Family and Children's Medicaid MA-3332 US CITIZENSHIP REQUIREMENTS

A data match with SSA

No further verification of citizenship or identity is needed. Allegation of citizenship consistent with SSA data. Automatically entered by EIS.

A data match with SSA.

No further verification of citizenship or identity is needed. Allegation of citizenship consistent with SSA data. Use when manually entering C/I code.

A U.S. public birth record showing birth in:

· One of the 50 U.S. States;

· District of Columbia;

· American Samoa (if born after November 4, 1986 (NMI local time));

A data match with the local register of deeds or State Vital Records or a copy of a certified birth certificate is acceptable. Do not accept a souvenir “birth certificate” issued by the hospital.

· Swain’s Island (if born after November 4, 1986 (NMI local time));

· *Puerto Rico (if born on or after January 13, 1941);

· *Virgin Islands of the U.S. (if born on or after January 17, 1917);

· *Northern Mariana Islands (if born after November 4, 1986 (NMI local time)); or

· Guam

The birth record document may be recorded by the State, Commonwealth, territory or local jurisdiction. It must have been recorded before the person was 5 years of age.

A delayed birth record document that is recorded at or after 5 years of age is considered fourth level evidence of citizenship. If recorded before 5 years of age, it is considered second level evidence.

Note: if the document shows the individual was born in Puerto Rico, the Virgin Islands of the U.S., or the Northern Mariana Islands before these areas became part of the U.S., the individual may be a collectively naturalized citizen. *Refer to VIII below, for additional requirements for Collective Naturalization.

NOTE: Only birth record documents that are issued or reissued on or after July 1, 2010 that show the individual was born in Puerto Rico are acceptable. See MA-2506/3332 VI.A.

Data Match with other state or federal agency’s database that is known to verify citizenship

Screen print the pertinent page and place in the file.

Certification of Report of Birth (DS-1350)

Consular Report of Birth Abroad of a Citizen of the United States of America (FS-240)

Certification of Birth Abroad (FS-545)

United States Citizen Identification Card (I-197 or I-179)

Northern Mariana Card (I-873)

Child adopted outside the U.S. (IR-3)

Child coming to the U.S. to be adopted (IR-4)

Adopted or biological children born outside the U.S. may establish citizenship obtained automatically under the Child Citizenship Act.

Final adoption decree

Must show the child’s name and U.S. place of birth. In situations where an adoption is not finalized and the State in which the child was born will not release a birth certificate prior to final adoption, a statement from a State approved adoption agency that shows the child’s name and U.S. place of birth is acceptable. The adoption agency must state in the certification that the source of the place of birth information is an original birth certificate.

Evidence of civil service employment by the U.S. government

Must show employment by the U.S. government before June 1, 1976.

Official military record of service

Must show a U.S. place of birth.

DOHS Systematic Alien Verification for Entitlement (SAVE) program

May be used to verify citizenship of naturalized citizens.

Extract of hospital record on hospital letterhead established at the time of the person’s birth and created at least 5 years before the initial application date, and indicates a U.S. place of birth.

Do not accept a souvenir “birth certificate” issued by the hospital.

Children under 16 only

Extract of hospital record on hospital letterhead created near the time of birth or 5 years before the initial date of application and indicates a U.S. place of birth.

Do not accept a souvenir “birth certificate” issued by the hospital.

Life or health or other insurance record showing a U.S. place of birth and was created at least 5 years before the initial application date.

Life or health insurance records may show biographical information for the person including place of birth. The record can be used to establish U.S. citizenship when it shows a U.S. place of birth.

Early school records showing a U.S. place of birth.

The school record must show the name of the child, the date of admission to the school, the date of birth, a U.S. place of birth, and the name(s) and place(s) of birth of the applicant’s parents.

Religious records recorded in the U.S. within 3 months of birth.

The record must show that the birth occurred in the U.S. and either the date of the birth or the individual’s age at the time the record was made. The record must be an official record recorded with the religious organization. Entries in a family bible are not considered recorded religious records.

Federal or State census record showing U.S. citizenship or a U.S. place of birth (Generally for persons born 1900 through 1950)

The census record must also show the applicant’s age.

