Update : Medi-Cal New Requirements for Verification of Citizenship & Identity

Transcription

1 Santa Clara County Social Services Agency page 1 Date: 11/19/07 References: ACWDL #07-12 Cross-References: Users Guide Update #07-13 BEnDs Update #07-21 Clerical: Handbook Revision: Yes Yes Update : Medi-Cal New Requirements for Verification of Citizenship & Identity Background The federal Deficit Reduction Act (DRA) of 2005, included new requirements for providing proof of United States (U.S.) citizenship or U.S. national status and proof of identity as a condition of eligibility for federal Medi-Cal funding. Prior to enactment of the DRA, proof of U.S. citizenship or U.S. national status was not required unless an applicant for full-scope Medi-Cal declared a birthplace outside the U.S., or if evidence suggested an applicant falsely claimed to be a U.S. Citizen or National. Assembly Bill 1807 (Chapter 74, Statutes of 2006) amended Welfare and Institutions Code Section to provide authority for California to implement the documentation requirements for citizenship/identity. Changes Effective December 10, 2007 verification of citizenship status and identity must be obtained for: All nonexempt U.S. citizen/u.s. national applicants prior to granting full scope Medi-Cal benefits, and All nonexempt U.S. citizen/u.s. national beneficiaries at the time of their next annual redetermination. The new requirements do NOT apply to non-citizens, including undocumented immigrants. For purposes of this Update, further references to citizens will include U.S. nationals and naturalized U.S. citizens. [Refer to Citizens Areas Outside the United States, page 41-26]

2 page 2 Children born in the U.S. to foreign sovereigns or diplomatic officers are not considered U.S. citizens. Verification of citizenship and identity is a one-time only activity for a Medi-Cal applicant or beneficiary. Once received, verification does not need to be requested again, even if the client moves to another county, has a break in aid, or can show that he or she has already documented citizenship in another state s Medicaid program. Exempt Individuals U.S. citizen applicants or beneficiaries currently in one of the following groups are exempt from citizenship and identity verification requirements: Current Supplemental Security Income (SSI) beneficiaries Social Security Disability Insurance (SSDI Title II) beneficiaries Social Security Retirement and Survivors Insurance (RSI Title II) beneficiaries who receive those benefits based on their own disability Medicare beneficiaries U.S. born Deemed Eligible (DE) infants (includes children born to non-citizen mothers and whose delivery was covered by Medi-Cal) Minor Consent applicants and beneficiaries Children receiving adoption or foster care assistance, including Kinship Guardianship Assistance Payment (Kin-GAP) recipients Former Foster Care Children in Aid Code 4M Infants eligible under the Abandoned Baby Program who are born in the U.S. and have no documentation. Individuals are exempt from the requirement to provide proof of citizenship and identity only if they are currently in one of the exempt status categories above, except for Deemed Eligible infants and infants eligible under the Abandoned Baby Program. [Refer to Exempt Individuals, page 41-31] Presumptive Eligibility Programs Individuals in the following Presumptive Eligibility (PE) programs are also exempt from the citizenship/identity requirements when PE is established: Presumptive Eligibility for Pregnant Women Presumptive Medi-Cal Eligibility under the Breast and Cervical Cancer Treatment Program Child Health and Disability Prevention (CHDP) Gateway program Medi-Cal Accelerated Enrollment program at the Single Point of Entry Healthy Families to Medi-Cal Bridging Program, and National School Lunch Program. [Refer to Presumptive Eligibility, page 41-5]

3 page 3 Citizenship and identity must be verified during the application process in order to grant full scope benefits, unless the client meets one of the exempt categories above. Electronic Birth Record Match The Department of Health Care Services (DHCS) has implemented a process to complete an automated birth record match with California Vital Records data for applicants and beneficiaries born in California. Information from MEDS, SCI and CalWIN is used to obtain a record of citizenship. [Refer to Electronic Birth Record Match, page 41-33] Acceptable Documents Acceptable documents for verification of citizenship and identity are grouped as follows: (See Attachment 1 of this Update for a complete list) Tier one evidence is the most reliable and establishes both citizenship and identity, such as a U.S. Passport or Certificate of Naturalization. Tiers two through four include successively less reliable groups of documents verifying citizenship. Verification of identity must also be provided when a document from one of these categories is provided. Tier five lists documents acceptable as proof of identity when a document from Tier 1 is not available. If a client originally provided a less reliable document and later provides a document of higher reliability, the case information must be updated. Expired documents are acceptable proof of citizenship/identity. [Refer to Acceptable Citizenship/Identity Documents, page 41-33] Children Under 16 For children under 16, a parent, guardian or caretaker relative signature, signed under penalty of perjury on the application is acceptable verification of identity for the child. Once the child turns 16, no further verification of identity is required. This affidavit of identity is permanently valid. An affidavit for identity cannot be used if an affidavit for citizenship was provided. Children born in California should meet the citizenship requirement based on a successful birth record match and a signature on the application form. [Refer to Children Under 16, page -3]

