Revision 13-2; Effective June 1, 2013
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 proof 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 that establish both U.S. citizenship and identity, the person must provide one document that establishes:
- U.S. citizenship; and
Levels of evidence of citizenship are documents that establish citizenship based on reliability of evidence. See Appendix V, Levels of Evidence of Citizenship and Acceptable Evidence of Identity Reference Guide. Begin with the second level and continue through the levels to explore the most reliable source of documentation of citizenship 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 document citizenship (third level), include in the case record a reason why a source from the second level is not used – "None of the second level of evidence of citizenship documents are available."
Note: When using the levels of evidence of citizenship, the same document cannot be the source to verify both citizenship and identity.
Example: If a person provides a birth certificate to verify citizenship, the person must provide a document other than a birth certificate to verify identity.
Note: Affidavits are to be used only as a last resort if the person is unable to provide any other documentary evidence of citizenship.
Criteria for acceptable affidavits:
- The person applying for or receiving Medicaid or the person's 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, incorporates the required criteria.
Documentation of citizenship and identity is a one-time activity. Once documentation of citizenship is established and documented in the case record, do not request again even after a break in eligibility. The documentation must be available and the case information must not be purged.
If the individual has a Social Security number (SSN), use Social Security Administration (SSA) records to verify citizenship by submitting a citizenship verification request via Wire Third-Party Query (WTPY). If the WPTY response indicates that citizenship is verified, no additional action is required. If the WTPY response indicates that citizenship is not verified and the individual is not exempt from providing verification of citizenship, allow the individual a WTPY Citizenship Resolution Period using policy in D-5320, Using Wire Third-Party Query (WTPY) to Verify Citizenship.
If the individual has applied for an SSN but has not been issued one and:
- additional information is required to determine eligibility, request the additional information and verification of citizenship. Allow the individual 10 days to provide proof; or
- no other information is required to determine eligibility, allow the individual a period of reasonable opportunity to provide the verification using policy in D-5500, Reasonable Opportunity. If a reasonable opportunity period has been provided, citizenship must be verified before certifying for Medicaid.
After allowing reasonable opportunity or a WTPY Citizenship Verification Resolution Period, if the applicant or recipient refuses or fails to provide proof, deny the individual until proof is provided.
If all applicants or recipients in the household refuse or fail to provide proof of citizenship, deny the Eligibility Determination Group (EDG).
Note: If a person declares U.S. citizenship but cannot provide documentation, do not certify the person for ME-A and D-Emergency.
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 Using Wire Third-Party Query (WTPY) to Verify Citizenship
Revision 13-2; Effective June 1, 2013
If an applicant has an SSN, use WTPY to verify citizenship. WTPY will return a response indicating that citizenship is verified or not verified for the individual.
If the WTPY response comes back with Codes A or C indicating citizenship is verified, take no further action unless the response also comes back with an indication of death (Code C). If this occurs, treat the death information as a change.
If the WTPY response is returned with any other code indicating that citizenship is not verified and the individual is not exempt from providing verification (see D-5310, Exceptions to Documentation of Citizenship and Identity Requirement), take the following actions:
- Review the information entered into the WTPY request with the information provided by the applicant/recipient. If a typographical error is found, submit a new WTPY request with the correct information.
- If no typographical errors are found, contact the applicant/recipient by phone to ensure the information provided is accurate. If new information is provided, submit another WTPY request with the correct information. Note: Update the case record with the correct information.
- If unable to verify citizenship via WTPY, certify the individual. Allow a WTPY Citizenship Verification Resolution Period to give the individual additional time to provide verification of citizenship using sources found in D-5300, Acceptable Documentation of Citizenship and Identity. The WTPY Citizenship Verification Resolution Period begins with the date the TF0001, Notice of Case Action, is generated.
- Generate Form TF0001 to inform the individual of the WTPY Citizenship Verification Resolution Period. TF0001 informs the individual citizenship verification is needed and lists the names of each individual who must provide citizenship verification and the due date.
The day after the WTPY Citizenship Verification Resolution Period expires, TIERS will generate an alert that will create a task. Deny the individual if he/she has not provided citizenship verification.
Applicants requesting three months prior Medicaid coverage must provide citizenship verification before prior coverage can be provided.
If the applicant was denied and later reapplies:
- Do not allow another WTPY Citizenship Verification Resolution Period to clear discrepancy. This includes situations in which an individual only received a portion of the WTPY Citizenship Verification Resolution Period. Examples: The individual moved out of state before the end of the 95-day period or an individual was added to an existing case and the case has a review due before the end of the 95-day period.
- Allow a WTPY Citizenship Verification Resolution Period to provide verification of citizenship if the individual never received the WTPY Citizenship Verification Resolution Period.
- Do not allow a WTPY Citizenship Verification Resolution Period for individuals who already received reasonable opportunity to provide proof of citizenship.