In France, access to healthcare is a fundamental right that does not depend solely on your immigration status. For foreign nationals residing in France without legal status, the Aide Médicale de l'État (AME, State Medical Aid) is the central system allowing them to benefit from health expense coverage. This national solidarity mechanism, which is often misunderstood or complex to navigate, obeys strict rules defined by the Code de l'action sociale et des familles (French Code of Social Action and Families) and the Code de la sécurité sociale (French Social Security Code). Whether you are personally affected or are helping a loved one with their administrative steps, this comprehensive guide written by AvocatAI explains in detail how AME works, its eligibility criteria, and the practical steps to obtain it.
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The Aide Médicale de l'État (AME) is a humanitarian and public health program created in 1999. It allows foreign nationals in an irregular administrative situation (without a valid titre de séjour [residence permit] or a récépissé [application receipt] for a residence permit application) to access medical and hospital care.
Contrary to popular belief, the AME is not a classic social security benefit, but rather a state aid managed by the Assurance Maladie (French National Health Insurance). It serves a dual purpose: a humanitarian goal of protecting vulnerable individuals, and a public health goal aimed at preventing the spread of contagious diseases within the general population living in France.
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To qualify for the standard AME, the applicant must meet three cumulative conditions set by Article L. 251-1 of the Code de l'action sociale et des familles (CASF).
The applicant must be a foreign national and must not hold a residence permit or any document proving the legality of their stay in France (expired visa, lack of a residence card, lack of an asylum application receipt, etc.). Citizens of the European Union, the European Economic Area, and Switzerland are subject to specific conditions regarding resources and residency.
The applicant must have resided in France uninterruptedly for more than 3 months.
The AME is means-tested. The applicant's income (and that of their household) must not exceed a certain ceiling, which is identical to the threshold set for receiving the Complémentaire Santé Solidaire (C2S, Solidary Supplementary Health Insurance) without financial contribution.
This annual ceiling varies depending on the household composition and geographic area (metropolitan France or Overseas Departments). As of April 1, 2024, the annual resource ceilings for metropolitan France are as follows:
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To better understand how the Caisse primaire d'assurance maladie (CPAM, Local Health Insurance Fund) evaluates resources, let us look at a concrete situation.
Example: Carlos and Maria's Family
Carlos and Maria have been living in France without a residence permit for 8 months with their 6-year-old child (a household of 3 people). They are being housed by a friend. Carlos worked informally and earned a total of 9,200 € over the last 12 months. Maria had no income.
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The AME offers 100% coverage of Social Security official rates, with a total exemption from advancing any costs (tiers payant or third-party billing).
> Please note: For adults, certain non-urgent procedures (such as scheduled cataract operations or certain joint prostheses) are only covered after a 9-month waiting period from the date of admission to the AME, unless there is a proven medical emergency.
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The AME application must be completed carefully to avoid rejections or requests for additional documents, which delay the start of your coverage.
You must download and complete the official form *Cerfa n° 1224609** (titled "Demande d'aide médicale de l'État"). Only one form needs to be filled out for the entire household (the applicant, spouse or cohabitant, and dependent children under 18).
You must attach photocopies of the following documents:
1. Proof of Identity: Passport (even if expired), national identity card from your home country, birth certificate extract, or a copy of your expired visa.
2. Proof of Residence of more than 3 months:
3. Proof of Resources: A declaration of resources over the past 12 months (to be filled out directly on the form), accompanied by any document proving this income or, failing that, a sworn statement of lack of resources (attestation sur l'honneur).
4. ID Photo: A recent passport-sized photo for each adult member of the household.
The complete file must be dropped off in person or sent by mail to the Caisse primaire d'assurance maladie (CPAM) of your place of residence. In certain French departments, the first application must be submitted in person at a CPAM desk or through a partner social service (such as the Permanences d'accès aux soins de santé - PASS - in hospitals).
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If you do not yet meet the 3-month residency requirement or if your AME application is currently being processed, you will not be left without care in the event of a medical emergency.
1. The "Soins Urgents" (Urgent Care) System (Article L. 254-1 of the CASF): Public hospitals provide care to individuals not admitted to the AME when their life is in danger or to prevent the spread of a disease. This care is funded by a specific state fund.
2. PASS (Permanences d'Accès aux Soins de Santé): Available in most hospital centers, PASS units allow you to consult doctors, receive treatment, and obtain medications free of charge without active health coverage, while also receiving social work assistance to help you apply for the AME.
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No. AME beneficiaries do not receive a carte Vitale (the green French health insurance card). The CPAM issues them a paper or laminated card called the carte d'admission à l'aide médicale de l'État, which features their photo. This physical document must be presented to healthcare professionals (doctor, pharmacist, hospital) along with an ID card to benefit from the exemption of advancing costs.
No. Minor children (under 18) whose parents are undocumented benefit from the AME as a matter of right. The 3-month residency condition cannot be used to deny them urgent or essential care. Furthermore, they are not subject to the 9-month waiting period for certain scheduled procedures.
No, absolutely not. Admission to the AME is covered by medical and professional secrecy. The files of the Assurance Maladie are not shared with the préfectures (local government authorities) for immigration control purposes. On the contrary, holding successive AME cards constitutes solid, official legal proof of your continuous presence on French territory, which can be highly useful when applying for an exceptional residency permit (admission exceptionnelle au séjour under the Valls circular).
If the CPAM refuses to grant you the AME, you have 2 months from the date of the refusal notification to challenge the decision. You must first file a mandatory prior administrative appeal (recours administratif préalable obligatoire - RAPO) before the Commission de recours amiable (CRA, Amicable Appeals Commission) of your CPAM. If this appeal fails, you can take the matter to the competent Administrative Court (Tribunal administratif).
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Legal information for guidance only, not personalised legal advice. For your specific situation, ask your question free of charge on AvocatAI — answers based on French law, in your language.