4 page 4 Original Documents All documents provided as verification of citizenship and identity must either be originals or copies certified by the issuing agency. Uncertified copies or notarized copies do not meet the new requirements. Clients may provide original documents in person, by mail or by an authorized representative. It is best to encourage clients to bring in original documents in person whenever possible. If the client does not wish to make an appointment, original documents may be provided by mail if the client chooses to do so. [Refer to Original Documents, page 41-34] Document Certification Form The Proof of Citizenship or Identity Received (DHCS 0005) must be completed and signed to validate the receipt of each original document or certified copy provided by an individual. A copy of the DHCS 0005 must be given to the client as a receipt that an original document was provided. Certified Application Assisters (CAAs) employed by Santa Clara Valley Health and Hospital Systems (HHS) are qualified to view and certify original documents and complete the DHS A DHCS 0005 signed by a CAA from VMC is valid and acceptable proof an original document was viewed. [Refer to Document Certification Form, page 41-36] Receipt of Original Documents Extreme care must be used when handling original documents. When the client brings in or mails in an original document, staff must: Immediately make a copy and date stamp the COPY Complete/sign Proof of Citizenship or Identity Received (DHCS 0005) Return the original to the client along with the DHCS 0005 if in person Return the original to the client via CERTIFIED MAIL with a return receipt along with the DHCS 0005 if the document was mailed. The copies of the document and the DHCS 0005 are given to the EW and must be scanned into IDM. [Refer to Receipt of Original Documents, page 41-37] CZ/ID Documents On File Any document in Tiers 1 through 5 that meets the citizenship and identity requirements already on file in the case record or IDM is considered acceptable and must not be re-verified. The DHCS 0005 does not need to be completed. Reasonable Opportunity Period All applicants and beneficiaries must be given a reasonable opportunity period to provide acceptable verification of citizenship/identity. This period is defined as the time needed to obtain required documents based on the

5 page 5 individual s circumstances and ability to obtain that verification and the client s good faith efforts. Once provided, full scope benefits are granted from the date of application and any eligible retroactive months requested. [Refer to Reasonable Opportunity Period, page 41-37] Applicants The following rules apply to applicants declaring U.S. citizenship: New applicants who meet all other eligibility criteria are not eligible for full scope Medi-Cal benefits until acceptable CZ/ID documents are provided. This time frame is determined on a case-by-case basis, depending on how much time the client needs. Follow up is necessary to ensure that documents are provided. Applicants who fail to provide verification of citizenship and identity after the reasonable opportunity period ends, are granted restricted benefits (Medi-Cal emergency and pregnancy-related services, and state-only long term care benefits). [Refer to Applicants, page 41-38] Beneficiaries The following rules apply to beneficiaries at the annual redetermination: Current beneficiaries who meet all other eligibility criteria remain eligible for full-scope benefits as long as they are making a good faith effort to provide verification of citizenship/identity. Beneficiaries who have not provided verification of citizenship/identity are reduced to restricted benefits only at the point when the client states he/she is no longer making a good faith effort and the reasonable opportunity period ends. [Refer to Beneficiaries, page 41-38] Documents Received After Restricted Benefits are Granted For applicants or beneficiaries who are granted restricted Medi-Cal for failure to provide verification of citizenship/identity, full scope eligibility may be restored back to the month restricted benefits began if they provide the necessary verifications within one year of the date of application or redetermination and any applicable retroactive months if good cause exists. If documents are provided more than one year after the application or redetermination, or if good cause does not exist, full scope eligibility is established effective the first of the month in which the documents are received. [Refer to Documents Received After Restricted Benefits are Granted, page 41-39]

