Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 06 - Medical Services
Rule 016.06.17-020 - Medicaid and CHIP Coverage for Lawfully Residing Alien Children Under Age 19 and Pregnant Women
Current through Register Vol. 49, No. 9, September, 2024
Medical Services - Appendix C, Verification of Citizenshipi Alien Status and SSN Enumeration
I. Citizenship Verification - Acceptable Documents for Proof of Citizenship
When citizenship cannot be verified through the Federal Data Services Hub (FDSH) or the SSA match, the worlcer must access Vital Records through ARFinds for verification of birth. If citizenship documentation cannot be obtained through Vital Records, specific forms of documentation may be acceptable evidence of citizenship. If an individual presents evidence from the listing of Primary Documentation, no other information is required.
To establish U.S. citizenship, the document must show a U.S. place of birth and that the person is a U.S. citizen. The documents must be original or certified copies. Copies of documents already obtained wilt be accepted as assumed made from the original unless questionable (e.g. stamped "copy", or unreadable).
In general, the caseworker should obtain primary evidence of citizenship before using the secondary documentation or tertiary list. The following forms of documentation may be accepted:
Primary documentation- The highest reliability that conclusively establishes identification and citizenship.
* A U.S. Passport.
* A Certificate of Naturalization (United States Department of Homeland Security (USDHS) Forms N-550 or N-570).
* A Certificate of U.S. Citizenship (USDHS Forms N-560 or N-561).
Secondary documentation- Secondary evidence of citizenship is documentary evidence of satisfactory reliability that is used when primary evidence of citizenship is not available.
* 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).
* An American Indian Card issued by the Department of Homeland Security with the classification code "KIC". (Issued by DHS to identify U.S. citizen members of the Texas Band of Kickapoos living near the U.S./Mexican border).
* Final adoption decree.
* Evidence of civil service employment by the U.S. government before June 1976.
Medical Services - Appendix C, Verification of Citizenship, Alien Status and SSN Enumeration
* An official military record of service showing a U.S. place of birth.
* A Northern Mariana Identification Card (issued by the USDHS to a collectively naturalized citizen of the United States who was born in the Northern Mariana Islands before November 4,1986).
Third level documentation- Third level evidence of U.S. citizenship is documentary evidence of satisfactory reliability that is used when neither primary nor secondary evidence of citizenship is available. This documentation includes:
* Extract of U.S. hospital record of birth established at the time of the person's birth, created at least 5 years before the initial application date and indicating a U.S. place of birth.
* Life or health or other insurance record created at least 5 years before the initial application date showing a U.S. place of birth.
* Religious records recorded in the U.S. within 3 months after the birth which show that the birth occurred in the U.S. showing the date of the birth of the individual or the individual's age at the time the record was made. These must be official records recorded with the religious organization (e.g., baptismal certificates). Entries in a family bible are not considered recorded religious records.
* Early school records which show the name of the child, the date of admission to the school, the date of birth {or age at the time the record was made), a U. S. place of birth, and the name(s) and place(5) of birth of the applicant's parents.
Fourth level documentation - Fourth level evidence of U.S. citizenship is documentary evidence of the lowest reliability. This level should only be used in the rarest of circumstances. This level of evidence is used only when primary evidence is not available, both secondary and third level evidence do not exist or cannot be obtained within the reasonable opportunity period, and the applicant alleges a U.S. place of birth. This documentation includes:
* Federal or State census record showing U.S. citizenship or a U.S. place of birth, as well as the applicant's age.
* Birth records that were recorded with vital statistics 5 years after a birth (a delayed birth record).
* Institutional admission papers from a nursing home, skilled nursing care facility or other institution created at least 5 years before the initial application date and which indicate a U.S. place of birth.
Medical Services - Appendix C, Verification of Citizenship, Alien Status and SSN Enumeration
* Medical (clinic, doctor, or hospital) record which 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.
* Other document that was created at least five years before application for Medicaid. These documents are Seneca Indian tribal census record, Bureau of Indian Affairs tribal census records of the Navaho Indians, U.S. State Vital 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.
* The Roll of Alaska Natives maintained by the Bureau of Indian Affairs.
* Written affidavit. This should be in rare circumstances when the applicant or recipient cannot provide evidence from another listing.
Written affidavits may be used in circumstances when the state is unable to secure evidence of citizenship from another listing. The affidavits must be supplied by at least two individuals, one of whom is not related to the recipient. Each must attest to having a personal knowledge of the event(s) establishing the recipient's claim of citizenship. Those making affidavits will be subject to prosecution for perjury. If the persons claiming knowledge of another's citizenship has information, which explains why documentary evidence establishing the claim of citizenship does not exist or cannot be readily obtained, the affidavit should contain this information as well.
A second affidavit from the recipient or other knowledgeable individual explaining why documentary evidence does not exist or cannot be readily obtained must also be requested.
II. Identity
If citizenship is verified with a document on the secondary or lower level listed above, providing proof of identity will be required. Acceptable forms of identity are:
Medical Services - Appendix C, Verification of Citizenship, Alien Status and SSN Enumeration
uoii: If the expiration date has expired, the ID is still acceptable.
III. Alien Status Verification - Using SAVE (Systematic Alien Verification for Entitlement)
At application, individuals will be requested to provide information of alien status including document type, alien number, document ID, date of entry into the United States and expiration date of document. This information will be electronically verified using the Verified Lawful Presence (VLP) service through the Federal Data Services Hub (Hub) for the MAGI population or through the web-based connection to SAVE for the non-MAGI population. When prompted, the paper G-845 will be utilized.
