Family and Children's Medicaid MA-3330 – ALIEN REQUIREMENTS

XI. PROCEDURES TO OBTAIN USCIS VERIFICATION

The IMC must verify the alien status for all qualified aliens through the Systematic Alien Verification for Entitlements (SAVE) Program. This requirement does not apply to non-qualified aliens.

A. Initial Verification Procedures

The U.S. Department of Homeland Security Systematic Alien Verification for Entitlements (SAVE) system is used for verifying the status of an alien in order to determine eligibility for Medicaid. This web-based system is used to verify the authenticity of the alien's USCIS documents, the date of admission, and his current immigration status. This is the primary automated procedure for verifying alien status. Instructions for accessing and using this web-based system are found in EIS 1108, SAVE Verification Information System.

B. Secondary Verification Procedures: Form G-845S and G-845 Supplement

1. Require secondary verification using Form G-845S and G-845 Supplement any time:

a. A document appears to be counterfeit or altered. Characteristics of suspect documentation include photograph substitution and ink discoloration.

b. A non-citizen presents unfamiliar documentation, or a document that indicates immigration status, but does not contain an A-number.

c. A non-citizen presents immigration documentation with an A-number in the 60,000,000 or 80,000,000 series.

REVISED 05/01/11– CHANGE NO. 09-11

(XI. B. 1)

d. The non-citizen has no immigration documentation and is hospitalized, medically disabled, or who can otherwise show good cause for his inability to present documentation. Good cause may be defined as hospitalized or disabled as shown by receipt of Social Security benefits.

e. The non-citizen presents a foreign passport and/or Form I-94 and the “Admission for Permanent Residence” endorsement is more than 1 year old.

2. Obtaining Secondary Verification

a. To initiate secondary verification, complete and mail form G-845S and G-845 Supplement to USCIS with fully readable photocopies of original immigration documents.

b. Complete a separate G-845S and G-845 Supplement for each alien requesting Medicaid. Attach a photocopy of all applicable printed pages of each piece of immigration documentation presented for that person only. If a family unit has applied for a benefit, each a.u. member with alien status will require a separate G-845S and G-845 Supplement.

• A G-845S and G-845 Supplement sent to USCIS without photocopies showing front and back of original documents will be returned without a status determination.
• Although a USCIS document is all the identification required to complete the secondary verification process, the attachments should include identification bearing a photograph of the a/r whenever possible. If the alien has presented another pertinent document, such as a marriage record or court order, it should be included as well. Examples of USCIS documentation must be returned to the alien a/r.

c. Retain a copy of every alien a/r's immigration documentation in his file. Return the original documentation to the alien.

3. Completing Form G-845S

Complete the G-845S as fully as possible. It is essential that the form contain enough information to identify the alien. Complete the G-845S as follows:

a. Alien Registration or I-94 Number:

• Enter the A-Number as the letter “A” followed by a series of seven or eight digits.
• Include the Admission Number if available. The Admission Number is found on Form I-94 and in the Alternate ID field.

REVISED 05/01/11– CHANGE NO. 09-11

(XI. B. 3)

b. Applicant's Name: Enter last, first, and middle names of the a/r. If user documentation indicates more than one variation of the name, enter all versions.

c. Nationality: Enter the foreign nation or country to which the applicant owes legal allegiance. This is normally, but not always, the country of birth.

d. Date of Birth: Enter the birth date using the format MM/DD/CCYY. If the complete date of birth is not known, give available information.

e. Social Security Number: Enter the alien's nine-digit Social Security Number, if known. Copy the number directly from the alien's Social Security Card whenever possible.

f. Verification Number: Enter the Verification Number assigned during the automated query, if applicable.

g. Photocopy of Document Attached/Other Information Attached: Indicate that USCIS documentation is attached by checking the top box. Use the bottom box if other information has been included in support or in lieu of USCIS documents.

h. Benefit/Your Case Number: Mark the blocks showing the entitlement benefit program(s) for which this alien has applied. Show applicable county case numbers for the appropriate block.

i. The submitting IMC should provide his name, title, telephone number, and the current date. The name and address of the DSS should be typed or stamped in the block labeled "From."

4. Completing Form G-845 Supplement

The G-845 Supplement may only be used in conjunction with the G-845S, not separately. It should also be completed as fully as possible. The following information should be provided on the G-845 Supplement:

• Non-citizen applicant’s last, first, and middle name;
• Social Security Number (if available);
• Alien Registration Number (A-Number) and/or I-94 Number;
• Typed or stamped name and address of submitting agency;
• Current date;
• Submitting agency’s telephone number.

