Can Green Card Holders Get Medicaid in New York Before Five Years?

By Albert Goodwin, attorney, Law Offices of Albert Goodwin, New York. Last reviewed 2025. Income and resource figures below are the 2025 New York figures and change each January.

Yes. A lawful permanent resident who lives in New York and meets the financial rules can receive full New York Medicaid, even during the first five years after receiving the green card. Federal law bars most new permanent residents from federally funded Medicaid for five years. New York pays for those five years itself because of a 2001 Court of Appeals decision, Aliessa v. Novello, 96 N.Y.2d 418 (2001). New York is one of a small number of states that does this.

This page covers the questions that only a green card holder, or the family of one, needs answered: the five-year bar and why it does not apply in New York, how Medicaid interacts with public charge and with the sponsor's affidavit of support, and how a non-citizen qualifies for home care or nursing home Medicaid without losing the house. It does not repeat the general application checklist or the MAGI rules that apply to everyone. For the general rules, start with the New York State Department of Health Medicaid pages.

The federal five-year bar

The 1996 federal welfare reform law (PRWORA) divides non-citizens into "qualified aliens" and everyone else. Lawful permanent residents are qualified aliens. 8 U.S.C. § 1641. Qualified aliens who entered the United States on or after August 22, 1996 are barred from "federal means-tested public benefits," including Medicaid, for five years after they obtain qualified status. 8 U.S.C. § 1613. Refugees, asylees, Cuban and Haitian entrants, Amerasians, trafficking victims, and certain veterans and active-duty service members and their families are exempt from the bar.

The same law left states free to decide whether to cover barred immigrants with state money. 8 U.S.C. § 1622. New York's legislature first chose not to. Social Services Law § 122, as enacted in 1997, denied state Medicaid to permanent residents within the five-year bar and to immigrants who were "permanently residing under color of law" (PRUCOL).

What Aliessa v. Novello actually held

The plaintiffs in Aliessa were twelve lawful immigrants in New York City, most of them PRUCOL and one a permanent resident inside the five-year bar, who had been cut off from Medicaid under Social Services Law § 122. Several had serious illnesses and were receiving only emergency coverage.

The Court of Appeals struck down § 122 as applied to them on two grounds. First, Article XVII, § 1 of the New York Constitution provides that "the aid, care and support of the needy are public concerns and shall be provided by the state." The Court held that the legislature may decide how to help the needy, but may not define a class of needy residents out of the program entirely based on immigration status. Second, the statute violated the Equal Protection Clauses of the state and federal constitutions. Because Congress had not set a uniform national rule and instead left the choice to each state, New York's classification was a state decision subject to strict scrutiny, which it failed.

Two points are often stated wrongly on legal websites. The Court did not "promulgate" anything; it declared a statute unconstitutional and the state then changed its rules. And the decision was not limited to green card holders. It protects PRUCOL immigrants as well. The result is that New York funds Medicaid for these groups with state and local dollars only, with no federal match, for as long as federal law excludes them.

The practical consequence for a new permanent resident is simple. If you move to New York from a state that does not cover the five-year bar, you can qualify here. If you move away from New York during those five years, you may lose coverage in your new state.

Which immigrants New York covers, and with what money

• Permanent residents, five or more years in qualified status: Full Medicaid with federal matching funds, same rules as citizens.
• Permanent residents inside the five-year bar: Full Medicaid under Aliessa. Adults are covered with state-only funds. Children under 21 and pregnant women are covered with federal funds because New York elected the option Congress created in 2009 (CHIPRA § 214) for lawfully residing children and pregnant women.
• Conditional permanent residents (two-year cards): Treated as permanent residents. Status pending renewal through Form I-751 does not interrupt eligibility.
• Refugees, asylees, Cuban and Haitian entrants, Amerasians, and trafficking victims: Exempt from the federal bar and covered with federal funds from the date status is granted.
• PRUCOL immigrants: Full Medicaid with state funds under Aliessa. New York's list of PRUCOL categories appears in 18 NYCRR 360-3.2 and in Department of Health guidance. Deferred action, including DACA, has been treated as PRUCOL for New York Medicaid.
• Temporary visa holders (tourists, students, most work visas): Not PRUCOL. Emergency Medicaid only, with three exceptions: children under 19 (Child Health Plus), pregnant women (prenatal and postpartum coverage), and, since January 1, 2024, anyone aged 65 or older regardless of immigration status, who may receive full state-funded Medicaid.
• Undocumented immigrants: The same three exceptions, otherwise Emergency Medicaid only.