6 page 6 Adding a Person When adding a person to an existing Medi-Cal case/mfbu, he/she is considered a new applicant and must meet CZ/ID requirements prior to receiving full scope benefits. When adding a person who is already eligible for Medi-Cal, that person is considered a beneficiary and receives ongoing Medi-Cal during their reasonable opportunity period, if all other eligibility factors are met. [Refer to Adding a Person to an Existing Case, page 41-39] Good Faith Effort Examples of good faith effort include, but are not limited to providing: A copy of a document request sent to the appropriate agency such as a photocopy of a letter, copy of an or receipt for the requested document. Copies of acceptable documents along with verification that an original or certified copy has been ordered. A written or verbal statement of effort to obtain verification of citizenship. [ Affidavit of Reasonable Effort to Get Proof of Citizenship (DHCS 0003)] A copy of a check receipt or other proof indicating a citizenship or identity document has been ordered. A written or verbal update of progress made in obtaining verification of citizenship or identity. A written or verbal explanation of attempts to locate two persons who could attest to the applicant s/beneficiary s citizenship. Staff must thoroughly explain good faith effort to applicants and beneficiaries to ensure clients understand they may have additional time to provide documents. [Refer to Good Faith Effort, page 41-39] Immediate Need An applicant with an urgent medical need may elect not to make a good faith effort to provide the required documents for citizenship/identity in order to receive restricted benefits. Additionally, if a pregnant woman states she cannot make a good faith effort to provide the required documents, she can be issued restricted scope benefits for pregnancy related services. EWs must thoroughly explain this policy in order for the client to make an informed decision. [Refer to Immediate Need, page 41-40]

7 page 7 Providing Client Assistance EWs must assist applicants and beneficiaries in obtaining verification of citizenship/identity whenever necessary. This includes situations when a client is incapable of taking the steps necessary to obtain the required documents due to incapacity or disability, or the client is unable to provide acceptable documents for whatever reason. [Refer to Providing Client Assistance, page 41-41] Requesting Client Birth Certificates When a Medi-Cal applicant or beneficiary is unable to provide one of the acceptable documents and was born outside of California, or was born in California but an electronic birth record match was not successful, EWs are to request a certified copy of the client s birth certificate from the applicable agency via completion of the Clerical Check Sheet (SC 109). Requesting Identity Documents When a Medi-Cal applicant or beneficiary is unable to provide an acceptable identity document, EWs are to complete and issue the Verification for Reduced Fee Identification Card (DL 937) to the client to request a reduced cost California Identification (ID) card from the Department of Motor Vehicles. The DL 937 is available for staff use on the SSA Intranet. Allow the client 10 days to provide the ID. Implementation The new citizenship/identity requirements are effective December 10, Processing Intake Applications The following outlines procedures when clients have not already provided acceptable citizenship/identity documents: Face-to-Face Interview For non-exempt applicants who apply in person, follow the steps below: STEP Who ACTION 1. CST Prints the MEDS INQE screen for each person with the other necessary MEDS screens during the File Clearance Process. 2. Intake EW Prior to Face-to-Face Intake interview: Reviews SC 41 to determine HH members with CZ status Searches IDM and prior case files for CZ/ID verification Reviews for CZ/ID exemptions Reviews INQE for CZ/ID coding. NOTE: If MEDS shows client was active in another county and there is no data on INQE, contact the other county to request CZ/ID documents.

8 page 8 STEP Who ACTION 3. Intake EW Collects original CZ/ID Documents at Face-to-Face interview. IF Verification is... THEN... Provided Follows Report CZ/ID Data CalWIN process to record receipt of documents to MEDS. Completes DHCS 0005 to certify receipt of original documents. NOT Provided Completes Request for CA Birth Record (DHCS 0004) with client to request MEDS Birth Record Match if client was born in CA. Follows Request Birth Record Match CalWIN process to submit a request for CA birth record. If client was NOT born in CA or data match is not successful, explains acceptable verification documents per Tiers 1-5. Completes Proof of Citizenship or Identity Needed (DHCS 0006) and gives to client with a 10-day due date. If the client claims to have an acceptable document, allow an additional 10 days if verifications are not provided within the original 10-day due date. If verifications are still not provided or client is unable to obtain documents, completes the SC 109 to request the Birth Certificate and/or the DL 937 to request the CA ID. Ensures all contacts are documented in the Maintain Case Comments window. Approves/denies application and completes all required CalWIN entries. NOTE: Some individuals may have a Pass result and others may be Pending depending on which individuals the EW received verifications for. Enters Special Indicator Pending CZ/ID Verifications in Display Individual Demographics Detail window for each person with pending verification. NOTE: At this point, cases pending citizenship or identity verification may be transferred to Continuing. Cases cannot be transferred out of Intake without either a Birth Record Match, acceptable citizenship/identity documents or an SC 109/DL 937 on file.the SC 109 and the DL 937 must be scanned into IDM. 4. EW Sup Transfers case to internal control # if individuals are pending. 5. Clerical For cases going to MCSC, transfers case to Caseload #A7M1.

