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