Electronic Verification
SAVE electronically verifies immigration status or naturalized or derived citizenship using a three-step process:
* Initial Verification (first step) - electronically compares information the agency enters against immigration databases and returns a response within seconds. The system will respond with the applicant's current immigration status or naturalized or derived citizenship information and other specific information (such as employment authorization, admit to/expiration date) or a message prompting the user to "Institute Additional Verification".
* Additional Verification (second step) - is initiated electronically by the agency. A Status Verifier with SAVE's Status Verification Operations (SVO) will conduct a manual search of immigration databases, including databases not automatically searched during the initial step. This step takes between 3-5 federal working days. The status verification system will return either the applicant's immigration status or U.S. citizenship
Medical Services - Appendix C, Verification of Citizenship, Alien Status and SSN Enumeration
information and other information such as employment authorization, admit to or expiration date or a request to "Resubmit with Doc". The "Resubmit with Doc" response is the prompt for a third step verification. Note: The agency may use the Scan and Upload function at second step to electronically submit photocopies (front and back) of the applicant's relevant immigration/citizenship documents when initiating second step verification and avoid the possibility of a "Resubmit with Doc" response. The benefit Is that, except for very limited circumstances, the entire verification process will be completed at second step within 3-5 federal working days.
* Third Step Verification - is an electronic process for most agencies. The agency must submit photocopies (front and back) of the applicant's relevant immigration documents to a designated SVO office. The photocopies can be submitted electronically with the Scan and Upload function or attached to a Form G-845, Verification Request, and sent by traditional mail. A Status Verifier conducts a manual search of immigration databases. Agencies should receive a response through the system within 3-5 days if using the Scan and Upload function or 10-20 federal working days if sent by traditional mail.
Paper Based G-845 Verification
The SAVE Program also provides a paper-based verification method as an alternative to the electronic system. It can be used to initiate a verification or to conduct third step verification. Agencies may verify an applicant's immigration status or U.S. citizenship by mailing a USCIS Form G-845, Verification Request, with photocopies (front and back) of the applicant's immigration document(s) to a designated SVO Office. The Status Verifier at the designated SVO office generally takes 10 to 20 federal working days from the date of receipt of the Form G-845 and document photocopies to conduct a manual search of immigration databases and mail the Form G-845 back to the agency with the applicant's current immigration status or naturalized or derived citizenship information, or the action necessary to complete the verification process as indicated on the G-1120 or the G-845 Part 3.
IV. Alien Documentation Chart
The chart below shows the types of documentation that can be used to verify alien status, and additional verification that certain aliens must provide to verify that they are eligible for Medicaid (e.g., the date they were admitted to the U.S., or the date a particular alien status was granted or adjusted).
Medical Services - Appendix C, Verification of Citizenstiip, Alien Status and SSN Enumeration
Note: USDHS Form 1-94 is processed electronically and can be retrieved online at www.cbp.eov/l94.
|
Alien Status |
Acceptable Documentatlon of AIipn Status |
Medicaid Status |
|
Amerasian immigrant |
* USDHS Form 1-551, Permanent Resident Card, annotated AM6,AIM7or AM8. * Unexpired temporary 1-551 stamp in a foreign passport annotated AIVIl, AM2 or AIVI3. * USDHS Form 1-94, Arrival/Departure Record, annotated AMI, AM2orAM3. |
Eligible Regardless of U.5. entry date |
|
Asylee |
* USDHS Form 1-94, Arrival/Departure Record, noting admittance under section 208 of the INA. * USDHS Form 1-94, Arrival/Departure Record, annotated AS-1, AS-2 or AS-3. * USDHS Form 1-94, Arrival/Departure Record, witli Visa 92 or V-92. * Order of an immigration judge granting asylum. * Written decision letter from the Board of Immigration Appeals. * USDHS Form 1-730, Approval Letter. * USDHS Form 1-766, Employment Authorization Document, annotated "AS." |
Eligible as of date asylum is granted |
|
Battered Allen |
Proof of admission of entry date and one of the following documents: * 1-360 or 1-130 petition with proof of filing (a file-stamped copy of the petition or another document demonstrating filing, such as a signed certified return receipt or cash register or computer-generated receipt). * Order or document from the Immigration Court or Board of Immigration Appeals granting suspension of deportation under INA section 244(a)(3), or cancellation or removal under INA section 204A(b)(2). * Application for cancellation of removal (Form EOIR 42B] or suspension of deportation (Form EOIR 40) with proof of filing (a file-stamped copy of the application or another document demonstrating filing, such as a signed certified return receipt or cash register or computer-generated receipt). * A document from the Immigration Court or Board of Immigration Appeals Indicating that the applicant has established a prima facie case for suspension of deportation under INA section 244(a)(3), or cancellation of removal under INA section 204A(b)(2). |
