, the 
state could determine that an individual is indigent if income deemed from the sponsor 
and the immigrants own income combined is under 133 percent federal poverty level or 
other income standard used for Medicaid or CHIP eligibility determinations.  
 
  Different Income Methodologies: States could employ a different reasonable income or 
resource methodology.  For example, a state could combine the sponsor and sponsored 
immigrants gross incomes, count their taxable income under MAGI methodologies, or 
exclude certain types or amounts of income, such as not counting the value of any in-kind 
contributions from a sponsor, in making an indigence determination.   
   
 
 
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Appendix C  
Verifications through SAVE -- Sponsor and Naturalized Citizenship Information 
 
To obtain sponsor information from SAVE, the state agency (requesting agency) must indicate 
that it is requesting sponsor information for an immigrant.  
 
For requesting agencies that utilize the Federal Data Services Hub to verify immigration status 
through SAVE, the state agency selects Y (true) in the RequestSponsorDataIndicator field 
on the outbound file.  This indicates that the state agency is requesting a return of sponsor data.   
 
States using SAVE request sponsor information based on a document type associated with 
verification of lawful permanent resident status.  Sponsor information can be requested with the 
following document types: Form I-327 (Reentry Permit), Form I-551 (Permanent Resident 
Card), the Machine Readable Immigrant Visa (with Temporary I-551 Language), the Temporary 
I-551 Stamp (on passport or I-94), and other by sending an A-Number or I-94 number.21   
 
If a household member has signed a Form I-864A Contract, the information may also be 
available through SAVE.    
 
The state agencys system will need to be configured to receive this information on the inbound 
file.  If sponsorship information is available, the SponsorDataArrayDataElement field will 
indicate Y (true).  Up to 11 data elements will be returned regarding the sponsor: the first, 
middle and last name of the sponsor, Social Security Number, address and country code and 
country name (if an international address).  Please refer to Table 34, Hub to Requestor
Sponsorship Data Array Data Elements, in the Verify Lawful Presence (VLP) v37 Business 
Services Definition (BSD) and DHSs Interface Control Agreement Between VIS Agency Web 
Service Method and Agencies, Version 37.  Requesting agencies that need a copy of the VLP v37 
BSD Requesting agencies that need a copy of the DHS Interface Control Agreement Version 37 
should contact SAVE at (877) 469-2563 from 7:00 am to 5:00 pm Central Time, Monday 
through Friday or at SAVE.help@uscis.dhs.gov  Please include the name of your agency. 
 
To obtain verification of U.S. citizenship for naturalized citizens, the state agency (requesting 
agency) provides specified information to SAVE, including the Naturalization Certificate 
number, Certificate of Citizenship number and/or the individuals A-Number, depending on the 
document the individual is using to verify citizenship.22  State agencies may verify an 
individuals naturalized citizenship through the Federal Data Services Hub or a direct connection 
with SAVE using DHSs GUI web-based service.  
 
 
 
 
 
 
 