9 page 9 Mail-In Applications For non-exempt applicants using the mail-in process, follow the steps below: STEP WHO ACTION 1. CST Completes SAWS 1/SC 41 Process Gives or mails the client a complete Intake Packet with SC 1481 and DHCS 0001 Informs client of Mail-In option or scheduling an appointment. Completes File Clearance Process Prints MEDS INQE screen along with other necessary screens for each person. Completes Application Registration Process 2. Applicant Chooses to mail in Application Receives Intake Packet with 10-day due date Returns Statement of Facts form with required verifications. 3. Intake EW Reviews Statement of Facts to determine which applicants are citizens Searches IDM/case record for CZ/ID verification Reviews for CZ/ID exemptions Reviews INQE for CZ/ID coding. NOTE: If MEDS shows client was active in another county, and there is no data on INQE, contact the other county to request CZ/ID documents. Processes Mail-In Application IF Verification is... THEN... Provided Follows Report CZ/ID Data CalWIN process to record receipt of documents to MEDS Completes DHCS 0005 to certify receipt of original documents.

10 page 10 STEP WHO ACTION NOT Provided If client was born in CA, contacts client to complete Request for CA Birth Record (DHCS 0004). Follows Request Birth Record Match CalWIN process to initiate a data match If client was not born in CA or if data match is not successful, explains acceptable verification documents per Tiers 1-5. If client claims to have an acceptable document, completes Proof of Citizenship or Identity Needed (DHCS 0006) and mails to client with a 10-day due date. If verification is still not provided or client is unable to obtain documents, completes the SC 109 and/or DL 937 IMPORTANT: The SC 109 and the DL 937 must be scanned into IDM in (Permanent Verification). Ensures all client contacts are documented in Case Comments Approves/denies application and completes all required CalWIN entries. NOTE: Some individuals may have a Pass result and others may remain Pending depending on which individuals the EW received verifications for. Enters Special Indicator Pending CZ/ID Verifications in the Display Individual Demographics Detail window If verifications are pending. NOTE: At this point, cases pending citizenship or identity verification may be transferred to Continuing. Cases cannot be transferred out of Intake without either a Birth Record Match, acceptable citizenship/identity documents or an SC 109/DL 937 on file. 4. EW Sup Transfers case to internal control number if individuals are pending. 5. Clerical For cases going MCSC, transfers to Caseload # A7M1. Single Point of Entry Applications Individuals active on a PE program, including Presumptive Eligibility for Pregnant Women, Accelerated Enrollment, CHDP Gateway, and Healthy Families to Medi-Cal Bridging must provide citizenship and identity documents during the application process to continue full-scope Medi-Cal. Copies are acceptable if original documents were viewed and certified by an authorized CAA. Follow steps 1-5 above for processing Mail-In applications.

11 page 11 Annual Redeterminations The following outlines procedures when clients have not provided citizenship/identity documents or no Birth Record Match is returned: Face-to-Face Annual RD (Non MCSC) CalWORKs, Food Stamps, Medi-Cal: STEP Who ACTION 1. EW Prior to Face-to-Face interview: Searches IDM and prior case files for CZ/ID verification already on file Reviews for CZ/ID exemptions Reviews INQE for CZ/ID coding. NOTE: If verification is not found and MEDS shows client was previously active in another county, contact other county to request CZ/ID documents. Reviews and updates CalWIN Redetermination Appointment Letter (CSC 35) indicating which case member(s) need CZ/ID documents. Mails RD packet with DHCS 0002 included. At RD Interview IF Verification is... THEN... Provided Follows Report CZ/ID Data CalWIN process to record receipt of documents to MEDS. Completes DHCS 0005 to certify receipt of original documents. NOT Provided If client was born in CA, completes DHCS 0004 with client to request a data match Follows Request Birth Record Match CalWIN process to initiate a data match Explains acceptable documents in Tiers 1-5 Provides Fact Sheet with contact #s Schedules a return appointment to bring in CZ/ID verification Enters Special Indicator Pending CZ/ID Verifications in the Display Individual Demographics Detail window. If the client does not keep the scheduled appointment and the data match is not successful, contact the client by phone to request documents and/or send the DHCS 0006 with a 10-day due date. IF Verification is... THEN Provided Follows Report CZ/ID Data CalWIN process to report receipt of documents to MEDS. Completes DHCS 0005 to certify original documents. NOT Provided Completes SC 109 and/or DL 937 process if client is unable to provide documents Follows up to ensure BC or ID is received. IMPORTANT: The SC 109 and/or DL 975 must be scanned into IDM (F-1 Permanent Verification).

