D-5000, Citizenship and Identity

Revision 09-4; Effective December 1, 2009

An individual may become a U.S. citizen by birth or naturalization.

For Medicaid eligibility purposes, a person meets the citizenship requirement if he/she:

was born in one of the 50 states, the District of Columbia, Puerto Rico, Guam, Virgin Islands of the U.S., American Samoa, Swains Island or the Northern Mariana Islands;
was born to a U.S. citizen living abroad; or
is a naturalized U.S. citizen.

The Immigration and Nationality Act of 1952 provides that a child of unknown parentage found in the U.S. while the child is under five years old is a citizen of the U.S. unless it is shown (before the child is 21) that the child was not born in the U.S.

Note: While all U.S. citizens are U.S. nationals, persons born in American Samoa or Swains Island are technically considered non-citizen U.S. nationals. For purposes of Medicaid eligibility, "citizenship" includes these non-citizen nationals when discussed in this section. A person born in the Independent State of Samoa (formerly known as Western Samoa) is not a U.S. national and therefore is not included in the discussion of citizenship in this section.

D-5210 Child Citizenship Act of 2000

Revision 13-4; Effective December 1, 2013

The Child Citizenship Act (CCA) of 2000 amended the Immigration and Nationality Act to provide derivative citizenship to certain foreign-born children of U.S. citizens. This applies to individuals who were under age 18 on Feb. 27, 2001, and anyone born since that date. Children included in the provisions of the CCA are:

adopted children meeting the two-year custody requirement,
orphans with a full and final adoption abroad or adoption finalized in the U.S.,
biological or legitimated children, or
certain children born out of wedlock to a mother who naturalizes.

The CCA provides that foreign-born children who meet the conditions below automatically acquire U.S. citizenship on the date the conditions are met. They are not required to apply for a certificate of naturalization or citizenship to prove U.S. citizenship. These conditions are that the child:

has at least one parent who is a U.S. citizen (whether by birth or naturalization);
is under age 18;
has entered the U.S. as a legal immigrant;
if adopted, has completed a full and final adoption; and
lives in the legal and physical custody of the U.S. citizen parent in the U.S.

Adopted children automatically become U.S. citizens if they meet all of the above conditions and were:

adopted under the age of 16 and have been in the legal custody of and resided with the adopting parent or parents for at least two years;
adopted while under the age of 18, have been in the legal custody of and resided with the adopting parent or parents for at least two years, and are siblings of another adopted child under age 16;
orphans adopted while under the age of 16 who have had their adoption and immigration status approved by U.S. Citizenship and Immigration Services (USCIS) (need not have lived with the adoptive parents for two years); or
orphans adopted under the age of 18 who have had their adoption and immigration status approved by USCIS and are siblings of another adopted child under age 16 (need not have lived with the adoptive parents for two years).

USCIS, under the Department of Homeland Security, is the federal agency formerly known as the Immigration and Naturalization Service (INS) that is responsible for citizenship and lawful immigration to the U.S.

D-5220 Compact of Free Association (COFA) Citizens

Revision 21-3; Effective September 1, 2021

The Compacts of Free Association (COFA) are agreements between the United States and three independent states:

Republic of the Marshall Islands (RMI);
Federated States of Micronesia (FSM); and
Republic of Palau (PAL).

Under these agreements, COFA citizens have a special status with the U.S. which allows them to enter the country, work and acquire a Social Security number without obtaining an acceptable immigration status.

COFA citizens are considered qualified non-citizens and are exempt from the five-year waiting period and the seven-year limited period. They are eligible for full Medicaid if they meet all other eligibility requirements.

Acceptable verification of immigration status for COFA citizens includes:

I-94 or I-766 with the following Class of Admission (COA) Codes:
- CFA/RMI – Citizen of Republic of the Marshall Islands (RMI) due to the Compact of Free Association
- CFA/FSM – Citizen of the Federated States of Micronesia (FSM)
- CFA/PAL – Citizen of the Republic of Palau
I-766 Employment Authorization Document (EAD) with the following Category Code:
- A-08 Citizen of the Marshall Islands, Micronesia or Palau admitted as a nonimmigrant
An unexpired passport with annotations “CFA/RMI,” “CFA/FSM” or “CFA/PAL.”

