Adult Medicaid Manual MA-2506 US CITIZENSHIP REQUIREMENTS

IV. Citizenship and Identity REQUIREMENTS AT APPLICATION

Each applicant or recipient claiming U.S. citizenship must provide or cooperate in obtaining acceptable proof of both citizenship and identity.

A. Procedures to Document Citizenship and Identity at Application

1. The preferred method of citizenship/identity verification for applicants stating they are a US Citizen is a SSA Citizenship/Identity data match. See MA-2505, Citizenship/Identity SSA Data Match, for procedures.

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2. If unable to verify citizenship/identity through a SSA data match, follow the procedures outlined below. The DMA-5178, US Citizenship Documentation Desk Reference, is a guide/worksheet to assist in this process. This is for county DSS use only and is not to be sent to the a/r.

The DMA-5177, Documentation of Identity and Citizenship for US Citizens, is a desk reference only and is not all inclusive.

NOTE: The following procedures include instances in which SSA cannot document citizenship and identity due to a hyphen or embedded spaces in the spelling of the name, individuals with no SSN, newborns not entitled to auto newborn coverage, individuals who previously received the 90 day reasonable opportunity period, and recipients at redetermination. See MA-2504, Alien Requirements, for individuals who are qualified aliens.

3. Review the case record and all county records, including other program records, for citizenship and/or identity evidence the agency may have on file.

4. If evidence is located, make a copy of the evidence documentation for the Medicaid file and clearly document:

a. Where the evidence was located,

b. The date the documentation was provided to the county, and

c. What hierarchy code it falls in.

If the date of receipt by the county is unknown, note the date the worker located the document.

5. If the evidence is not on file, discuss with the applicant what documents may be available and who can obtain those documents. If the applicant 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 applicant/recipient in acquiring the documents, including cost involved. See MA-2303, Verification Requirements for Applications. Send or give the individual the Request for Information (DMA-5097) advising what items can be used to verify citizenship and identity.

6. If possible in your county, establish citizenship through electronic data matching with the local register of deeds. Screen print the data. The county may also go to the register of deeds and locate the birth record. Document the birth record observed and the location at the register of deeds. Place documentation and complete the DMA-5177, Documentation of Identity and Citizenship for US Citizens, in the CID subfolder in the recipient’s permanent record.

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7. When the a/r requests assistance in obtaining citizenship documentation, use the DMA-5176, US Citizenship Documentation Birth Certificate Request, to send to the county register of deeds or State Vital Records to request a birth certificate. For the county to make a request for a birth certificate, the applicant, a parent or legal guardian must sign an authorization. A copy of the guardianship/custody papers must accompany the request.

Unless grandparents are legal guardians, they cannot authorize the release of the certified birth certificate to the county. However, the grandparent can request and obtain a birth certificate from the county register of deeds or State Vital Records.

Instructions on obtaining a North Carolina certified birth record/certificate are also on the North Carolina Vital Records web site at http://vitalrecords.dhhs.state.nc.us. Links to other state’s Vital Records web sites are at http://www.cdc.gov/nchs/howto/w2w/w2welcom.htm.

8. To establish identity, a document must show evidence that provides identifying information that relates to the person named on the document.

9. Conduct an SOLQ social security number inquiry for each applicant. The SSN given by the a/r when applying must match the information on the SOLQ. If the inquiry returns a validated social security number match, print the screen and complete the DMA-5177, Documentation of Identity and Citizenship for US Citizens. If the social security number does not validate, pursue another form of identity.

10. If any documentation no matter the level is provided within 45/90 days, process the application. See MA-2304, Processing the Application.

B. Reasonable Opportunity to Provide Documentation of Citizenship/Identity at Application

If all other eligibility factors are met except for citizenship/identity documentation, an individual may receive Medicaid or NCHC while securing the documentation, known as the reasonable opportunity period. The reasonable opportunity to provide documentation is a one (lifetime) 90 day period.