12 page 12 Mail In RDs (Non-MCSC If the client does not keep their scheduled appointment for the CalWORKs/Food Stamps annual face-to-face interview, the EW must mail a Medi-Cal RD packet to the client. If any original documents are received by mail, staff must follow the process Receipt of Original Documents above. Adding a Person The process below applies when adding a person to a case in District Office: NOTE: Deemed Eligible newborns are excluded from CZ/ID requirements. STEP WHO ACTION 1. Client Calls the EW to add a person 2. EW Searches IDM/prior case files for CZ/ID verification already on file Reviews for CZ/ID exemptions Reviews INQE for CZ/ID coding. NOTE: If verification is not found and MEDS shows client was previously active in another county, contact the county to request CZ/ID documents. If both CZ/ID verification on file, follows standard process to add a person Follows Report CZ/ID Data CalWIN process to record receipt of documents to MEDS NOTE: For CalWORKs, determine if a face-to-face interview is required. If client was born in CA, completes DHCS 0004 with client Follows Request Birth Record Match CalWIN process to initiate data match If data match is not successful, schedules appointment for client to bring in CZ/ID verification. Explains acceptable documents in Tiers 1-5 Provides Fact Sheet with contact #s Enters Special Indicator Pending CZ/ID verifications in the Display Individual Demographics Detail window. Completes DHCS 0005 if client provides original documents. Follows standard process to add a person when verifications are received. Client Drops in With Original Documents The process below applies at Intake and Continuing when clients drop off original documents at a District Office: STEP WHO ACTION 1. Clerical Follows standard District Office procedures to notify EW. 2. EW or CST Completes the DHCS 0005 to certify the documents are original. 3. EW Follows the Report CZ/ID Data CalWIN process to record receipt of documents to MEDS.

13 page 13 Annual Redetermination (MCSC) The procedure below applies to processing an annual RD at MCSC: STEP WHO ACTION 1. EW Receives RD packet assignment to process IF Verification is... THEN... Provided Completes/updates RD if all eligibility factors met Follows Report CZ/ID Received CalWIN process to record receipt of documents to MEDS. Not Provided Searches IDM/prior case files to determine if CZ/ID verification is already on file Reviews for CZ/ID exemptions Reviews INQE for CZ/ID coding Completes/updates RD if all eligibility factors met. 2. EW Changes Caseload # to A7M1. NOTE: If verification is not found and MEDS shows client was previously active in another county, contact the county to request CZ/ID documents. Follows Report CZ/ID Data CalWIN process to record receipt of documents in MEDS, OR If client was born in CA, completes DHCS 0004 with client by phone or by mail Follows Request Birth Record Match CalWIN process to request a birth record match Contacts client and explains acceptable documents in Tiers 1-4 if no match is returned. Schedules an appointment with Outstationed EW to bring in verifications if client can provide one of the acceptable documents Enters Special Indicator Pending CZ/ID verifications in the Display Individual Demographics Detail window. NOTE: Refer to Scenario 10 of BEnDS Client at Outstationed Office The following process applies when a client is seen by an Outstationed EW: STEP WHO ACTION 1. Client Brings in CZ/ID documents 2. O/S EW Completes/signs the DHCS 0005 and gives a copy to client Makes copies of original documents Date stamps the COPIES Returns originals to client immediately Places in basket to be returned to MCSC for scanning Schedules another appointment with client if there are still missing CZ/ID verifications. 3. Clerical Assigns RD packet and/or CZ/ID verifications to Processing EW

14 page 14 STEP WHO ACTION 4. Processing EW 5. O/S EW or Processing EW Follows Report CZ/ID Data CalWIN process to record receipt of CZ/ID documents to MEDS Completes and updates the RRR. Completes SC 109 and/or DL 937 if client is unable to provide acceptable documents from Tiers 1-5 Changes Caseload # to A7M1. IMPORTANT: The SC 109 and DL 975 must be scanned into IDM. Documents Received by Mail (MCSC) The following process applies if a client mails in original CZ/ID documents: STEP WHO ACTION 1. Clerical Completes the DHCS 0005 Makes copies of original CZ/ID documents Date stamps the COPIES Mails original CZ/ID documents back to the client immediately along with the DHCS 0005 via certified mail with a return receipt ID s and assigns to processing EW. 2. Processing EW Reviews copies of documents Follows Report CZ/ID Data CalWIN process to record receipt of CZ/ID documents to MEDS. Adding a Person (MCSC) The following process applies when adding a person at MCSC: NOTE: Deemed Eligible newborns are excluded from CZ/ID requirements. STEP WHO ACTION 1. Client Calls the # to add a person. 2. Outreach EW Searches IDM and prior case files to determine if CZ/ID verification is already on file Reviews for CZ/ID exemptions Reviews INQE for CZ/ID coding Follows MCSC process to add a person if documents are on file Completes Report CZ/ID Data CalWIN process to record receipt of CZ/ID documents Completes DHS 0004 if person was born in CA Completes Request Birth Record Match CalWIN process to request a CA birth record match If missing CZ/ID documents, schedules appointment with an O/S EW for client to being in verification Completes SC 109 and/or DL 937 if client is unable to provide acceptable documents. 3. O/S EW Changes Caseload # to A7M1.