Barred for five (5) years if entered U.S. on or after 8/22/96 Eligible If entered U.S. before 8/22/96 |
Medical Services - Appendix C, Verification of Citizenship, Alien Status and SSN Enumeration
|
Alien Status |
Acceptable Documentation of Alien Status |
IVledicaid Status |
|
Canadian-born American Indian |
* USDHS Form 1-551, Alien Registration Receipt Card, coded S13. * i-551 stamp in a Canadian passport coded S13. * USDHS Form 1-94, Arrival/Departure Record, coded S13. * Proof of tribal membersliip or a tribal document sliowing tlie individual has at least 50% American Indian blood. Proof of membership can be a tribal membership card, other tribal documents showing membership, or collateral contact with the tribe's government. |
Eligible Regardless of U.S. entry date |
|
Conditional Entrant Cuban or Haitian Entrant |
Proof of admission or entry date and one of the following documents: * USDHS Form 1-94, Arrival/Departure Record, with stamp showing admission under section 203(a)(7) of the iNA. * USDHS Form i-766. Employment Authorization Document, annotated "AS." * USDHS Form 1-551, Permanent Resident Card, annotated CU6, CU7 or CH6. * Unexpired temporary 1-551 stamp in a foreign passport annotated AlVIl, AIVI2 or AIVI3. * USDHS Form 1-94, Arrival/Departure Record, annotated CU6 or CU7, or with a stamp showing parole as "Cuban/Haitian Entrant" under section 212(d)(5) of the iNA. |
Barred for five years if entered U.5. on or after 8/22/96. Eligible if entered U.S. before 8/22/96 Eligible regardless of U.S. entry date |
|
Cuban or Haitian Entrants in tlie Haitian Family Reunification Program |
* USDHS Form i-130, Petition for Alien Relative. * USDHS Form i-131. Application for Travel Document. * USDHS Form 1-134, Affidavit of Support. * USDHS Form 1-765, Application for Employment Authorization, Once paroled into the United States, HFRP Program beneficiaries will meet the definition of Cuban/Haitian entrants under section 501(e)(1) of the Refugee Education and Assistance Act of 1980, as amended, and will be qualified aliens |
Ei igi bie regard 1 ess of U .5. 1 entry date. |
|
Deportation or removai withheid |
* USDHS Form 1-766, Employment Authorization Document, annotated "AlO." * Order of an immigration judge showing deportation withheld under section 243(h) or removai withheld under section 241(b)(3) of the iNA and date of grant. |
Eligible Regardless of U.S. entry date |
|
Lawfuiiy admitted for permanent residence |
* USDHS Form 1-551, Permanent Resident Card. Unexpired 'Temporary 1-551" stamp in a foreign passport. * USDHS Form 1-94, Arrival/Departure Record, with a temporary 1-551 stamp. |
Barred for five years if entered U.S. on or after 8/22/96 Eligible if entered U.S. before 8/22/96 |
|
Paroled into U.S. for at least one Year |
Proof of admission or entry date and USDHS Form 1-94, Arrival/Departure Record, showing admission for at least one year under section 212(d)(5) of the INA. Note: The applicant cannot use admission oeriods for less than one year to meet the one-year requirement. |
Barred for five years if entered U.S. on or after 8/22/96 Eligible if entered U.S. before 8/22/96 |
|
Refugee |
* USDHS Form 1-94, Arrival/Departure Record, showing entry under section 207 of the INA. * USDHS Form 1-766, Employment Authorization Document, annotated "A3." * USDHS Form 1-571, Refugee Travel Document. NgTE: Refugees who have adjusted to lawful permanent resident status are still considered refugees for IVIedicatd eligibility, if a refugee has a Form 1-551, Permanent Resident Card*, it will be annotated RE-6, RE-7, RE-8, RE-9 or R8-6. |
Eligible regardless of U.S. entry date |
|
Veteran or active duty military personnel lawfully admitted for permanent residence (and families) |
To verify alien status: * USDHS Form 1-551, Permanent Resident Card. * Unexpired "Temporary 1-551" stamp in a foreign passport. * USDHS Form 1-94, Arrival/Departure Record, with a "Temporary l-SSI" stamp. To verify military status: * Honorably discharged veteran: Original or notarized copy of form DD214 (discharge papers). Note: This verification is sufficient when the veteran is a U.S. citizen, and the spouse or unmarried dependent children (or surviving spouse and unmarried dependent children of a deceased veteran) are aliens. * Active duty: Original or notarized copy of the current orders showing the person is on full-time duty In the U.S. Army, Navy, Air Force, Marine Corps, or Coast Guard, or a DO form 2 military ID card (active duty papers). |
Eligible regardless of U.S. entry date |
|
Other (legal or illegal) |
Documents that indicate the person's alien status is one other than those specifically listed under Aliens Subject to Five-Year Bar (MS D-223] or under Aliens Exempt from Five-Year Bar (MS D-2241. |
Ineligible regardless of U.S. entry date |
The below chart lists the immigration status for lawfully present alien children under age 19 and pregnant women who are exempted from the five year bar waiting period:
|
Alien Status |
Acceptable Documentation of Alien Status |
Children under 19 and Pregnant Women |
|
Qualified alien |
* USDHS Form 1-551, Permanent Resident Card. * Any verification from the 1 m m igration a utho rities or other authoritative documents indicating Qualified Alien. |
Eligible and exempted from the 5 year bar. |
|
Valid Nonimmigrant Status |
* USDHS Form 1-94, Arrival/Departure record. * Any verification from tiie immigration autliorities or otiier authoritative documents indicating nonimmigrant Status. |
Eligible and exempted from the 5 year bar. (This status includes nonimmigrants from Micronesia, IVIarshall Islands, and Palau.) |
|
Paroled Into United States for less tlian 1 Vear |
