New Medicaid Requirement to Document U.S. Citizenship

  

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As of July 1, 2006 a new Medicaid requirement goes into effect requiring states to secure evidence of U.S. citizenship from any individual applying for or seeking to renew eligibility for Medicaid coverage (see acceptable proof of identity and U.S. citizenship below). Many individuals will face particular difficulty meeting this documentation requirement and may be denied or lose Medicaid coverage. Mental health advocates have an important role in working with state Medicaid offices to ensure that consumers are informed of the new requirements and receive support in securing needed documentation.

The Centers for Medicare and Medicaid Services (CMS, the federal agency that oversees Medicaid) issued regulations implementing this new requirement on July 6th. Below are some key points from these regulations.

  • Individuals receiving Medicare or Supplemental Security Income (SSI) are exempt from the documentation requirement.
  • All documents presented must be originals or certified copies.
  • States may also document citizenship and identity through data matches with government agencies.
  • States are directed to assist special populations including individuals with mental illness with meeting the new documentation requirement.
  • Individuals who are already Medicaid recipients will remain eligible for a reasonable period while they secure the required documentation.
  • But individuals newly applying for Medicaid will not be enrolled until they have presented the required evidence.
  • At the time of application or redetermination of Medicaid eligibility, the state must give an applicant or recipient a “reasonable opportunity” to present documents establishing proof of U.S. citizenship and identity. (It is unclear exactly how long this “reasonable opportunity” period may last and it will vary by state.)
  • If the applicant or recipient tries in good faith to present satisfactory documentation, but is unable because the documents are not available, the state may provide additional time for the applicant or recipient to provide documentation and should assist the individual in securing these documents.

Resources for Obtaining Required U.S. Citizenship Documentation

Accepted Evidence Of Identity And Citizenship

Source: Centers for Medicare and Medicaid Services

Tier 1 Documents (proves both citizenship and identity). A state must first seek proof of U.S. citizenship from the Tier 1 level list before looking to subsequent lists. No other information is required of the Medicaid applicant or recipient if any one of the three acceptable primary documents is presented.
  • A U.S. Passport
  • A Certificate of Naturalization (DHS Forms N-550 or N-570)
  • A Certificate of U.S. Citizenship (DHS Forms N-560 or N-561)
Tier 2 Documents (proves citizenship, but not identity). If primary documents cannot be obtained, the state will consider documentary evidence of citizenship from the Tier 2 level list accompanied by an accepted form of proof of identity (see acceptable proof of identify documents below).
  • A U.S. birth certificate
  • A Certification of birth issued by the Department of State (Form DS-1350)
  • A Report of Birth Abroad of a U.S. Citizen (Form FS-240)
  • A Certification of Birth Abroad (FS-545)
  • A U.S. Citizen I.D. card (DHS Form I-197)
  • An American Indian Card issued by the Department of Homeland Security with the classification cod “KIC”
  • Final adoption decree
  • Evidence of civil service employment by the U.S. government before June 1976
  • An official military record of service showing a U.S. place of birth
  • A Northern Mariana Identification Card
Tier 3 Documents (proves citizenship, but not identity). If Tier 1 and Tier 2 documents cannot be obtained, the state will consider documentary evidence of citizenship from the Tier 3 level list accompanied by an accepted form of proof of identity (see acceptable proof of identify documents below).
  • Extract of U.S. hospital record of birth established at the time of the person’s birth and was created at least 5 years before the initial application date and indicates a U.S. place of birth
  • Life or health or other insurance record showing a U.S. place of birth and was created at least 5 years before the initial application date
Tier 4 Documents (proves citizenship, but not identity) If Tier 1, Tier 2 and Tier 3 documents cannot be obtained, the state will consider documentary evidence of citizenship from the Tier 4 level list accompanied by an accepted form of proof of identity (see acceptable proof of identify documents below). Tier 4 documents can only be used after showing that documents from other tiers cannot be obtained within a reasonable period of time.
  • Federal or State census record showing U.S. citizenship or a U.S. place of birth
  • Institutional admission papers from a nursing home, skilled nursing care facility or other institution and was created at least 5 years before the initial application date and indicates a U.S. place of birth
  • Medical (clinic, doctor, or hospital) record and was created at least 5 years before the initial application date and indicates a U.S. place of birth unless the application is for a child under 5
  • Seneca Indian tribal census record, Bureau of Indian Affairs tribal census records of the Navaho Indians, U.S. StateVital Statistics official notification of birth registration, an amended U.S. public birth record that is amended more than 5 years after the person’s birth or a statement signed by the physician or midwife who was in attendance at the time of birth
  • Written affidavits from at least two individuals, one of whom is not related to the applicant or recipient (May be used only in rare circumstances when the state is unable to secure evidence of citizenship from another listing.)
Proof of Identity: Acceptable documentation to verify proof of identity (must accompany acceptable proof of U.S. citizenship).
  • A current state driver’s license bearing the individual’s picture or State identity document also with the individual’s picture
  • Certificate of Indian Blood, or other U.S. American Indian/Alaska Native tribal document
  • Any identity document described in section 274A(b)(1)(D) of the Immigration and Nationality Act:
    • Driver’s license issued by State or Territory either with a photograph of the individual or other identifying information of the individual such as name, age, sex, race, height, weight or eye color
    • School identification card with a photograph of the individual.
    • U.S. military card or draft record
    • Identification card issued by the Federal, State, or local government with the same information included on driver’s licenses
    • Military dependent’s identification card
    • Native American Tribal document
    • U.S. Coast Guard Merchant Mariner card
Children who are age 16 or younger may have their identity documented using other means, when the child does not have or cannot get any document on the preceding lists:
  • School identification card with a photograph
  • Military dependent’s identification card if it contains a photograph
  • School record that shows date and place of birth and parent(s) name
  • Clinic, doctor or hospital record showing date of birth
  • Daycare or nursery school record showing date and place of birth
  • Affidavit signed under penalty of perjury by a parent or guardian attesting to the child’s identity

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