15 page 15 EW Supervisors EW Supervisors must review this material with their unit as soon as possible, but no later than 11/30/07. Documentation EWs must accept and document in the Maintain Case Comments window any reasonable information provided by an applicant or beneficiary which shows that they are attempting to obtain the required CZ/ID verifications. Data Systems CalWIN Effective December 10, 2007, CalWIN is modified to collect citizenship and identity information and to partially automate AP19 transactions as follows: The Collect Individual Demographic Details window [Demographics Detail] Tab is updated to add a new U.S. Citizenship Document Number field. EWs will enter the document type in the Verification Source field and the document number of the verification provided by the client. The Collect Individual Demographic Details window [Identification Detail] Tab is updated to add a new Identification Document Number field. EWs will enter the document type in the Verification Source field and document number of the verification provided by the client. The Send Forced Add/Suppress Transactions to MEDS window includes a new [Forced AP19 to MEDS] Tab. Users can submit an AP19 transaction through CalWIN to report citizenship and identity documents received directly to MEDS and request an automated Birth Record Match for persons born in CA. BENDS for detailed descriptions of the necessary CalWIN workarounds for citizenship and identity verification requirements.] Report CZ/ID Documents For initial approvals, CalWIN sends an automated AP19 Transaction in Batch if citizenship/identity documents are entered on the Collect Individual Demographic Details window [Demographics Detail] and [Identification Detail] tabs and benefits are being granted for the first time. If the AP19 transaction is successful, no further action is necessary. For beneficiaries; follow the process below to report citizenship and identity documents received to MEDS: Enter citizenship and identity document information in the Collect Individual Demographic Details window [Demographics Detail] and [Identification Detail] Tabs. Select MEDS Data under Interface Activities

16 page 16 On the Send Forced Add/Suppress Transactions to MEDS window, select the [Forced AP 19 to MEDS] Tab Enter the data provided by the client on the DHCS 0004 in the Client s Birth Name fields Check the AP19-Citizenship/Identification box and click [Send] button. Request CA Birth Record Match Follow the process below to request a Birth Record Match for clients born in California: Enter citizenship document information in the Collect Individual Demographic Details window [Demographics Detail] Tab. Select MEDS Data under Interface Activities On the Send Forced Add/Suppress Transaction to MEDS window, select the [Forced AP19 to MEDS] Tab. Enter the data provided by the client on the DHCS 0004 in the Birth Certificate Information fields. Check the AP19 - Birth Match Request box and click the [Send] button. MEDS MEDS is modified to capture and maintain a permanent record of citizenship and identity verification as follows: INQE Screen The Citizenship Document Type and Identity Document Type fields on the MEDS INQE screen are displayed when: Citizenship is verified via an automated Birth Record Match Acceptable proof of CZ/ID is provided and reported via AP19 The client is exempt from the citizenship/identity verification requirement and an Exemption Status Code is reported, or The client is given a reasonable opportunity period and an End of Reasonable Opportunity Period (ROP) code is reported. [Refer to Update : User s Guide to State Systems for a list of Exemption Status codes and ROP codes.] EWs must review the Citizenship Document Type and Identity Document Type fields to determine if citizenship and/or identity have already been verified or if a client is exempt from the verification requirement. When a valid birth record match is found for a child under 16, MEDS is updated to reflect verification of citizenship. However, identity information included in the signed application/statement of Facts on file must still be reported to MEDS.