* USDHS Form 1-94, Arrival/Departure Card with a stamp displaying a grant of parole under Section 212 (d)(5) of the INA. The 1-94 may be stamped "PIP" or "HP" * USDHS Form 1-765, Application for Employment Authorization, or receipt fi'om USCI5 indicating filing of application. * USDHS Form 1-766, Employment Authorization Document. * USDHS Form 1-512 Parole Authorization annotated with the reason parole was granted under section 8 CFR. |
Eligible and exempted from the 5 year bar. |
|
Temporary Resident Status |
* USDHS Form 1-687, Application for Status as a Temporary Resident. * Any verification from the immigration authorities or other authoritative documents indicating Temporary Status. |
Eligible and exempted from the 5 year bar. |
|
Temporarv Protected Status (TPS) |
* USDHS Form 1-765, Application for Employment Authorization, or receipt from USCiS indicating filing of application. * USDHS Form 1-766, Employment Authorization Document. * Any verification from the immigration authorities or other authoritative documents indicating Temporary Protected Status. |
Eligible and exempted from the 5 year bar. |
|
Emplovment Autliorization |
* USDHS Form 1-765, Application for Employment Authorization. * Any verification from the immigration authorities or other authoritative documents indicating Employment Authorization. |
Eligible and exempted from the 5 year bar. |
|
Family Unity Beneficiary |
* USDHS Form 1-797, Notice of Action showing approval of 1-817, Application for Family Unity. * USDHS Form 1-765, Application for Employment Authorization, or receipt from USCIS indicating filing of application. * USDHS Form I-76S, Employment Authorization Document. * Any verification from the immigration authorities or other authoritative documents indicating Family Unity status. |
Eligible and exempted from the 5 year bar. |
|
Deferred Enforced Departure (DED) |
* USDHS Form 1-765, Application for Employment Authorization, or receipt from USCIS Indicating filling of application. * USDHS Form 1-766, Employment Authorization Document. * Any verification from the immigration authorities or other authoritative documents indicating Deferred Enforced Departure status. |
Eligible and exempted from the 5 year bar. |
|
Deferred Action Status P |
* USDHS Form 1-797 indicating a notice of action for Deferred Action. * USDHS Form 1-765, Application for Employment Authorization or receipt from USCIS Indicating filing of application. * USDHS Form 1-766, Employment Authorization Document. * Any verification from the Immigration authorities or other authoritative documents indicating Deferred Action Status. |
Eligible and exempted from the 5 year bar except noncltlzens granted deferred action under the Deferred Action for Childhood Arrivals (DACA) process are not considered lawfully present and is not eligible for Medicaid. |
|
Administrative Stay of Removal |
* USDHS Form 1-246, Stay of Removal. * Any verification from the immigration authorities or other authoritative documents indicating Administrative Stay of Removal. |
Eligible and exempted from the 5 year bar. |
|
VISA with Adjustment of Status |
* USDHS Form 1-94, Arrival/Departure Record. * USDHS Form 1-485, Application to Register Permanent Residence or Adjust Status. * Any verification from the 1 m m Igration auth orltles or other authoritative documents indicating VISA with Adjustment of Status. |
Eligible and exempted from the 5 year bar. |
|
Asylum and for Withholding of Removal |
* USDHS Form 1-589, Application for Asylum and Withholding, filed. * USDHS Form 1-755, Application for Employment Authorization, filed. * USDHS Form 1-765, Employment Authorization Document |
Eligible and exempted from the 5 year bar. |
|
Withholding of Removal under the Convention Against Torture |
* USDHS Form 1-589, Application for Asylum and for Withholding of Removal. * Any verification from the immigration authorities or other authoritative documents Indicating Withholding of Removal under the Convention Against Torture. |
Eligible and exempted from the 5 year bar. |
|
Special immigrant Juvenile |
* USDHS Form 1-360, Petition for Amerasian, Widow(er), or Special Immigrant. * Any verification from the immigration authorities or other authoritative documents indicating Special Immigrant Juvenile. |
Eligible and exempted from the 5 year bar. |
|
victim of Severe trafficking |
USDHS Form 1-914, Application for T-Nontmmlgrant Status. * USDHS Form 1-918, Petition for U-Nonimmlgrant Status. Any verification from the Immigration authorities or other authoritative documents indicating Victim of Severe Trafficking. |
Eligible and exempted from the 5 year bar. J |
V. Social Security Number (SSN) Enumeration
SSNs that have mismatched through the electronic verification process will be submitted to the queue with a message that the SSN could not be verified.
To resolve the mismatch, first check for obvious mismatches, (e.g., errors in keying the SSN, sex, name or date of birth). Next check SOLQto determine if a correction can be made in the system from the SSA data on SOLQ.
Other methods of resolving a mismatch include:
* Viewing the social security card. The name in the system must match the name on the social security card; and
* Viewing a copy of the birth certificate or other proof of age or date of birth mismatch.
Household Cooperation in Clearing the Mismatch
When declared SSNs are returned by SSA as unverified, it is often necessary for the household to furnish the information necessary to resolve the mismatch.
A request for contact must be issued by the caseworker to advise the recipient of the mismatch, what caused the problem (e.g., name is incorrect) and what information must be provided to resolve the problem. The recipient will be given 10 days to furnish the information. If the household does not furnish the needed information by the end of the designated 10-day period an advance notice of adverse action will be issued.