1. Applicants who state they are a US Citizen are allowed one (lifetime) 90 day reasonable opportunity period to provide documentation of citizenship if all other eligibility factors are met. The 90 day reasonable opportunity starts the date the first Request for Information (DMA-5097) is sent to the individual.

2. Applications can include a request for retroactive and/or ongoing Medicaid and are treated as separate applications. The one (lifetime) 90 day reasonable opportunity period to provide documentation of citizenship applies whether the application is retroactive and/or ongoing. See MA-2304, Processing the Application, for procedures.

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(IV.B.)

3. The preferred method of citizenship/identity verification for applicants stating they are a US Citizen is a SSA Citizenship/Identity data match. See MA-2505, Citizenship/Identity SSA Data Match for procedures.

4. Instances in which SSA cannot document citizenship/identity due to a hyphen or embedded spaces in the spelling of the name, individuals with no SSN, and newborns not entitled to auto newborn coverage, who state they are a US Citizen, are provided one (lifetime) 90 day reasonable opportunity period to provide documentation of citizenship if all other eligibility factors are met.

5. Send the individual the Request for Information form (DMA-5097) advising what items can be used to verify citizenship and identity.

6. Complete the 8125 approving the application and authorize with the appropriate certification period using C/I code 97. The date entered is the date the first Request for Information (DMA-5097) is sent to the individual.

7. Allow the individual 12 days and, if the requested information is not received, a second DMA-5097 is required.

NOTE: The 90 days remain the same. Do not give an additional 90 days from the date the second DMA-5097 is sent.

Complete the DMA-5177, Documentation of Identity and Citizenship for US Citizens, in the CID subfolder with a C/I code 97. The date is the date the first Request for Information (DMA-5097) is sent.

8. Although the individual is authorized, citizenship and identity have not been verified, and the information must be requested from the individual. The individual is allowed 90 days from the date the first Request for Information form (DMA-5097) is sent to provide acceptable documentation of citizenship and identity. The individual appears on the Case Management Report under special message “RESOLVE CITIZENSHIP ISSUE DUE” until the individual is terminated, or the C/I code is changed to another code.

NOTE: It is important to key the date the first DMA-5097 is sent when entering C/I code 97 on the 8125. EIS automatically calculates the 90 days from the date entered for the Case Management report.

9. The caseworker must verify citizenship within 90 days. If unable to verify, send a timely notice, DSS-8110, on the 91st day or the next workday following the 90th day to terminate the individual or case.

10. The individual is allowed only one (lifetime) 90 day reasonable opportunity period to provide documentation of citizenship/identity. If he reapplies, citizenship documentation must be provided before approval of benefits.

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C. Pending the Application up to 6 Months for Citizenship/Identity Documentation

1. Pend the application up to 6 months with a “CID” entry on the Date Screen in EIS when:

a. The individual has an existing CID code 97 and has previously received his 90 day reasonable opportunity period to secure citizenship documentation, and

b. The applicant is making a good faith effort to provide the documentation, or

c. The county has not received verification from an inquiry, and

d. All other eligibility requirements are met except for those items listed in MA-2304, Processing the Application.

2. If additional items in MA-2304, Processing the Application, are also needed prior to processing the application, pend the application with the item most likely to take the most time to obtain. Process the application when all information is received.

3. Deny the application after pending 6 months when documentation is not received or necessary information to seek the evidence is unavailable. At the end of the 6 months, if the county knows of emergency services the applicant incurred, evaluate for emergency Medicaid. Do an administrative application using as the application date the first day of the month of the emergency service.