REVISED 05/01/11– CHANGE NO. 09-11

(XI.B. 4)

You must indicate what status information is required from USCIS by checking off the appropriate numbered blocks in the “Complete the following items:” section on the top portion of the Form G-845 Supplement. It is very important that you complete this section, so that USCIS can provide all appropriate USCIS status information required to make a determination regarding the applicant’s eligibility for benefits. The following USCIS information can be obtained by submitting the G-845 Supplement:

a. immigration status;

b. date alien entered the United States;

c. date status was granted;

d. date status expires;

e. citizen status;

f. special benefit provisions for certain victims of abuse; and

g. affidavit of support.

5. Mailing Form G-845S and G-845 Supplement to USCIS

a. Copies of USCIS documentation should be stapled to the G-845S and G-845 Supplement with a single staple in the upper left-hand corner. The form(s) and documents should then be folded and placed in a window envelope so that the block labeled "To" will appear in the address area. More than one G-845S and G-845 Supplement may be mailed in a single envelope; however, USCIS discourages collecting forms over an extended period of time in order to mail them in bulk.

b. Mail the document verification requests to the USCIS office listed below. Additional supplies of the G-845S and G-845 Supplement may be ordered through the USCIS Forms Request Line: 1-800-870-3676 (Due to the high volume of calls to this line, the best time to call is early mornings.); however, users may duplicate the blank Form G-845S and G-845 Supplement to meet immediate needs.

U.S. Citizenship and Immigration Services

10 Fountain Plaza, 3^rd Floor

Buffalo, NY 14202

Attention: Immigration Status Verification Unit

REVISED 05/01/11– CHANGE NO. 09-11

(XI.B.)

6. G-845S Response From USCIS

a. The Immigration Status Verifiers (ISV) at the USCIS will research the alien's records in USCIS files, complete the response portion of Form G-845S, and return both the form and the attached photocopies to the DSS within ten working days of receipt by the USCIS Office.

b. The G-845S is a self-reply form. The ISV will check all appropriate statements on the lower half and the back of the form to indicate the a/r’s immigration status and work eligibility.

c. Statements on the front of the form are interpreted as follows:

(1) This document appears valid and relates to a Lawful Permanent Resident alien of the United States: Checked where the documentation submitted is determined to be a valid I-551, I-181, or I-94, with the notation “Processed for I-551, Temporary Evidence of Lawful Admission for Permanent Residence.” Immigration law allows this person to live and work in the U. S. on a permanent basis

The term "temporary" used here refers to documentary evidence. It does not mean the immigration status itself is temporary.

This person is a qualified alien. The IMC must determine whether the alien is under the five-year disqualification period.

(2) This document appears valid and relates to a Conditional Resident alien of the United States: Checked when the documentation submitted is determined to be a valid I-551, I-181, or I-94 stamped with the notation "Processed for I-551, Temporary Evidence of Lawful Admission for Permanent Residence." Under the law, this person is allowed to live and work in the U.S.; however, USCIS will re-evaluate his status within two years. Conditional resident alien status normally is granted to aliens that marry U.S. citizens or nationals, or permanent resident aliens.

This individual is ineligible for full Medicaid coverage unless he has a valid I-551 showing he is admitted as an LPR and has met the disqualification period.

REVISED 05/01/11– CHANGE NO. 09-11

(XI.B.6.c.)

(3) This document appears valid and relates to an alien authorized employment as indicated below: Checked to indicate whether the authorization covers full time or part-time employment and when, if applicable, the period of employment will expire. "Indefinite" will be indicated if there is no specific expiration date for employment eligibility. This individual is not a qualified alien.

(4) This document appears valid and relates to an alien who has an application pending for: Checked when an alien is pending a new immigration status or change of status is pending, the appropriate block indicating the current status also will be checked. This individual is not a qualified alien

(5) This document relates to an alien having been granted asylum/refugee status in United States: Checked when an alien has been granted asylee or refugee status in the U.S. because of persecution or a well-founded fear of persecution in his country of nationality. Documentation presented may include Form I-94, stamped with “Section 207-Refugee” or “Section 208 - Asylee,” or a Form I-571. This individual is a qualified alien.

(6) This document appears valid and relates to an alien paroled into the United States pursuant to Section 212 of the I&N Act: Checked for an alien allowed to enter the United States under emergency conditions or when his entry has been determined to be in the public interest. This status is temporary. Documentation presented may include Form I-94, stamped with "Section 212(d)(5) - Parolee." This individual is a qualified alien if the record shows he has been paroled for the duration of at least one year. You must determine whether the alien is under the five-year disqualification period.