Related Policy

Qualified Aliens Not Subject to a Waiting Period or Limited Period, D-8320

Revision 24-4; Effective Dec. 1, 2024

A person applying for or receiving Medicaid and declaring to be a U.S. citizen or national must provide evidence of citizenship. Documentation must establish both citizenship and identity.

The following primary evidence documents are acceptable as verification of both citizenship and identity:

U.S. passport
Certificate of Naturalization (N-550 or N-570)
Certificate of U.S. Citizenship (N-560 or N-561)

If a person does not provide one of these primary evidence documents to establish both U.S. citizenship and identity, the person must provide two separate documents, one document each to verify:

U.S. citizenship; and
identity.

Refer to Appendix V , Levels of Evidence of Citizenship and Acceptable Evidence of Identity Reference Guide, for other verification sources based on the reliability level of the document as proof of citizenship when primary evidence of citizenship is not available. Begin with the second level of evidence and continue through the levels to explore the most reliable source of documentation available. If a document from the second level is not used, include in the case record the reason why a more reliable source of documentation of citizenship is not available.

Example: If a hospital record of birth is used to verify citizenship, document why a second-level source was not used.

Note: If citizenship verification is not a primary-level source, that verification cannot also be used to verify identity.

Example: If a person provides a birth certificate to verify citizenship, the person must provide a different document to verify identity.

Note: Affidavits are a last resort if the person is unable to provide any other documentary evidence of citizenship.

Criteria for acceptable affidavits:

The person or their authorized representative must provide an affidavit explaining why documentary evidence does not exist or cannot be readily obtained.
Two adults, regardless of the blood relationship to the person, must each complete an affidavit.
The two adults must attest that they have proof of their own citizenship and identity. These adults are not required to submit proof of citizenship and identity.
The two adults must provide any available information explaining why documentary evidence establishing the person's claim of citizenship does not exist or cannot be readily obtained.
Affidavits must be signed under penalty of perjury.

Form H1097 , Affidavit for Citizenship/Identity, meets the required criteria.

Verification of citizenship and identity is a one-time requirement. Once citizenship is verified and documented in the case record, do not re-verify even after a break in eligibility.

If the person has a Social Security number (SSN), use all available electronic data sources (ELDS) to verify citizenship before requesting verification.

Follow the instructions in the table below if the person has not been issued an SSN yet: If the person has applied for an SSN but has not been issued one, and:	Then:
more information is required to determine eligibility	request the additional information and verification of citizenship. Allow the person 10 days to provide proof.
no other information is required to determine eligibility	allow the person a period of reasonable opportunity to provide the verification. If a reasonable opportunity period has been provided, citizenship must be verified before certifying for Medicaid.

If the person refuses or fails to provide proof of citizenship during the reasonable opportunity period, deny the person.

Note: If a person declares U.S. citizenship but cannot provide documentation, do not certify the person for ME – A&D Emergency.

Related Policy

Reasonable Opportunity to Provide, D-5500

D-5310 Exceptions to Documentation of Citizenship and Identity Requirement

Revision 13-1; Effective March 1, 2013

The following individuals are not required to provide evidence of identity and citizenship when they claim to be U.S. citizens or U.S. nationals and are:

active SSI recipients.
denied SSI recipients. If the State Data Exchange (SDX) contains the needed information to verify U.S. citizenship. Use SDX as a valid documentation source of both citizenship and identity when the denial is for any reason other than citizenship. SDX action code N13 is the denial code for citizenship.
determined to be entitled to or enrolled in Medicare Part A or B. This includes persons determined disabled for Social Security benefits who are in the 24-month period before receiving Medicare.
receiving Social Security Disability Insurance (SSDI) benefits based on their own disability.
in foster care and assisted under Title IV-B of the Social Security Act, and are beneficiaries of foster care maintenance or adoption assistance payments under Title IV-E of the Social Security Act.

Note: Neither the ineligible spouse of a person applying for Medicaid nor a parent applying for a child are required to provide evidence of citizenship and identity.

D-5320 Reserved for Future Use

Revision 24-4; Effective Dec. 1, 2024

Medicaid for the Elderly and People with Disabilities Handbook