17 page 17 Electronic Birth Record Matches MEDS is modified to allow the ability to request an automated birth record match with the Department of Vital Records database for applicants and beneficiaries born in California. Electronic birth records are considered the highest reliable verification of citizenship. The Department of Health Care Services (DHCS) previously completed a match of all Medi-Cal beneficiaries in California through June When a successful match was returned for these individuals, the citizenship information was populated on the MEDS INQE screen. Birth Record data is not available for persons born after June 2006 until further notice. Reminder: Applicants and beneficiaries for whom an electronic birth record match is found will have met the citizenship verification requirement but must still provide verification of identity (except for children under 16). Forms The following forms were developed for the implementation of CZ/ID verification requirements. An initial supply of new forms have been sent to all district offices. Follow standard procedures for ordering additional forms from Central Supply. All forms listed below are available on the SSA Intranet: DHCS 0001 The U.S. Citizens and Nationals Applying for Medi-Cal Must Show Proof of Citizenship and Identity (DHCS 0001) must be included in Medi-Cal intake application (MC 210 or MC 321 HFP) packets effective 12/10/07. The DHCS 0001 must be included in the Intake packet sent to the family when an MC 321 HFP application is received from the Single Point of Entry (SPE) to inform them of the new requirements. DHCS 0002 The Proof of Citizenship and Identity New Requirements for Medi-Cal Beneficiaries Who Are U.S. Citizens or Nationals (DHCS 0002) must be included in Medi-Cal redetermination (MC 210 RV or MC 262) packets effective with the December packets. DHCS 0003 The Affidavit of Reasonable Effort to Get Proof of Citizenship (DHCS 0003) is completed by the client to attest to the fact that he/she is making a good faith effort to obtain required documents.

18 page 18 DHCS 0004 The Request for California Birth Record (DHCS 0004) is used to obtain information from the client necessary to initiate an electronic birth record match. it may be completed by the client or by the EW over the phone. DHCS 0005 The Proof of Citizenship or Identity Received (DHCS 0005) is completed by designated staff to certify the document submitted by an individual for proof of citizenship and/or identity is an original or a certified copy from the issuing agency. The DHCS 0005 may also be completed by CAAs stationed at any of the VMC locations. The DHCS 0005 does not have a space to enter the individual s name. Until the DHCS 0005 is revised, staff will need to add the client s name when completing the form. Staff will be notified when the new version is available. DHCS 0006 The Proof of Citizenship or Identity Needed for Medi-Cal Applicants and Beneficiaries Who Are U.S. Citizens or Nationals (DHCS 0006) is used by the EW to request verification of citizenship and/or identity when the phone contact is unsuccessful. The SC 265 must also be included in the applicable language, as the DHCS 0006 does not include a list of acceptable citizenship/identity documents. DHCS 0009 The Affidavit of Identity for U.S. Citizen Children Under 16 (DHCS 0009) may be used as verification of identity for children under 16. SC 101 The following new forms may be used as affidavits of citizenship or identity: SC 101 CZ (Available in English/Spanish/Vietnamese & Chinese) SC 101 ID (Available in English/Spanish/Vietnamese & Chinese). SC 1481 The Verifications Needed for Your Medi-Cal Determination (SC 1481) has been revised to include citizenship/identification documents for U.S. citizens. The SC 1481 is included in all Medi-Cal Intake and RD packets. SC 265 A new Fact Sheets Medi-Cal Rules Have Changed (SC 265) has been developed for outreach purposes to have available in District Office lobbies and for use with community partners. The SC 265 is available in English, Spanish, Chinese and Vietnamese.

19 page 19 Notices of Action Notices of Action for implementation of the new citizenship/identity verification requirements are still under development. The new forms will be distributed as soon as they are available. In the interim, staff are to use the MC 239 P when approving an applicant for restricted benefits or reducing a beneficiary s benefits from full scope to restricted. The MC 239P is also available as shelf stock in both English and Spanish. Outreach State Mailers Informing notices are being mailed to Medi-Cal beneficiaries by the state advising them of the new citizenship rules. The first group of notices were sent to clients with an RD due in December, January and February. Subsequent mailings will be staggered on a quarterly basis. Along with this notice, a second notice is included that either: Lists the individuals for which an automated California birth record match was found, OR Indicates no match was found and verification must be provided. The state is in the process of developing a poster to be placed in district office lobbies. A supply of these posters will be distributed as they become available. Recorded Phone Line A county recorded phone line is available for clients to call for more information. This line is not staffed by a live person and is simply a message line for clients who receive the mailer to call if they have questions about the new rules. The numbers are: (408) & (650) Callers will be told they do not need to contact their worker at this time, and do not need to provide any documents until notified. DRA Website Additional information on the new citizenship and identity verification rules can be found on the state DRA Website This information is intended for staff purposes only. It is not necessary to refer clients to this website. Other Programs CalWORKS Individuals who meet the citizenship and identity requirements for CalWORKs do not need to provide verification again to establish Medi-Cal eligibility in the future. However, EWs must ensure MEDS is updated to indicate how the requirements were met if that information is not already on INQE. Future MEDS programming is planned to automate this process for CalWORKs recipients.