The notice will specify that:
Medical Services - Appendix C, Verification of Citizensliip, Alien Status and SSN Enumeration
If the recipient claims that the information needed to clear the mismatch report cannot be furnished, the caseworker must substantiate the inability to provide the needed information. For example, a household may claim it cannot verify a name change because official records were destroyed in a fire. The case worker would attempt to verify the occurrence of the fire because SSA records cannot be corrected without the missing documentation. If the caseworker verifies that the recipient cannot provide the information needed to verify the SSN, the individual may continue to participate if otherwise eligible.
All actions taken to clear SSN mismatches must be fully documented in the system.
Monitoring
The DCO Supervisor, or designee in the absence of the supervisor, will be responsible for monitoring the mismatch notifications.
Medical Services Policy Manual, Section B
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B-250 Unborn Child (Pregnant Woman)
MS Manual 0?/??/l?7
This group consists of non-citizen pregnant women who do not meet the alienage requirements for Medicaid and whose household income is at or below 209% of the federal poverty level for the appropriate household size. This includes pregnant women who are either of the following:
* Lawfully admitted aliens who do not yet meet the 5 year residency requirements or one of the conditions listed in D-224;
* Undocumented aliens.
The purpose of this group is to provide pre-natal care to the unborn child who is expected to be born in the United States. As this coverage is intended to benefit unborn children who will be U.S. citizens at birth, the pregnant woman will not qualify for this coverage if she intends to leave the U.S. before the baby is born.
This group is also different from the other Pregnant Women groups in that it receives an enhanced federal match rate under the Children's Health Insurance Program (CHIP). The CHIP enhanced funding coverage is available only to pregnant women who have no other insurance that covers pregnancy related services.
The non-citizen pregnant woman will receive postpartum coverage. Postpartum coverage is through the end of the month in which the 60"' day from the date of delivery falls.
Medical Services Policy Manual, Section D
D-200 General Citizenship and Alien Status Requirements
MS Manual 01/01/14
Medicaid coverage will only be provided to those individuals verified to be citizens or nationals of the United States or an alien in satisfactory immigration status.
D-201 Declaration of Citizenship or Satisfactory Alien Status
MS Manual 01/30/15
The Immigration Reform and Control Act of 1986 (IRCA) requires that all Medicaid applicants and recipients must declare in writing under penalty of perjury that they are citizens or nationals of the United States, or that they are an alien in satisfactory immigration status.
For individuals declaring to be U.S. citizens or nationals, the declaration will be made at the time of application. If the application was made via an application form, then the application form itself will serve as the declaration of citizenship.
For applicants declaring to be aliens in satisfactory status, form DCO-9, Declaration of Citizenship or Satisfactory Immigration Status, must be completed regardless of the application form used. If the applicant is unable to sign, the authorized representative's declaration on the application form will be accepted as the declaration of citizenship.
In LTC cases where the recipient or legal guardian has completed an application form, no further action for this requirement is necessary. In instances where an authorized representative other than a legal guardian has signed the application, the applicant should sign the DCO-9, unless he or she is physically or mentally incompetent to do so. If the applicant is unable to sign, the authorized representative's declaration on the application form will be accepted as the declaration of citizenship.
Once an adult has provided the declaration of citizenship or satisfactory immigration status for himself, herself or others, a declaration will not be required again unless the individual loses eligibility. If the individual later applies, a new declaration of citizenship or satisfactory immigration status will be obtained.
D-210 Citizenship
MS Manual 10/01/17 48 U.S.C. 1806e
Consider any person born in the United States to be a citizen. People born abroad are considered U.S. citizens when at least one of the parents is a U.S. citizen. Also, consider a person who is a U.S. national the same as a U.S. citizen. A U.S. national is a person who is born in one of the U.S. territories. The U.S. territories include:
* Puerto Rico
* Guam
* The Virgin Islands
* The Northern Mariana Islands American Samoa
* The Swain Islands
People who are not citizens or nationals can become citizens through the process of naturalization.
T Note: Citizens of the Marshal Islands including Palau and Micronesia are under a
Compact of Free Association with the United States. They are free to travel to and from the U.S. without a visa. They are not U.S. citizens, nor are they under an alien status. Marshall Island pregnant women and children who are lawfully residing in the United States may be approved for Medicaid if they meet all other eligibility criteria for the category being applied for (MS D-2241. However, other Marshall Island individuals are not eligible for Medicaid except for Emergency Medicaid Services jMS B-500).
Citizenship must be verified for all Medicaid applicants declaring to be U.S. citizens or nationals. Refer to MS G-130 for verification requirement.
D-211 Citizenship of Children Born Outside of the U.S.
MS Manual 10/01/17
A child born abroad to at least one parent who is a U.S. citizen automatically becomes a U.S. citizen at birth if the parent{s) reports the birth to an American Consular Office and registers for a Consular Report of Birth (FS-240). An original FS-240 is furnished to the parent(s) at the time the registration is approved.
The Child Citizenship Act of 2000 allows the automatic acquisition of U.S. citizenship for both biological and adopted children of U.S. citizens who are born abroad and who do not acquire U.S. citizenship at birth. Under this act, a child born outside of the United States automatically becomes a citizen when the following conditions are met:
* The child is under the age of 18.
* The child is residing in the U.S. in the legal and physical custody of the U.S. citizen parent after having been lawfully admitted into this country as an immigrant for lawful permanent residence.
* If the child has been adopted, the adoption must be final.
