TN 22 (05-95)
GN 00303.800 Eligibility Under the HI/SMI Program for Uninsured Individuals
Social Security Act, Sections 1818 and 1836;
42 C.F.R. 406.11, 406.20, 407.10-407.25.
A. Policy - Uninsured HI/SMI Eligibility
1. Definition - U.S.
“U.S. Under HI/SMI Program for Uninsured Persons” is defined as the 50 States, District of Columbia, Commonwealth of Puerto Rico, the Northern Mariana Islands, Virgin Islands of the U.S., Guam and American Samoa (including Swain's Island).
2. Requirements Uninsured HI/SMI Eligibility
To be eligible for uninsured HI/SMI or for deemed insured HI, an individual must be a U.S. resident and either a U.S. citizen or a LAPR who has continuously resided in the U.S. for the 5 years immediately before the first month of eligibility.
A beneficiary can become eligible for insured HI/SMI before the 5-year residency requirement is met because of a change in status under the law. For example, eligibility for spouse's benefits can be established after one year of marriage to an insured number holder.
REMEMBER: End-stage-renal disease HI (R-HI) has no residency, citizenship or alien status requirements. (See HI 00801.201 for insured status requirements which must be met.) (See GN 00303.300 for determining and documenting U.S. citizenship.) (See HI 00801.006 for HI regular insured status requirements and HI 00801.201 for R-HI insured status requirements.)
3. LAPR Status
Follow GN 00303.610 to GN 00303.640 to verify all immigration documents submitted to establish LAPR status.
When the individual attains age 65 before acquiring LAPR status, the first month of eligibility cannot be earlier than the month in which LAPR status is acquired. The ADM/ADJ DATE field on the I-551 identifies the date the alien was admitted for permanent residence.
If the I-551 does not have an entry in the ADM/ADJ date field or if the I-151 does not show a date of entry, contact DHS to determine the date.
(See GN 00303.440 for determining and documenting LAPR status.)
CAUTION: While other sources can be used to determine an alien's date of entry to the U.S., only DHS can provide the beginning LAPR date or date of adjustment in status.
4. 5-Year U.S. Residency
In addition to establishing U.S. residency, the alien must have continuously resided in the U.S. for the 5-year period immediately preceding the month of effective enrollment (or effective filing for deemed HI). The alien need not have had LAPR status during this 5-year period.
The 5-year period of U.S. residency begins the day the NH arrives in the U.S. with the intention of establishing a home. Arrival as a visitor or tourist does not begin a period of residence.
REMINDER: The period of residence continues so long as the NH continues to maintain a U.S. residence, and is physically present for a significant part of the 5-year period. (See GN 00303.740 for procedure on establishing U.S. residency.)
B. Procedure - Establishing 5-Year U.S. Residency
The ADM/ADJ field and date of entry on the I-551 generally reflect the alien's lawful date of entry to the U.S. Follow the procedure below to establish the 5-year U.S. residency requirement.
NOTE: The claimant does not need to be in LAPR status for the entire 5 years immediately before the first month of eligibility. The claimant just needs to establish continuous residency in the U.S. for the 5 years immediately before the first month of eligibility.
1. ADM/ADJ Date or Entry Date 5 Years Earlier
If the date of entry on the I-551 is at least 5 years earlier than the first month of eligibility, use the date shown as the date of entry to the U.S.
2. No Date of Entry Shown
If the I-151 does not show the date of entry into the U.S., generally accept the residency statements on the application for Hospital or Medical Insurance.
If there is evidence to the contrary or if the residency statements for the current claim do not agree with either the residency statements or date of entry to the U.S. allegation in a prior claim, request evidence of the date of entry to the U.S.
3. ADM/ADJ Date or Entry Date Less Than 5 Years
Under certain circumstances the alien may have entered the U.S. in refugee or some other status before acquiring LAPR status.
If the I-551 shows an ADM/ADJ date or the I-151 shows a date of entry which is not 5 years earlier than the first month of eligibility and the individual alleges an earlier date of entry by which the 5-year U.S. residency period would be met, obtain evidence to determine the beginning of the U.S. residency period.
Consider reliable evidence from other sources to include (but not be limited to):
Numident record showing date of application for an SSN;
Claimant's SSN is a number which was issued more than 5 years ago;
Documents from the Department of State bearing an entry date; (e.g., visitor's visa);
Records of refugee assistance agencies; or
Evidence such as that listed in GN 00303.740C.1.
If reliable evidence of the earlier date of entry is not readily available from other sources, contact DHS for the date of entry in its records.
4. Absence From U.S.
If the alien alleges intent to maintain U.S. residency during an absence from the U.S., obtain evidence to support the allegation. Do not consider a temporary visit abroad as an interruption to a period of residence in the U.S. However, if the visit is for more than 6 months, do not consider it a temporary visit in the absence of a strong showing to the contrary. Evidence demonstrating an intent to remain a U.S. resident is:
Maintaining a house or apartment at which the NH keeps his/her furnishings or other belongings;
Paying U.S. income taxes for the period of absence;
Returning to the same job;
Departing with the reentry permit; or
Performing other similar acts showing an intention to reside in the U.S.
REMINDER: When the alien alleges having a period of absence from the U.S. with no intent to maintain U.S. residency during that absence, the 5-year U.S. residency period begins with the date of the most recent return to the U.S. with the intention of establishing residency.
C. Procedure - Documenting U.S. Citizenship /Residency
Document the file with evidence establishing:
U.S. citizenship (see GN 00303.300C.) or LAPR status (see GN 00303.440C.); and
U.S. residency (see GN 00303.740C.1. for documentation requirements); and
5-years continuous U.S. residency (see GN 00301.287 - GN 00301.289 for how evidence is recorded on the MCS system.)
If the alien alleges any periods of absence during the 5-year residency period, document the file with the claimant's signed statement explaining his /her intent to maintain U.S. residency during the period of absence.