 
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1 https://www.whitehouse.gov/presidential-actions/memorandum-enforcing-legal-responsibilities-sponsors-aliens/. 
2See 8 U.S.C.  1183a(a)(1)(A).  If the petitioning sponsor is on active duty in the U.S. Armed Forces (other than for 
training) and is petitioning for his or her spouse and/or minor child (under age 21), the petitioning sponsor must 
demonstrate he or she can maintain income at only 100 percent of the poverty level for the household size.   
3 The Form I-864A Contract is a document in which a household member agrees to support the immigrant, and to be 
jointly and severally liable for repayment of any sponsor obligations to any agency that provides means-tested 
public benefits.  It is typically used when the income and resources of the individual executing the Form I-864 
Affidavit of Support alone are insufficient to meet affidavit of support requirements under Section 213A of the INA. 
4 HHS Federal Register Notice, Personal Responsibility and Work Opportunity Reconciliation Act of 1996 
(PRWORA); Interpretation of Federal Means-Tested Public Benefit, 62 FR 45256 (issued Aug 26, 1997) 
(designating Medicaid as a federal means-tested public benefit); State Health Official Letter (issued Jan 14, 1998) 
(designating CHIP as a federal means-tested public benefit), available at https://www.medicaid.gov/Federal-Policy-
Guidance/downloads/sho011498.pdf. 
5 Medical assistance to treat an emergency medical condition described at section 1903(v)(3) of the Act is not 
considered a means-tested public benefit subject to sponsor deeming or repayment requirements.  See Presidential 
Memorandum, Section 7 Definitions (c) (defining means-tested public benefit has the meaning set forth in 8 CFR 
 213a.1); 8 CFR  213a.1 (defining means-tested public benefit, specifically that a benefit described in section 
401(b) of Public Law 104-193 is not considered a means-tested public benefit); 8 U.S.C.  1611(b)(1)(A).    
6 Some sponsored immigrants may have a joint sponsor who also has executed a Form I-864 Affidavit of Support 
and accepted joint and several liability to satisfy the requirements of section 213A of the INA.  See 8 CFR  213a.1.  
Joint sponsors also may have household members who have executed a Form I-864A Contract in support of a Form 
I-864 Affidavit of Support provided by the joint sponsor.  The sponsor deeming requirements apply to an immigrant 
with joint sponsors and any of their household members executing a Form I-864A Contract, and the repayment 
obligations apply to both joint sponsors and any of their household members who signed a Form I-864A Contract.  
The sponsor deeming rules do not apply to LPRs for whom the Form I-864 Affidavit of Support was not filed, 
including those whose sponsor signed a different affidavit such as Affidavit of Support (Form I-134) or Affidavit of 
Financial Support and Intent to Petition for Legal Custody for Public Law 97-359 Amerasian (Form I-361); those 
whose status was adjusted to LPR from refugee or asylee status under 8 U.S.C. 1159; or those who were admitted 
as LPRs, applied for an immigrant visa, or applied for adjustment of status before December 19, 1997 (i.e. before 
the date the Form I-864 Affidavit of Support came into effect). 
7 For the definition of relative, see 8 CFR  213a.1.  See also 8 CFR  213a.2(a)(2)(i)(C) for applicability of INA 
Section 213A requirements for employment-based immigrants. 
8 Per 8 CFR  213a.2(e)(2)(E)(ii), the death of one person who had a support obligation under a Form I-864 
Affidavit of Support or Form I-864A Contract does not terminate the support obligation of any other sponsor, 
substitute sponsor, joint sponsor, or household member with respect to the same sponsored immigrant. 
9 Note, though, that since DHS regulations at 8 CFR  213a.2(a)(2)(ii)(C) exempt intending immigrants who have 
accrued 40 quarters from having to provide an affidavit of support in the first place, it would be rare for an LPR to 
both have a Form I-864 Affidavit of Support pertain to the LPR and to have accrued 40 quarters before becoming an 
LPR. 
10 If the sponsors spouse signed either a Form I-864 Affidavit of Support or a Form I-864A Contract, the spouses 
income should be included.  Deeming does not apply under 8 U.S.C.  1631(a)(2) to any spouse who did not sign 
either of these forms, as relevant spousal responsibility for deeming and reimbursement is covered by treating such 
spouses directly as sponsors under section 1631(a)(1) based upon executing either a Form I-864 Affidavit of Support 
or the Form I-864A Contract. 
11 Although less common, states could also apply standard MAGI-based methodologies if the sponsor is not a 
spouse or parent of the sponsored immigrant, but is a different member of the sponsored immigrants MAGI-based 
household--for example, an 18-year old sibling who signed an I-864A Contract to support a younger sibling 
sponsored by their mother, with whom both are living, and the 18-year old sibling is required to file a federal 
income tax return such that his income is counted in determining the younger childs income under the MAGI-based 
methodologies. 
12The DHS regulations refer to requests for reimbursement made to a sponsor, household member, or joint 
sponsor.  8 CFR  213a.4(a)(1)(i).  The sponsor or joint sponsor is an individual who has executed a Form I-864 
Affidavit of Support; the household member is a sponsor who has executed a Form I-864A Contract. 
 
 
 
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13 Personal service is defined in 8 CFR  103.8(a)(2). 
14 See also State Medicaid Director letter, issued June 10, 1998, available at https://www.medicaid.gov/Federal-
Policy-Guidance/downloads/smd061098.pdf.15 Sections 1903(v)(4)(B) and 2107(e)(1)(N) of the Act.  
16 See 8 U.S.C.  1183a(b)(1)(A) (describing repayment from a sponsor only when a sponsored non-citizen has 
received federal means-tested public benefits; 8 CFR  213a.1(specifying that means-tested public benefit does 
not include a benefit described at section 401(b) of PRWORA, codified at 8 U.S.C.  1611(b)).   
17 For additional detail on sponsor information available through SAVE, see Verify Lawful Presence (VLP) v37 
Business Services Definition (BSD), Table 34, Hub to RequestorSponsorship Data Array Data Elements (03/19); 
DHSs Interface Control Agreement Between VIS Agency Web Service Method and Agencies, Version 37 (Exhibits 
30 and 72) (03/19). See above for SAVE contact information to obtain these documents. 
1842 CFR part 433, 80 FR 75817-75843 (Dec 4, 2015); Medicaid and CHIP FAQs:  Enhanced Funding for 
Medicaid Eligibility Systems, April and August 2013, available at https://www.medicaid.gov/State-Resource-
Center/FAQ-Medicaid-and-CHIP-Affordable-Care-Act-Implementation/Downloads/FAQs-by-Topic-75-25-
Eligibility-Systems.pdf.  
19 See 7 CFR 273.4(c)(3)(iv) and Supplemental Nutrition Assistance Program Guidance on Non-Citizen Eligibility, 
available at https://fns-prod.azureedge.net/sites/default/files/snap/Non-Citizen_Guidance_063011.pdf.      
20 SSAs Program Operations Manual System (POMS), SI 00502.200 Sponsor-to-Alien Deeming; SI 00502.280 
Indigence Exemption to Sponsor Deeming. 
21 See Sponsorship Data column in Table 42 Document Types for types of documents that can be requested to obtain 
sponsorship data in the Verify Lawful Presence (VLP) v37 Business Services Definition (BSD) and in Exhibit 78 
DHS Document Types in the Interface Control Agreement (ICA) Between VIS Agency Web Services Access Method 
and Agencies, Version 37.  See above for SAVE contact information to obtain these documents. 
22 See id., for specified information required to be submitted to SAVE to verify citizenship through a Naturalization 
Certificate or Certificate of Citizenship.    
 
 
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