If a child's citizenship is questionable, the following documents can be used if needed to verify that the child has acquired U.S. citizenship:
* Certificate of Citizenship (N-560 or N-561).
* Certificate of Naturalization (N-550 or N-570).
If proof of citizenship is needed but documentation is not available, refer the person to the United States Department of Homeland Security (USDHS) for a determination of U.S. citizenship.
D-220 Alien Status
MS Manual 10/01/17 431 of PRWORA
This section contains policy relating to eligibility requirements for individuals who are aliens or immigrants. The immigration status of aliens who appear to be eligible for Medicaid must be verified. If the applicant claims alien status, he or she must provide documentation from the USDHS verifying their status. The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), P. L 104-193, enacted August 22,1996, changed Medicaid eligibility for individuals who are not citizens of the United States. This act divides immigrants into two basic categories:
* "Qualified Aliens" - those legally living in the United States and meeting one of the conditions at MS D-223 or MS D-224.
* "Nonqualified Aliens" - those living in the United States without meeting legal conditions or those admitted legally but not meeting one of the conditions at MS D-223 or MS D-224.
Medicaid eligibility for aliens is determined by whether the alien is qualified or nonqualified and whether the individual meets the other eligibility requirements for Medicaid. In addition to alien status, the individual must meet all eligibility factors for the category for which he/she is applying. Applicants must provide documentation of qualified alien status for each person for whom Medicaid is being requested. Refer to MS G-140 for alien verification requirements. If an alien has a sponsor, the sponsor's income and resources may be deemed available to the alien when determining eligibility (MS E-3001.
Qualified aliens who entered the United States before August 22,1996 are generally eligible for Medicaid, provided they meet other eligibility criteria.
Qualified aliens who entered the United States on or after August 22,1996, are barred from participation in Medicaid (with the exception of emergency services) for five years from the date of entry. After these individuals have been in the U.S. for five years, their sponsors' income may then be deemed available to them for determining income eligibility for Medicaid with some exceptions. Refer to MS E-300 and MS E-445. Certain groups of qualified aliens are exempt from this five-year bar. Refer to MS D-223 -MSD-224 for conditions of exemption.
Nonqualified aliens who meet the other Medicaid eligibility requirements are eligible for emergency Medicaid services only. Refer to MS B-500. A nonqualified (undocumented) alien woman who is pregnant may be eligible for Pregnant Woman Unborn Child (MS B-250).
D-221 Alien Categories
MS IVIanual 10/01/17
Any person who is not a citizen or national of the United States is termed an alien. Definitions for some of the different types of aliens are found below:
* Non-immigrant - an alien who seeks temporary entry to the U.S. for a specific purpose.
* Asylee - an alien living in the U.S. who is unable or unwilling to return to his/her country of origin, or the last place they lived, or unwilling or unable to seek protection of that country because of persecution or a well-founded fear of persecution. Persecution or the fear of persecution may be based on the alien's race, religion, nationality, social status, or political opinion.
* Refugee - an alien living outside his/her country of nationality who is admitted into the U.S. because the individual is unable or unwilling to return to that country (or to the place they last lived) because of fear of persecution. Fear of persecution may be based on the individual's race, religion, nationality, social status or political opinion.
Qualified Alien - an alien lawfully admitted and lawfully accorded the privilege of residing permanently in the United States. Qualified aliens are ineligible for medical benefits, except emergency medical assistance, for five years from the date of entry to the U.S., unless they are exempt from the five-year bar. Alien groups exempt from the five-year bar are discussed at MS D-224.
* Non-qualified Alien - an alien who is living in the U.S. as an illegal alien or a legal alien who does not meet one of the conditions at MS D-223 or MS D-224. Conditions of eltgibllity for emergency medical services for non-qualified aliens are discussed at MS B-500. For additional information regarding Non-Qualified Aliens see (MS D-2301.
D-222 Public Charge
MS Manual 10/01/17
"Public Charge" has been a part of U.S. immigration law for more than 100 years as grounds for inadmissibility and deportation. Identification by the United States Department of Homeland Security (USDHS) as a public charge can be grounds for denying admission into the United States, for denying an application for permanent resident status, and in rare cases for deportation.
In 1999, the Justice Department issued regulations to clarify that receipt of most forms of Medicaid would not result in a public charge finding. To be considered a public charge by the USDHS, an alien must:
* Have become or be ltl[LESS THAN]ely to become primarily dependent on the government for survival through receipt of public cash assistance, or
* Be institutionalized at government expense in a long-term care facility.
Institutionalization in a long-term care facility includes residing in a nursing home or mental health institution. Short-term institutionalization for rehabilitation is not considered as public charge.
The receipt of cash assistance or being Institutionalized for long-term care does not automatically cause the Individual to be considered a public charge. The USDHS also considers a number of other factors, such as the Individual's age, health, financial status, education, and skills. Each determination is made on a case by case basis.
D-223 Aliens Subject to Five-Year Bar
MS Manual 10/01/17 431 of PRWORA
Individuals shown below, who entered the U.S. on or after August 22,1996, are barred from receiving Medicaid except emergency services for five years. The five-year period begins on the date the individual entered the U.S. with one of the following statuses:
* Aliens lawfully admitted for permanent residency.
* Aliens paroled into the U.S as Central American Minors for a period of at least two years.
+ Aliens paroled into the U.S. under section 212(d)(5) of the Immigration and Nationality Act (INA) for a period of at least one year.
* Aliens granted conditional entry under section 230(a)(7) of the INA as in effect before April 1,1980.
