Adult Medicaid Manual MA-2320 REDETERMINATION OF ELIGIBILITY

VI. U.S. Citizenship and identity DOCUMENTATION

Citizenship and identity documentation is required at application and does not need to be re-established at redetermination.

Review the case record(s) due for review for citizenship and identity documentation. Conduct an SOLQ social security number inquiry for each applicant or recipient at re-enrollment. If evidence is needed at redetermination, contact the recipient using the DMA-5097, DMA-5097s, Request for Information. Begin the redetermination process in case the documents are received.

There are a few exceptions when the case record may not contain citizenship documentation at redetermination.

REISSUED 10/01/11 – CHANGE NO. 18-11

(VI.)

A. North Carolina Health Choice Children

1. The citizenship/identity documentation requirement does not apply to North Carolina Health Choice (NCHC) recipients who applied prior to January 1, 2010. NCHC recipients who applied prior to January 1, 2010 and did not provide documentation of citizenship have a C/I code 98 in EIS. At redetermination, citizenship does not have to be established for these individuals who continue to be NCHC eligible. Complete the redetermination and continue to use C/I code 98.

Note: If the individual terminates, at reapplication citizenship documentation is required.

2. If a NCHC recipient who applied prior to January 1, 2010 and has a C/I code of 98 changes from NCHC to Medicaid at redetermination, citizenship/identity documentation must be provided. Contact the recipient using the DMA-5097, DMA-5097s, Request for Information.

a. If the recipient has the documents to provide citizenship and/or identity evidence, obtain them. Make copies, document the record, and complete the re-determination. Return the original documents to the recipient.

b. If the recipient states he does not have documentation and is making a good faith effort to obtain the needed documents, document the record. If all other eligibility requirements are met, complete the redetermination and authorize with the appropriate certification period. Retain the C/I code 98 and use Special Review Code “Z” on the DSS 8125 to follow up on the status of obtaining the documents. Use the third month of the new certification period for the date. A message will show on the Case Management Report to remind the worker citizenship and/or identity documentation is needed. (See EIS 4000, Codes Appendix.)

c. Contact the third party source or the recipient to determine status of obtaining the documents.

d. Continue to use Special Review Code “Z” for another 3 months. Continue to contact the recipient every 3 months or until the end of the certification period, provided:

(1) The recipient has not yet provided documents but continues to make a good faith effort to obtain the documents, or

(2) The county has not received documentation or a response from an inquiry made to assist the client.

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(VI.A.2.d.)

(3) Terminate at any time when a response is received indicating that no documentation confirming citizenship/identity is found or the recipient is not continuing a good faith effort to obtain the documents or provide the county with information needed to assist in obtaining documentation.

e. If documentation confirming citizenship/identity is not provided by or at the end of the certification period, complete the DSS 8125, update the C/I code to C/I code 97 with the date the first DMA-5097 was sent requesting the documentation. Terminate the case effective the last day of the current certification period. The individual has received reasonable opportunity to provide documentation of citizenship/identity and must provide documentation confirming citizenship/identity at reapplication.

f. If the recipient cannot obtain the necessary documents, requests help, or has special needs demonstrating a need for assistance and lacks someone who can act on his behalf, the county must assist the recipient in acquiring the documents including cost involved. Vital Records requires an authorization from the recipient, parent or legal guardian to provide a certified copy to the county. Use the DMA-5176, U.S. Citizenship Documentation Birth Certificate Request. Instructions on obtaining a certified birth certificate are on the Vital Records web site, http://vitalrecords.dhhs.state.nc.us/vr/index.html.

B. Exceptions to Providing Further Citizenship Documentation at Redetermination

Do not require further citizenship/ identity documentation at redetermination for the following:

1. Title IV-E and Title IV-B children. See MA-3230, Eligibility of Individuals Under Age 21, for procedures to obtain the necessary documentation of Title IV-B or Title IV-E status at redetermination.

2. Children born in the United States whose delivery was covered by Medicaid.

3. Current or former SSI recipient. Use OLV to access the SDX to prove current or former SSI status.

4. Current or former Social Security Disability Insurance (SSDI) recipient, or Medicare recipient. Use OLV to access SOLQ to prove current or former Medicare and SSDI status.

5. Current or former lawful permanent resident (LPR). Refer to MA-2504, Alien Requirements, for acceptable documentation for LPR applicants and use SAVE, Systematic Alien Verification for Entitlement Program, to verify the authenticity of the LPR document.

Print the screen with the evidentiary information and put in the Citizenship/Identity Documentation sub-folder in the recipient’s permanent record.

REVISED 07/01/10 – CHANGE NO. 10-10

C. Ex Parte

1. Use OLV to document citizenship and identity for current or former SSI and Medicare recipients. Use SDX to document citizenship and identity for former SSI recipients. Use SOLQ to document citizenship and identity for current or former SSDI and Medicare recipients. Continue to use C/I code 50.

2. If the individual is changing programs and an 8124 is required, a SSA data match is completed.