20 page 20 Clerical See Original Documents, Implementation, and Forms Kudos Thank you to the following members of the DRA Workgroup for their assistance in identifying and resolving important issues, and developing the Business Processes for Intake and Continuing: Anna Quevedo, Armand Barreras, Catherine Lam, Eva Chaboya, Gloria Figueroa, Linda Ly, Lucy Sanchez, Mamie Rocha, Margaret Badal, Maria P. Gonzalez, Marie Sanders, Mary Cardenas, Olga Maldonado, Rosa Huerta, Sabrina Ding, Tracey Medina and Fatima Ojeda. UMESH POL, DIRECTOR CalWIN Division KATHERINE BUCKOVETZ, DIRECTOR Department of Employment and Benefit Services Contact Person(s): Alice Turney, Medi-Cal Program Coordinator, (408)

21 page 21 Table 1 - Documents Establishing U.S. Citizenship Hierarchy of Reliability of Citizenship Documents Evidence of Highest Reliability<<<<<<<<<<<<<<>>>>>>>>>>>>>>Evidence of Lowest Reliability Primary Documents (Tier 1) Secondary Documents (Tier 2) Third Level Documents (Tier 3) Fourth Level Documents (Tier 4) Establishes both Citizenship & Identity Must be Provided with Identity Document Must be provided with Identity Document Must be Provided with Identity Document U.S. passport issued without limitation Certificate of Naturalization (DHS Forms N-550 or N-570) Certificate of Citizenship (DHS Form N-560 or N-561) U.S. Public Birth Record issued before age 5 (1) Certification of Report of Birth (DS-1350) Certification of Birth issued by the Department of State (Form FS-545 or DS-1350) Report of Birth Abroad of a U.S. Citizen (FS-240) U.S.Citizen ID Card (Form I-197 or I-179) American Indian Card (I-872) Northern Mariana Identification Card (I-873) Final Adoption Decree (2) Evidence of Civil Service employment by U.S. Government showing employment before 6/1/76 U.S. Military Record (2) Extract of a Hospital Record on Hospital Letterhead Established at the time of Birth (2,3) Life or health or other insurance record (2,3) Federal or State Census Record showing U.S. Citizenship or a U.S. place of birth (Generally for persons born ) (4) Seneca Indian tribal census record (2,3) Bureau of Indian Affairs tribal census record of the Navaho Indians (2,3) U.S. State Vital Statistics official notification of birth registration (2,3) Amended U.S. public birth record amended more than 5 years after the persons s birth (2,3) Statement signed by the physician or midwife who was in attendance at the time of birth (2,3) Institutional admission papers from a nursing facility, skilled care facility or other institution Medical (clinic, doctor or hospital) record (excludes immunization records)(2,3) Written Affidavit (5) (1) Must show birth in: one of the 50 U.S. States; District of Columbia, America Samoa, Swain s Island; Puerto Rico (DOB on or after 1/13/41); Virgin Islands of the U.S. (DOB on or after 1/17/17), Northern Mariana Islands (DOB after 11/4/86, NMI local time); or, Guam (DOB on or after 4/10/1899). (2) Must show U.S. Place of Birth (3) Must have been created at least 5 years before the Medi-Cal application, unless applicant is a child under the age of 5 (4) Must show applicant s age (5) Affidavits should only be used in rare circumstances. An Affidavit by at least two individuals of whom one is not related to the applicant/beneficiary and who have personal knowledge of the event(s) establishing the applicant s/beneficiary s claim of citizenship. The person(s) making the affidavit must be able to prove his/her own citizenship and identity for the affidavit to be accepted. A second affidavit from the applicant/beneficiary or other knowledgeable individual explaining why documentary evidence does not exist or cannot be readily provided must also be obtained.

22 page 22 Table 2 - Documents Establishing Identity Acceptable Verification of Identity for Citizens and Nationals who do not Provide a Tier 1 Citizenship Document (Tier 5) Certificate of Degree of Indian Blood, or other U.S. American Indian/Alaska Native Tribal document. (Acceptable if the document carries a photograph of the applicant or beneficiary, or has other personal identifying information relating to the individual.) 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 identification card or draft record Identification card issued by the Federal, State, or local government with the same identifying information included on driver s licenses U.S. military dependent s identification card Native American Tribal document U.S. Coast Guard Merchant Mariner card For children under 16, school records may include nursery or day-care records An affidavit to establish identity of children under 16 is only acceptable if signed under penalty of perjury by a parent or guardian stating the date an place of birth of the child, and cannot be used if an affidavit for citizenship was provided A U.S. Passport, current or expired, even if issued with limitation. NOTE: Expired identity documents are acceptable for proof of identity. Attachment 1