You must document status. A green card (Form I-551), a foreign passport with a temporary I-551 stamp, or a Form I-94 with the correct notation is enough. The agency checks the document against Department of Homeland Security records through the SAVE system. A mismatch, often from a name change or an expired card that has not been renewed, is the most common reason a permanent resident is wrongly denied. The fix is usually a corrected document and, if the agency will not reopen the case, a fair hearing request within 60 days of the notice.

Financial rules are the same for citizens and permanent residents

Immigration status decides whether you are in the program and who pays for it. It does not change the income or resource limits. For adults under 65 who are not disabled, Medicaid is based on modified adjusted gross income up to 138% of the federal poverty level, with no asset test. For people who are 65 or older, blind, or disabled, New York applies both an income test and a resource test. The 2025 figures are:

• Income: $1,800 per month for one person, $2,433 for a couple. Income above the limit does not disqualify you; it becomes a "spend-down" or can be placed in a pooled income trust (see below).
• Resources: $32,396 for one person, $43,781 for a couple. The home is exempt if you live in it or intend to return to it and your equity is at or below $1,097,000, or if a spouse or dependent child lives there. One car, household goods, an irrevocable prepaid funeral and certain retirement accounts in payout status are also exempt.
• Nursing home applicants: The applicant's resource limit is the same $32,396, not a lower figure. The spouse who stays home may keep a community spouse resource allowance of at least $74,820 and up to $157,920 in 2025, plus a monthly income allowance of up to $3,948.

These numbers come from the Department of Health's annual GIS release and change every January. Confirm the current year's figures on the Medicaid Reference Guide before relying on them.

One financial rule does hit permanent residents harder than citizens. Medicare is not available to a permanent resident who turns 65 without 40 quarters of covered work until he or she has lived in the United States for five continuous years, and even then Part A must be purchased. 42 U.S.C. § 1395i-2(a)(3). An older parent who was sponsored by an adult child often has no Medicare at all. For that parent, New York Medicaid is the primary and only coverage, which makes the eligibility and planning rules below matter more.

Does Medicaid count against you as a public charge?

Under the Department of Homeland Security rule in effect since December 23, 2022 (8 C.F.R. §§ 212.21 and 212.22), the only Medicaid that counts in a public charge determination is "long-term institutionalization at government expense." Ordinary Medicaid, Emergency Medicaid, Child Health Plus, the Essential Plan, and Medicaid home care do not count. Medicaid paying for a long-term nursing home stay does count, as do SSI and cash assistance.

Just as important is when the test is applied. Public charge is a ground of inadmissibility. It is assessed when a person applies for a visa, for admission at the border, or for adjustment of status to permanent resident. It is not part of the naturalization test. A permanent resident who already has the green card is not re-examined for public charge when applying for citizenship, and receiving Medicaid lawfully does not affect "good moral character." Lying on a benefits application can. If you have concerns about statements made on a prior application, read our page on misstatements on food stamp and Medicaid applications.

The exception is travel. A permanent resident who is absent from the United States for more than 180 continuous days is treated as an applicant for admission on return and may be questioned about public charge. INA § 101(a)(13)(C)(ii), 8 U.S.C. § 1101(a)(13)(C)(ii). A green card holder in a Medicaid-funded nursing home should not take a long trip abroad without first speaking with an immigration attorney.