* Battered aliens under 8 USC 1641(c). For the alien and children to emigrate or remain in the United States, the alien's spouse must file a petition for lawful permanent residence status via USDHS Form 1-130, Petition for Alien Relative. Unless the spouse files this petition, the alien and children have no lawful immigrant status and face being deported. Since the 1994 enactment of the Violence Against Women Act, a battered alien may self-petition for lawful permanent residency via USDHS Form 1-360, Petition for Amerasian, Widow(er) or Special Immigrant, without the cooperation or knowledge of the abuser.
The battered alien may be eligible for Medicaid if he/she entered the U.S. before August 22,1996. If the date of entry is on or after August 22,1996, the battered alien, spouse or child is subject to the five-year bar, except for emergency medical treatment.
r NOTE: Pregnant Women and children who are legally residing in the United States, may be eligible without meeting the five year bar if they meet one of the conditions listed at MS D-224.
Due to the abusive relationship, battered aliens may not have access to the needed USDHS documents. Applicants without documentation should be referred to the USDHS Forms Request Line, 1-800-870-3676.
D-224 Aliens Exempt from Five-Year Bar
MS Manual 10/01/17 431 of PRWORA
Aliens with the following statuses are potentially eligible for Medicaid from the date the status is obtained:
* Refugees admitted under section 207 of the Immigration and Nationality Act (INA).
* Iraqi and Afghan Special Immigrants admitted as lawfully permanent residents but treated as refugees.
* Aliens granted asylum under section 208 of the INA.
* Aliens whose deportation or removal is withheld under section 243(h] or section 241(b) (3) of the INA.
* Cuban or Haitian entrants under section 501(e) of the Refugee Education Assistance Act of 1980.
* Cuban or Haitian entrants in the Haitian Family Reunification Program.
* Amerasian immigrants.
* Canadian born American Indians who have treaty rights to cross the U.S. borders with Canada and Mexico.
* Aliens lawfully living in the United States on 8/22/96 who were receiving AABD Medicaid at that time may continue to receive Medicaid benefits. This applies only to AABD categories.
* Aliens lawfully living in the United States on 8/22/96 who subsequently become blind or disabled may receive Medicaid benefits in the future.
* Aliens lawfully admitted for permanent residence who are veterans honorably discharged for reasons other than alienage, and their spouses, surviving un-remarried spouses, and unmarried dependent children. This includes alien spouses, surviving unremarried spouses, and unmarried dependent children of veterans who are U.S. citizens or deceased veterans.
* Aliens lawfully admitted for permanent residence who are active-duty personnel of the United States Armed Forces and their spouses, surviving un-remarried spouses, and unmarried dependent children. This includes alien spouses, surviving un-remarried spouses, and unmarried dependent children of active duty personnel who are U.S. citizens or deceased active duty personnel. Active duty excludes temporary full-time duty for training purposes performed by members of the National Guard or Reserves.
* Pregnant Women and Children who are lawfully present. This includes but is not limited to pregnant women and children in the following statuses:
* Granted temporary resident status in accordance with 8 U.S.C. 1160 or 1255a, respectively;
* Granted Temporary Protected Status (TPS) in accordance with 8 U.S.C. 1254a, and individuals with pending application for TPS who have been granted employment authorization;
* Granted employment authorization under 8 CFR 274a . 12c;
* Family Unity beneficiaries in accordance with section 301 of Pub. L. 101-649, as amended;
* Under Deferred Enforced Departure (DED) In accordance with a decision made by the President;
* Granted Deferred Action status;
* Granted an administrative stay of removal under 8 C.F.R. 241 ;
* Beneficiary of approved visa petition who has a pending application for adjustment of status;
* Has been granted employment authorization; or
* Is under the age of 14 and has had an application pending for at least 180 days;
EXCEPTION: An alien with deferred action under the USDHS's deferred action for childhood arrivals process, as described in the Secretary of Homeland Security's June 15,2012 memorandum, shall not be considered lawfully present with respect to any of the above categories.
*f NOTE: Documentation that is required to verify lawfully residing status is found at Appendix C,
D-226 Victims of Trafficlting
MS Manual 01/01/14
Public Law 104-193 states that aliens who are certified as victims of trafficking by the Department of Health and Human Services (HHS) Office of Refugee Resettlement (ORR) are eligible aliens for Medicaid purposes. Eligibility for victims of trafficking is determined in the same manner as Medicaid for refugees.
Trafficking is defined as all acts involved in the movement of human beings, usually women and children, from one country to another or within national borders for sexual exploitation or forced labor.
Adults who are certified as victims of trafficking receive an ORR certification letter. Children who are victims of trafficking receive an eligibility letter or an interim assistance letter. An interim assistance letter is given to a child who may have been subjected to trafficking to allow the child to be eligible to receive benefits and services for a 90-day period. Certification letters no longer contain an expiration date. A victim of trafficking is eligible to apply for Medicaid starting with the date of certification by ORR. If eligible, Medicaid coverage will be valid for one eight month period. If Medicaid coverage is needed beyond the initial eight months, the initial certification letter will be used to establish continued eligibility.
Follow the usual procedures for determining eligibility for refugees except:
* Accept the original ORR certification letter for adults or the eligibility or interim assistance letter for children under 18 in place of INS documentation.
