Access to Medicaid is controlled by the same rules that govern the TANF program. For immigrants in the United States before August 22, 1996, states may determine if they are eligible for the program. Immigrants who arrived after that date are barred for a term of five years, after which states may again decide on including immigrants in the Medicaid program. Immigrants are automatically eligible for Medicaid again once they become citizens or have worked for 40 quarters.