Broadcast to All DPA Staff, DPA State Associates, and OCS Eligibility Staff From Policy and Program Development This broadcast provides initial instructions for implementing the new citizenship and identity verification requirements for Medicaid. These requirements take effect August 1, 2006 for applications and renewal forms received on or after that date. We will provide updates to this guidance as we receive additional clarification from the federal government, and as we determine the most effective ways to obtain this verification. The new requirements do not apply to individuals receiving SSI or Medicare, or to babies who qualify for newborn coverage. They also do not change the policies already in place concerning immigrants. Processing Medicaid and Denali KidCare Applications Applicants for Medicaid and Denali KidCare who declare they are U.S. citizens will be asked to provide proof of their citizenship and identity. If the proof is not provided with the application, and the individual is a previous recipient, the caseworker will check the prior case file to see if the required documents are already in the file. If the verification is not in the file, applications will be pended and a notice sent requesting the verification. Applicants may be allowed additional time beyond the normal processing timeframes if needed due to reasons beyond their control. Applicants may not be found eligible for Medicaid until the necessary verification is provided. If the individual refuses to provide the necessary proof or does not respond by the date requested, the application must be denied using the CI denial reason code. Processing Medicaid and Denali KidCare Renewals As reviews are submitted, caseworkers will check the existing case file for proof of citizenship and identity for Medicaid and Denali KidCare recipients. If the required documents are not in the file, a notice must be sent requesting the necessary verification. If necessary, recipients will remain eligible for Medicaid into the next month to allow time for their response to the request. However, eligibility for a new review period must be determined before a child will be allowed the 6-month period of continuous eligibility. Recipients who provide the requested verification, or state they are trying to get the verification but are unable to provide it at this time, may be found eligible for a new review period. In this situation, documentation will be required at the next redetermination. If the individual refuses to provide the necessary proof or does not respond by the date requested, the case will be closed with timely adverse action using the CI closure reason code. Verification Documents Attached is a detailed description of acceptable documents that can be used to verify citizenship and identity. Four levels of citizenship verification are provided, in order of preference. Although it is 1
preferred that a document from the highest level possible be provided, a document from any level can be accepted during our initial implementation. We are working with Bureau of Vital Statistics on a data match to verify citizenship for individuals born in Alaska. This data will provide the citizenship verification for a large number of individuals. We expect this to be completed by the end of August. An original or a certified copy of the document is also preferred; however, during initial implementation copies provided or in the file can be accepted. If an original or certified copy is provided, the caseworker will make a photocopy for the case file noting that an original or a certified copy was seen. Although some documents contain a statement, DO NOT COPY, DPA staff may copy and file these documents in the case file for the official purpose of establishing Medicaid eligibility. We are working with System Operations to add a series of verification codes that will indicate the level of verification provided and whether the document was an original or certified copy, or a photocopy. These codes will provide information that we may need to pursue additional verification in the future. Notices New Medicaid and Denali KidCare (DKC) Citizenship/ID Needed notices for both applications and renewals will be available for use by August 1, 2006. Closure and denial notices are also under development. Special Processing For Medicaid cases being converted to Denali KidCare, the Medicaid worker must forward any citizenship and identity documents in the case file to the Denali KidCare worker. A child placed in foster care by the Office of Children s Services is considered a recipient for Medicaid purposes and eligibility is allowed while the social worker is obtaining verification. However, documentation will be required at the next redetermination. If you have any questions, please contact the Policy and Program Development Team at DPAPolicy@health.state.ak.us. Citizenship Verification final... 2
U.S. CITIZENSHIP VERIFICATION DOCUMENTS To be eligible for Medicaid and Denali KidCare, a person must be a U.S. citizen or qualified alien. A new requirement became effective July 1, 2006 under the Budget Deficit Act of 2005, which requires Medicaid applicants and recipients to provide proof of U.S. citizenship and identity as a factor of eligibility. Self-attestation of citizenship and identity is no longer acceptable. Implementation for Alaska begins August 1, 2006 for applications and renewals received on or after that date. Verification of citizenship and identity is not required for: An SSI recipient; A Medicare recipient; or A newborn child receiving newborn coverage through the end of his or her first birthday. (Note: this provision does not apply to child born to a non-qualified alien) (Section 5330). Verification is needed only for the individuals who will receive benefits, not for individuals applying for or renewing Medicaid or Denali KidCare on behalf of someone else. Note: If an adult who is a mandatory household member is found ineligible for Medicaid for failure to prove their own citizenship status, that adult s needs, income, and resources continue to be included in the financial eligibility determination for the children. ACCEPTABLE