* Contact the trafficking verification line at 202-401-5510 to confirm the validity of certification letters for adults and 202-205-4582 to confirm the validity of eligibility or interim assistance letters for children and to notify ORR of the assistance for which the individual has applied.
T Note; Do not contact SAVE concerning victims of trafficking.
If the worker suspects that an applicant may be a victim of trafficking but does not have the required certification or eligibility letter, the worker will contact ORR at the above telephone numbers for verification of a certified letter.
D-230 Non-Citizens Eligible for Emergency Services
MS Manual ??/??/17 435.956(c)(2}
The USDHS issues non-immigrant visas to people who indicate that they are seeking entry for a temporary purpose. These non-immigrants are eligible for emergency services if they meet all other requirements including State residency. The following groups of people may be eligible in this category:
* Foreign government representatives on official business and their families and servants.
* Visitors for business or pleasure, including exchange visitors.
* Aliens traveling through the U.S.
* Crew members on shore leave.
* Treaty traders and investors and their families,
* Foreign students and their families who are here as dependents and are not otherwise eligible.
* International organization representatives and personnel and their families and servants.
* Temporary workers including agricultural contract workers.
* Members of foreign press, radio, film or other information media and their families.
T NOTE: This is not an all-inclusive list.
Medical Services Policy Manual, Section E
E-300 Sponsor Affidavits of Support and Deeming
MS Manual ?/?/17 PRWORA of 1996
Alien sponsor deeming established by the PRWORA, as amended by the Illegal Immigration Reform and Immigrant Responsibility Act of 1996 (IIRIRA), P. L. 104-208, and the Balanced Budget Act of 1997 (BBA), P. L. 105-33 will apply to all Medicaid categories.
Alien sponsor deeming will be applied to those aliens who are Lawfully Admitted Permanent Residents (LAPRs) that have been in the United States for five years. Refer to MS E-445 for exceptions to deeming for an alien's sponsor.
Aliens who seek admission to the U.S. as LAPRs must establish that they will not become a public charge (Re. MS D-222). Many aliens enter the country by having a sponsor who pledges to support them to establish that they will not become a public charge.
A sponsor is a person who signs an Affidavit of Support agreeing to support an alien as a condition of the alien's admission for permanent residence in the U.S. An alien may have more than one sponsor. There are two versions of the Affidavit of Support:
* Affidavit of Support, form 1-134 (Now unenforceable.)
* Affidavit of Support, form 1-864 (Effective December 19,1997.)
The process of counting the sponsor's income and resources for the sponsored alien is called deeming. Deeming will not apply when the sponsor is:
* An organization such as a church or service club,
* An employer who does not sign an Affidavit of Support, or
* The alien's eligible or ineligible spouse or parent whose income is otherwise considered in determining the alien's Medicaid eligibility.
A sponsored alien and the alien's spouse, if there is one, are responsible for providing information and documentation about the alien's sponsor and the sponsor's spouse. If the alien appears to be eligible for benefits but does not have the Affidavit of Support or does not know if there is a sponsor, instruct the alien to contact the United States Department of Homeland Security (USDHS) to obtain a copy of the Affidavit of Support. If the applicant requires assistance, the caseworker may request information from the USDHS by submitting Forms G-845 and G-845 Supplement.
Tlie USDHS will certify whether an alien has a sponsor and if so, what kind of affidavit the sponsor signed. Do not deem income or resources from a sponsor that has signed the old version, 1-134, Affidavit of Support, or 1-361, Affidavit of Financial Support and Intent to Petition for Legal Custody, as these affidavits are not considered enforceable.
Deeming instructions are shown below for individuals applying for Medicaid having an 1-864, Affidavit of Support:
* Count all income of the sponsor and sponsor's spouse living in the same household as if they were income and resources of the alien.
* Do not allow deductions from the sponsor's income or resources.
* Count the sponsor's income as the alien's unearned income and use it to determine the alien's eligibility.
* Do not count the sponsor's income when determining eligibility for the alien's eligible children.
* Do not include the sponsor in the alien's household size. Deeming continues until one of the following conditions is met:
* The sponsored immigrant becomes a U.S. citizen.
* The sponsored immigrant leaves the U.S. permanently. The sponsored immigrant or the sponsor dies.
E-44S Exceptions to Deeming for Alien's Sponsor
MS Manual V/lUVJ
Deeming from the alien's sponsor can be suspended for some aliens. The following aliens are not subject to deeming:
* Aliens who do not have sponsors.
* Aliens who have been battered or subject to extreme cruelty in the United States, and their children or parents who have been battered or subject to extreme cruelty. The abuse may be perpetrated by a U.S. citizen or lawful permanent residence spouse, parent, or their family members living in the same household in the U.S. This exception applies for 12 months from the date of determination that the alien has been battered. (Re. MS D-2231
* Aliens who are indigent. An alien with a sponsor who signed form 1-864, Affidavit of Support and the alien is unable to obtain food and shelter. If the alien lives with the sponsor, it will be assumed that the sponsor is providing food and shelter and the indigence exception will not be granted, and deeming will apply. If the alien is living apart from the sponsor, consider the alien unable to obtain food and shelter if:
* The income the alien receives is less than the income limit for the category of Medicaid for which the individual would be eligible.
* The resources available to the alien are under the resource limit for the Medicaid category for which the alien would be eligible.
* Aliens who can attain citizenship.
* Aliens qualifying for Emergency Medicaid services only. (Re. MS B-5001
* Pregnant women and children who meet one of the conditions In D-224.