Note: Census records from 1900-1950 contain certain citizenship information. To secure this information the a/r or DSS should complete a Form BC-600, Application for Search of Census Records for Proof of Age. Add in the remarks portion “U.S. citizenship data requested.” Also add that the purpose is for Medicaid eligibility. This form requires a fee.

One of the following documents that shows a U.S. place of birth provided it was created at least 5 years before the application for Medicaid.

• U.S. State Vital Statistics official notification of birth registration.

• A delayed 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, created at least five years before the initial application date, from a nursing facility, skilled care facility or other

institution

Admission papers generally show biographical information for the person including place of birth. The record can be used to establish U.S. citizenship when it shows a U.S. place of birth.

Medical (clinic, doctor, or hospital) record created at least 5 years before the initial application date that indicates a U.S. place of birth.

Medical records generally show biographical information for the person including place of birth. The record can be used to establish U.S. citizenship when it shows a U.S. place of birth. Note: An immunization record is not considered a medical record for purposes of establishing U.S. citizenship.

Children under 16 only:

Medical (clinic, doctor, or hospital) record created near the time of birth or 5 years prior to the Medicaid date of application.

Medical records generally show biographical information for the person including place of birth. The record can be used to establish U.S. citizenship when it shows a U.S. place of birth. Note: An immunization record is not considered a medical record for purposes of establishing U.S. citizenship.

Written Affidavit attesting to citizenship or naturalization:

Use only when the DSS is unable to secure evidence of citizenship listed in any other Chart.

There must be at least two affidavits by two individuals who have personal knowledge of the event(s) establishing the a/r’s claim of citizenship. At least one of the individuals making the affidavit cannot be related to the a/r. Neither of the two individuals can be the a/r.

The person(s) making the affidavit must be able to provide proof of his/her own citizenship and identity for the affidavit. If the affiant has information which explains why documentary evidence establishing the a/r’s claim of citizenship does not exist or cannot be readily obtained, the affidavit should contain this information as well.

A separate affidavit from the a/r or other knowledgeable individual (guardian or representative) explaining why the evidence does not exist or cannot be obtained must be provided.

The affidavits must also be signed under penalty of perjury by the person making the affidavit.

SOLQ Social Security number inquiry

Must have a “Social Security number verified” statement returned from the inquiry. Screen print the pertinent evidence for the file.

Data Match with other state agency’s data systems

The data match must indicate that an identity has been verified. Screen print the pertinent evidence for the file.

Driver’s license

Must have a photograph of the a/r or other identifying information of the individual such as name, age, sex, race, height, weight or eye color. Does not need to be current.

A copy of a driver’s license is acceptable with mail-in applications.

U.S. military card or draft record

School identification card

Must have a photograph of the individual

For disabled individuals in residential care facilities only:

If none of the above documents for identity are available, the disabled individual may have their identity attested to by the facility director or administrator. The affidavit must be signed under penalty of perjury.

Identification card issued by the Federal, State, or local government with the same information included on driver’s licenses.

Military dependent’s identification card

U.S. Coast Guard Merchant Mariner card

For children under 16 only:

School, clinic, doctor, or hospital records.

School records include nursery or daycare records, and report cards. School records must be verified with the issuing school.

For children under 16 only:

If none of the above documents for identity are available, an affidavit may be used. An affidavit is only acceptable if it is signed under penalty of perjury by a parent, guardian, or caretaker relative and states the date and place of birth. It cannot be used if an affidavit for citizenship was used.

Three or more corroborating documents, that together reasonably corroborate the identity of an individual provided such documents have not been used to establish the individual’s citizenship and the individual submitted second or third tier evidence of citizenship. You must ensure that no other identity evidence is available.

Such documents must at a minimum contain the individual’s name, plus any additional information establishing the individual’s identity. All documents used must contain consistent identifying information. Such documents as high school and college diplomas from accredited institutions, marriage certificates, divorce decrees, property deeds/titles, and employee ID cards may be used if the individual submitted a second or third tier citizenship document, but not if they submitted a fourth tier citizenship document.