DOCUMENTATION Below is a list of acceptable documents that may be used to verify citizenship and identity. Copies of the documents must be maintained in the case file, unless verified by an electronic data match. If an individual is unable to get the needed documentation, we must offer assistance. Once an individual s citizenship is verified and documented, it is not necessary to get proof again unless that person s citizenship becomes questionable. The State Data Exchange (SDX) interface may be used to verify a former SSI recipient s citizenship. This can be found in the Alien Indicator Code at position 578 on the SDX. There are four levels of verification in order of preference. Although it is preferred that we get a document from the highest level possible, we will accept a document from any level during our initial implementation. An original or a certified copy of the document is also preferred; however, during initial implementation, copies provided or in the file can be accepted. If an original or certified copy is provided, the caseworker will make a photocopy for the case file noting that an original or a certified copy was seen. July 2006 Page 1 of 4
Although some documents contain a statement, DO NOT COPY, DPA staff may copy and file these documents in the case file for the official purpose of establishing Medicaid eligibility. Level One: Acceptable for Both Proof of Citizenship and Identity A U.S. Passport; A Certificate of Naturalization (Forms N-550 or N-570); or A Certificate of U.S. Citizenship (Forms N-560 or N-561). Level Two: Acceptable for Proof of Citizenship: (Note: Must have an additional form of identity verification.) A U.S. birth certificate showing birth in one of the 50 States, the District of Columbia, Puerto Rico (if born on or after January 13, 1941), Guam (on or after April 10, 1899), the Virgin Islands of the U.S. (on or after January 17, 1917), American Samoa, Swain s Island, or the Northern Mariana Islands (after November 4, 1986); A Certification of Report of Birth (Forms FS-545 or DS-1350); A Report of Birth Abroad of a U.S. Citizen (Form FS-240); A U.S. Citizen I.D. Card (Forms I-179 or I-197); An American Indian Card (I-872) issued by the Department of Homeland Security with the classification code KIC ; A Northern Mariana Identification Card. (Form I-873); A final adoption decree showing the child s name and U.S. place of birth; Evidence of U.S. Civil Service employment before June 1, 1976; or U.S. Military Record showing a U.S. place of birth, such as a DD-214 or similar official document showing a U.S. place of birth. July 2006 Page 2 of 4
Level Three: (Note: Must have an additional form of identity verification.) Extract of a hospital birth record on hospital letterhead established at the time of the person s birth that was created 5 years before the initial application date and that indicates a U.S. place of birth. (For children under age 16, the document must have been created near the time of birth or 5 years before the date of application.); or Life, health, or other insurance record showing a U.S. place of birth that was created at least 5 years before the initial application date and that indicates a U.S. place of birth. Level Four: (Note: Must have an additional form of identity verification.) Federal or State census record showing U.S. citizenship or a U.S. place of birth; One of the following documents that show a U.S. place of birth and was created at least 5 years before the application for Medicaid: Seneca Indian tribal census record Bureau of Indian Affairs tribal census records of the Navajo 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 Statement signed by the physician or midwife who was in attendance at the time of birth Institutional admission papers from a nursing home, skilled nursing facility, skilled care facility or other institution; Medical (clinic, doctor, or hospital) record created at least 5 years before the initial application date that indicates a U.S. place of birth. (For children under age 16, the document must have been created near the time of birth or 5 years before the date of application.); or A written affidavit made by at least two individuals of whom one is not related to the applicant/recipient and who have personal knowledge of the event(s) establishing the applicant s or recipient s claim of citizenship. If known, the affidavit should also explain why documentary evidence establishing the applicant s claim of citizenship does not exist or cannot be readily obtained. The person(s) making the affidavit must be able to provide proof of his/her own citizenship and identity for the affidavit to be accepted. A separate affidavit is needed from the applicant/recipient or other knowledgeable individual (guardian or representative) explaining why the evidence does not exist or cannot be obtained. The affidavits must be signed under penalty of perjury. July 2006 Page 3 of 4
Acceptable Proof of Identity: (Note: Must have an additional form of citizenship.) A driver s license issued by a state or territory either with a photograph of the individual or other identifying information such as name, age, sex, race, height, weight, or eye color; Identification card issued by the federal, state, or local government with the same information included on driver s licenses listed above; U.S. military card or draft record; Military dependent s identification card; U.S. Coast Guard Merchant Mariner card; Native American Tribal document; Certificate of Degree of Indian Blood, or other U.S. American Indian/Alaska Native Tribal document with a photograph or other personal identifying information relating to the individual; School identity card with a photograph of the individual; or For children under age 16: School records, which may include nursery or daycare records; or A Medicaid or Denali KidCare application signed by a parent or guardian under penalty of perjury. A previous application or renewal form in the file that includes identifying information and relationship can be used. For Office of Children s Services cases, the signature of the social worker is satisfactory. July 2006 Page 4 of 4