Can your sponsor be billed for your Medicaid?

Most family-based permanent residents have a sponsor who signed Form I-864, the affidavit of support. The affidavit is a contract with the federal government. 8 U.S.C. § 1183a. It has two consequences for means-tested benefits.

Deeming: Federal law lets an agency treat the sponsor's income and resources as the immigrant's own when deciding eligibility. New York applies deeming in SNAP. New York has generally not deemed a sponsor's income for Medicaid, in part because the state covers the applicant with its own funds anyway during the bar. Policy on this point is set by the Department of Health and can change, so confirm it when you apply.

Reimbursement: An agency that provides a means-tested benefit may sue the sponsor to recover its cost. The sponsor's obligation ends when the immigrant becomes a citizen, is credited with 40 quarters of work (a spouse's quarters during marriage count), leaves the country permanently, or dies. New York Medicaid has not, as a routine matter, pursued sponsors, and a 2019 federal directive to step up enforcement was rescinded in 2021. The legal exposure still exists. A sponsor whose parent will need nursing home Medicaid should know that the Medicaid agency and, separately, the Family Court under Social Services Law § 366(3), could look to the sponsor for support, and that sponsor and spousal-refusal exposure can overlap when the sponsor is also the spouse.

Long-term care Medicaid for a non-citizen

This is where our office does most of its work for immigrant families. The planning tools are the same ones available to citizens. Immigration status changes how some of them are used.

The look-back and the Medicaid asset protection trust

New York reviews 60 months of financial records before approving nursing home Medicaid and penalizes uncompensated transfers made during that window. Social Services Law § 366(5)(e). A 30-month look-back for home care was enacted in 2020 (§ 366(5)(f)) but has not been implemented as of this writing. The standard planning response is an irrevocable Medicaid asset protection trust that holds the home and savings while the parent keeps the income and the right to live in the house. Five years after funding, the trust assets are not counted.

For an immigrant family, choose the trustee carefully. Under Internal Revenue Code § 7701(a)(30)(E), a trust is a domestic trust only if a United States court can supervise it and United States persons control all substantial decisions. Naming a son or daughter who lives abroad and is not a U.S. citizen or resident as sole trustee can make the trust a foreign trust for tax purposes, which triggers Form 3520 reporting and can expose the trust to tax on the sale of the house. Name a U.S. trustee or a U.S. co-trustee with the deciding vote.

Gifts to relatives overseas are also transfers. The Medicaid agency does not care that the recipient lives in another country. A gift of $50,000 to a sibling abroad four years ago is a penalized transfer if a nursing home application is filed today.

Property abroad

Real property in another country is a countable resource unless an exemption applies. A green card holder who owns an apartment in Guangzhou, Santo Domingo or Warsaw must disclose it and document its value. The agency may accept a local appraisal and may treat property that cannot legally or practically be sold as unavailable, but you must prove that. Failing to disclose foreign property is the kind of omission that creates both a Medicaid overpayment and an immigration problem.

Pooled income trusts for over-income permanent residents

A permanent resident whose Social Security, foreign pension or annuity income exceeds the monthly limit can keep home care Medicaid by depositing the excess into a pooled supplemental needs trust run by a New York nonprofit. 42 U.S.C. § 1396p(d)(4)(C). The trust pays the person's rent, utilities and other bills. New York permits people 65 and older to use pooled trusts for community Medicaid without a transfer penalty; deposits by someone over 65 are penalized only for nursing home Medicaid. Foreign pension income counts in full and must be documented with translated statements. See our page on the benefits of a special needs trust for how these trusts work.

Spousal refusal in mixed-citizenship couples

When one spouse needs care and the other has the assets, New York allows the well spouse to sign a "spousal refusal" declining to contribute. Social Services Law § 366(3)(a). The applicant is then evaluated on his or her own resources. The refusing spouse's citizenship does not matter; a U.S. citizen spouse may refuse on behalf of a permanent resident applicant and the reverse. The agency may later sue the refusing spouse for support, and if the refusing spouse also signed the I-864, there are two potential claims rather than one. Moving assets into the well spouse's name before the application is often part of the plan; read our page on moving assets under one spouse's name in New York and on whether you are responsible for a spouse's debts.