4. During the 6 month pending period, if all eligibility requirements are met except for citizenship/identity before the 90 day reasonable opportunity period ends, and the individual has not previously been approved with a C/I code 97, complete the 8125 approving the application and authorize with the appropriate certification period using C/I code 97. The date entered is the date the first Request for Information (DMA-5097) is sent to the individual. If documentation is requested from a third party source such as Vital Records, note on the DMA-5097 that the request was sent to the third party source. See 5. below for examples.

a. The 90 day reasonable opportunity period starts with the first notice (DMA-5097) even if the individual is not otherwise eligible at the time the first notice is sent. An individual pending 6 months for citizenship documentation and additional items in MA-3215 has been sent a Request for Information (DMA-5097) and a Your Application for Medicaid is Pending (DMA- 5098). It is not necessary to resend either request/form.

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b. Although the individual is authorized, citizenship and identity have not been verified, and the information must be requested from the individual and/or third party source. The individual is allowed 90 days from the date the first Request for Information form (DMA-5097) is sent to provide acceptable documentation of citizenship and identity. The individual appears on the Case Management Report under special message “RESOLVE CITIZENSHIP ISSUE DUE” until the individual is terminated, or the C/I code is changed to another code.

NOTE: It is important to key the date the first DMA-5097 is sent when entering C/I code 97 on the 8125. EIS automatically calculates the 90 days from the date entered for the Case Management report.

c. The caseworker must verify citizenship within 90 days. If unable to verify, send a timely notice, DSS-8110, on the 91st day or the next workday following the 90th day to terminate the individual or case.

d. During the 6 month pending period if all eligibility requirements are met except for citizenship/identity after the 90 day reasonable opportunity period, or the individual has previously been approved with a C/I code 97, continue to pend the application for 6 months. Deny the application after pending 6 months when documentation is not received. At the end of the 6 months, if the county knows of emergency services the applicant incurred, evaluate for emergency Medicaid. Do an administrative application using as the application date the first day of the month of the emergency service.

5. Examples

a. Application received 4/10/10 and Request for Information (DMA-5097) sent to individual 4/12/10 requesting documentation of citizenship and medical bills to meet a deductible. The 90 day reasonable opportunity period starts with the first notice (4/12/10) and the 90th day is 7/9/10.The individual does not respond and a DMA-5098 is sent. The Date Screen is completed in EIS and the application is put into 6 month pending.

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The deductible is met on the 60^th day (6/9/10). Authorize the individual because he became otherwise eligible prior to the 90^th day (7/9/10), and the individual has not prior received his 90 day reasonable opportunity period to secure citizenship documentation. Authorize effective the date the deductible is met (6/9/10) for certification period 4/1/10 – 10/31/10. Key the 8125 entering C/I code 97 and the date the first notice was sent (4/12/10). EIS automatically calculates the 90 days from the date entered and the individual appears on the Case Management Report under special message “RESOLVE CITIZENSHIP ISSUE DUE” until the individual is terminated, or the C/I code is changed to another code. The individual has until the 90^th day (7/9/10) to provide documentation of citizenship. If the documentation is not provided by or on the 90^th day (7/9/10), send a timely notice on the 91^st day or next workday following the 90^th day to terminate.

b. Application received 4/10/10 and Request for Information (DMA-5097) sent to individual 4/12/10 requesting documentation of citizenship and medical bills to meet a deductible. The 90 day reasonable opportunity period starts with the first notice (4/12/10) and the 90th day is 7/9/10. The individual does not respond and a DMA-5098 is sent. The Date Screen is completed in EIS and the application is put into 6 month pending.

The deductible is met on the 100^th day (7/1910). Do not authorize the individual because he became otherwise eligible beyond the 90 day reasonable opportunity period (7/9/10). The individual would remain pending until the end of the 6 month pending period or until all information is received. Deny the application after pending 6 months if information/documentation is not received.

D. Exceptions to Providing Proof at Application

Do not require further citizen/identity documentation of the following individuals:

1. Title IV-E and Title IV-B children are excluded from citizenship/identity documentation requirements. They are exempt as the social worker must verify citizenship/identity.

2. Children born in the United States whose mother was covered by Medicaid for the birth of the child. See Hierarchy Charts in VII below.

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

4. A 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.

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