(7) This document appears valid and relates to an alien who is a Cuban/Haitian entrant: Checked for Cubans who entered the United States between April 15, 1980, and October 10, 1980, and Haitians who entered the country before January 1, 1981. Documentation presented may include Form I-94, stamped "Cuban/Haitian Entrant." This status is covered by section 502(e) of I&N Act. This individual is a qualified alien.

REVISED 05/01/11– CHANGE NO. 09-11

(XI.B.6.c.)

(8) This document appears valid and relates to an alien who is a conditional entrant: Checked to indicate a refugee who entered the United States or adjusted his status to lawful permanent resident alien under the seventh preference category of Public Law 89-236. Documentation presented may include Form I-94, stamped with "Section 203(a)(7)." This status was defined by section 203(a)(7) of I&N Act, but was abolished by the Refugee Act of 1980. This individual is a qualified alien.

(9) This document appears valid and relates to an alien who is a non-immigrant: Checked to indicate an alien who is temporarily in the U.S. for a specific purpose. This category includes students, visitors, and foreign government officials. Documentation presented may include Form I-94. This individual is not a qualified alien.

(10) This document appears valid and relates to an alien not authorized employment in the United States: Checked when an alien's status prohibits employment in the United States. Several immigration statuses do not allow gainful employment. This individual is not a qualified alien.

(11) Continue to process as legal alien. USCIS is searching indices for further information: Checked if USCIS will withhold judgment regarding the status or validity of documentation pending further investigation. This statement does not imply that the applicant is an illegal alien or the holder of fraudulent documentation. Benefits should not be denied on the basis of this statement. The alien should be presumed legal until USCIS sends a final notification regarding immigration status. This individual is not a qualified alien.

(12) This document is not valid because it appears to be: Checked for expired documentation or when an item appears to be counterfeit or altered. The ISV will use the back of Form G-845S to elaborate on this entry. When the entries for counterfeit or altered documents are checked, the DSS should follow its own guidelines for investigating and prosecuting cases of fraudulent documentation. This individual is not a qualified alien.

d. The "Comments" block on the second page is used to give the IMC further instructions. It includes the following statements:

REVISED 05/01/11– CHANGE NO. 09-11

(XI.B.6 d.)

(1) No determination can be made from the information submitted. Please obtain a copy of the original alien registration documentation and resubmit. This individual is not a qualified alien unless additional documentation is received and verified.

(2) No determination can be made without seeing both sides of the document submitted: Resubmit the G-845S with copies of all sides of each document. This individual is not a qualified alien.

(3) Copy of document is not readable: Resubmit the G-845S with higher quality copies of the original alien documentation. This individual is not a qualified alien.

(4) Items 16 and 17 on the G-845S are designed to assist benefit issuing agencies and institutions in determining when an alien applicant is permanently residing in the United States under color of law (PRUCOL). This information is only provided to the Social Security Administration. Any additional comments will be included in item 18. This individual is not a qualified alien.

e. ISV will initial and stamp the front of the form in the block labeled “USCIS Stamp.”

7. G-845S Supplement Response From USCIS

Following is an explanation of the USCIS information that will be returned on the G-845 Supplement.

a. Immigration Status. The USCIS will provide the non-citizen applicant’s current immigration status by conducting a thorough search of USCIS automated databases and paper files.

b. Date alien entered the United States. The USCIS will provide the original date the non-citizen applicant entered the United States. (This date is not always the same as what is provided through the SAVE Verification Information System. It may be different if a non-citizen adjusts his immigration status. In most cases, the date of entry changes in SAVE Verification Information System to reflect the date the non-citizen obtained his Lawful Permanent Resident status.)

c. Date status was granted. The USCIS will provide the date the non-citizen obtained his current immigration status as noted in paragraph a. above.

REVISED 05/01/11– CHANGE NO. 09-11

(XI.B.7.)

d. Date status expires. The USCIS will provide the date the non-citizen’s immigration status expires. If the non-citizen’s immigration status is indefinite, USCIS will provide this information in the response.

e. Citizen status. The USCIS will confirm whether a prior non-citizen is naturalized and is a United States citizen.

f. Special Benefit Provision for Certain Victims of Abuse. The USCIS will confirm whether or not a non-citizen obtained his Lawful Permanent (or Conditional) Resident status because he was a battered alien or a parent of a battered child or a victim of domestic violence.

g. Affidavit of Support. The USCIS will confirm whether or not the non-citizen was sponsored on Form I-864, Affidavit of Support, and if so, USCIS will provide sponsorship information.

The ISV will initial and stamp the back of the form in the block labeled “Stamp.”

8. When the G-845S and G-845 Supplement are returned, the IMC must refer to Medicaid eligibility requirements and refer to the chart, Overview of Alien Eligibility For Medicaid, in IV. C. above to determine whether the a/r qualifies for Medicaid and the level of coverage.