Estate recovery against the New York home

After a Medicaid recipient aged 55 or older dies, New York may file a claim against the probate estate for Medicaid paid. Social Services Law § 369; 18 NYCRR 360-7.11. Citizenship is irrelevant. Recovery against the home is deferred while a surviving spouse, a child under 21, or a blind or disabled child lives there. A house that passed through a properly funded asset protection trust, or that was transferred to a caregiver child under the caregiver exception, is outside the probate estate and outside recovery. A house still in the parent's sole name at death is not.

Living abroad part of the year

Medicaid requires New York residence. 18 NYCRR 360-3.2. A temporary trip with intent to return does not end eligibility, but Medicaid pays nothing for care received outside the United States, and a managed long-term care plan can disenroll a member who is out of the plan's service area for an extended period. The immigration rules run in parallel: absences over six months invite questions at re-entry and an absence of a year or more creates a presumption that the green card was abandoned unless a re-entry permit was obtained first. A permanent resident parent who spends winters in the home country needs both the Medicaid plan and the immigration status reviewed before buying the ticket.

Two illustrations

These are hypothetical examples, not descriptions of actual clients or results.

Example one. A 72-year-old woman received her green card eighteen months ago through her daughter, a citizen who signed Form I-864. She has no Medicare and no work history in this country. She now needs help bathing and dressing. She is eligible for New York Medicaid home care today under Aliessa, funded by the state. Her $900 monthly foreign pension is below the limit. Home care does not count as a public charge benefit, and public charge is not relevant to her future naturalization in any event. The daughter's exposure as sponsor is theoretical but ends when her mother naturalizes or when the daughter's own 40 quarters are credited to her mother, which they are not, since quarters transfer only between spouses and from parent to minor child. The plan is to apply now and to begin the naturalization process at the five-year mark.

Example two. A 68-year-old permanent resident of nine years owns a two-family house in Queens worth $950,000 and has $120,000 in savings. His wife is a citizen. He has early dementia and will likely need a nursing home within a few years. Because he is past five years, federal funds will pay, but a nursing home stay would count for public charge if he ever had to re-enter the country, so his family is told to keep his travel short. The savings exceed the $32,396 limit. The plan combines an irrevocable trust for the house with a U.S. citizen child as trustee, a spousal refusal for the wife, and retention of enough liquid funds for the five-year window. The couple also updates their wills so that his share does not pass outright to his wife and then back into a Medicaid resource calculation if she later needs care herself.

Frequently asked questions

Sources

• Aliessa v. Novello, 96 N.Y.2d 418 (2001), New York Court of Appeals.
• N.Y. Constitution, Article XVII, § 1; Social Services Law §§ 122, 366, 369; 18 NYCRR 360-3.2 and 360-7.11.
• 8 U.S.C. §§ 1613, 1622, 1641 (PRWORA); 8 U.S.C. § 1183a (affidavit of support); 8 C.F.R. §§ 212.21–212.22 (public charge).
• New York State Department of Health, Medicaid Reference Guide, including the annual income and resource level GIS releases.
• USCIS, Public Charge Resources.

Speak with a New York Medicaid attorney

We help permanent residents and their families in New York City and Long Island qualify for home care and nursing home Medicaid, set up asset protection and pooled income trusts, and coordinate the plan with immigration status and the sponsor's obligations. Call the Law Offices of Albert Goodwin at 212-233-1233 or email [email protected]. Our office is in Midtown Manhattan. Spanish-speaking clients may also read our page on immigration and benefits in Spanish.

This page is general legal information for New York residents and is not legal advice for your situation. Medicaid figures change each January and immigration policy changes often; confirm the current rules before acting.