New York’s Essential Plan (EP) is a health insurance program offering affordable coverage—often with a $0 premium—to low-income residents who don’t qualify for Medicaid. A critical eligibility factor is immigration status.
This guide breaks down:
- Which immigration statuses qualify
- The difference between Qualified Immigrants vs. PRUCOL
- Common documentation examples
- 2025 updates including clarified guidance on DACA and new USCIS memos
- Best practices for assistors and brokers
Whether you're an immigrant New Yorker or a health insurance assister, this overview is designed to help you confidently determine EP eligibility.
What is the Essential Plan?
The Essential Plan is New York’s Basic Health Program for adults aged 19–64 who are not eligible for Medicaid. It includes comprehensive benefits:
- Primary and specialty care
- Hospital visits
- Prescriptions
- Dental and vision
- No deductibles, minimal copays
As of 2024, eligibility expanded to include:
- Individuals up to 250% of the Federal Poverty Level (FPL)
- DACA recipients
To qualify, an applicant must be:
- A New York State resident
- Aged 19–64
- Not eligible for Medicaid or Child Health Plus
- Not enrolled in other affordable coverage
- Meet income requirements
- Be a U.S. citizen or a lawfully present immigrant
Not Eligible for EP
- ❌ Undocumented immigrants:
- ❌ Immigrants without lawful presence:
- ✅ May qualify for Emergency Medicaid, Child Health Plus (under 19), or pregnancy Medicaid:
2025 Policy Updates
- USCIS Guidance Clarified: Applicants with prima facie eligibility for humanitarian statuses (e.g., VAWA, U visa, SIJS) remain “lawfully present” and PRUCOL for Essential Plan purposes.
- Expedited Processing: NYSOH systems now flag certain deferred action and TPS applications for quicker eligibility confirmation.
- DACA Recertification: Recipients must keep EADs current in 2025 to maintain EP eligibility. Submit renewals early to avoid gaps.
Qualified Immigrant vs. PRUCOL
What is a "Qualified Immigrant"?
Defined under 8 U.S.C. § 1641, this includes:
- Green Card Holders (LPRs)
- Refugees, Asylees
- Cuban/Haitian Entrants
- Parolees (≥1 year)
- Withholding of removal recipients
- VAWA self-petitioners
- T visa holders
- Amerasians
These immigrants are lawfully present and may face a 5-year wait for Medicaid—but can enroll in the Essential Plan meanwhile.
What is PRUCOL?
Permanently Residing Under Color of Law (PRUCOL) is not a legal status but is recognized for state-funded benefits like the Essential Plan in NY.
Includes individuals with:
- Deferred Action (non-DACA)
- Pending asylum or adjustment of status (I-485)
- TPS recipients
- Orders of supervision, stays of removal
DACA Update (2023–2025)
- DACA recipients are now eligible for Essential Plan in NY (effective 2024)
- HHS reclassified DACA as “lawfully present” in late 2024
- Renewals must be submitted on time to maintain eligibility
Immigration Categories That Qualify
✅ Qualified Immigrants (Federal)
| Status | EP Eligible? | Lawfully Present? | Example Documents |
|---|---|---|---|
| Lawful Permanent Resident | Yes | Yes | I-551 Card, I-797 |
| Refugee | Yes | Yes | I-94, EAD (A03) |
| Asylee | Yes | Yes | Asylum Grant, EAD (A05) |
| Cuban/Haitian Entrant | Yes | Yes | I-94, USCIS Letter |
| Parolee (≥1 Year) | Yes | Yes | I-94, Parole Approval |
| Withholding of Removal | Yes | Yes | Judge Order, EAD (A10) |
| T Visa Holder | Yes | Yes | T Visa, EAD (A16) |
| VAWA Self-Petitioner | Yes | Yes | I-360, EAD (C31) |
| Amerasian | Yes | Yes | I-94, AM Visa |
| SIV (Iraqi/Afghan) | Yes | Yes | I-94, SIV Stamp |
✅ PRUCOL & Lawfully Present (State Coverage)
| Status | EP Eligible? | Lawfully Present? | Example Documents |
|---|---|---|---|
| TPS | Yes | Yes | USCIS Notice, EAD (A12/C19) |
| Pending TPS | Yes | Yes | Receipt Notice, EAD (C19) |
| Parolee (<1 Year) | Yes | Yes | I-94, Parole Letter |
| Deferred Action (Non-DACA) | Yes | Yes | EAD (C14) |
| DACA (Post-2024) | Yes | Yes | EAD (C33) |
| Pending Asylum (150+ days) | Yes | Yes | I-589, EAD (C08) |
| Adjustment Applicant (I-485) | Yes | Yes | I-485 Receipt, EAD (C09) |
| U Visa Holder | Yes | Yes | EAD (A19/A20) |
| U Visa Deferred Action | Yes | Yes | EAD (C14) |
| Order of Supervision | Yes | Yes | I-220B, EAD (C18) |
| Stay of Removal | Yes | Yes | I-246, Court Order |
| DED | Yes | Yes | EAD (A11) |
| SIJS | Yes | Yes | I-360, EAD |
Best Practices for Assisters & Brokers (2025)
- Use “Immigrant Non-Citizen” on NYSOH application
- Submit correct docs (EAD, I-94, USCIS receipts)
- Use official OHIP immigration training slides
- Upload postal receipts or payment notices if needed
- Contact Broker Support for help on unclear statuses
Need Help?
AffordableCareAgents.com is your trusted source for training and case support.
Contact Mikh Yusupov, M.P.A. - [email protected] for consulting or training sessions.
Sources
- NY State of Health (NYSOH)
- USCIS, CMS, and 45 C.F.R. § 152.2
- Immigration Training (2022)
- Aliessa v. Novello (2001)
- USCIS Policy Updates (Q1 2025)
Information accurate as of April 2025. Confirm with NYSOH and USCIS for updates.
