Before 1996, every state was required to provide Medicaid coverage to all legally present immigrants who met the Medicaid eligibility requirements. The enactment of the Personal Responsibility and Work Opportunities Act (PRWOA) and the Illegal Immigration Reform and Immigrant Responsibility Act (IIRIRA) has greatly restricted the ability of many immigrants to obtain public health care benefits. PRWOA imposed a five-year ban for full Medicaid eligibility for all non-refugee immigrants entering the United States after August 1, 1996. Consequently, many immigrants and many aliens in the U.S. on student or work visas who were previously eligible for Medicaid no longer qualify for benefits.

Under the new rules, only "qualified" non-residents who established residency before August 1996 and who meet the Medicaid eligibility requirements can receive full Medicaid benefits. "Qualified" non-residents are: legal permanent residents (green card holders); refugees; asylum holders; immigrants who have had deportation withheld; immigrants granted parole for at least one year; immigrants granted conditional entry; battered immigrants and their children; immigrants born in Canada with certain American Indian ancestry; and immigrants who qualify as Cuban or Haitian entrants. Non-qualified non-residents, who are not Medicaid eligible, include: persons residing under color of law (including applicants for asylum and family unity, those having lived in the U.S. continuously since 1972, and immigrants granted indefinite voluntary departure); undocumented immigrants; and nonimmigrants such as students and foreign visitors. Qualified immigrants who enter the U.S. after August 1996 are barred from receiving Medicaid for the first five years after they enter the country.

Medicaid does provide some relief for immigrants in the form of emergency Medicaid coverage. Emergency Medicaid is available to all non-residents, regardless of immigration status, for the provision of treatment for emergency medical conditions. A medical condition qualifies as an emergency medical condition for the purpose of Medicaid coverage if the symptoms and severity of the condition are such that the absence of immediate medical attention would likely result in placing the patient's health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part. Labor and delivery are considered emergency medical conditions under the law.

For immigrants who do not qualify for Medicaid coverage, state and local governments have provided some safety nets. Many states continued to offer benefits to immigrant children who lost eligibility for the state's uninsured children's health plan after the enactment of PRWOA. California continued to offer both the state's children's health plan and Medicaid to those who lost benefits after PRWOA. In addition, many public and private providers of health care for the needy provide care for immigrants.

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