Revision 14-4; Effective December 1, 2014

 

All U.S. citizens and nationals are entitled to apply for and receive Medicaid if they provide documentation of their citizenship and identity and meet all other eligibility requirements.

 

D-5100 Texas Administrative Code Rules

Revision 09-4; Effective December 1, 2009

 

§358.203. Citizenship and Qualified Alien Status.

(a) In accordance with 42 CFR §435.406, to be eligible for a Medicaid-funded program for the elderly and people with disabilities (MEPD), a person must be:

(1) a citizen or national of the United States (U.S.);

(2) an alien who entered the U.S. before August 22, 1996, who has lived in the U.S. continuously since entry, and who meets the definition of a qualified alien at 8 U.S.C. §1641; or

(3) an alien who entered the U.S. on or after August 22, 1996, who has lived in the U.S. continuously since entry, and who meets the definition of a qualified alien at 8 U.S.C. §1641 with the eligibility limitations in 8 U.S.C. §1612 and §1613.

(b) A person must provide proof of eligibility under subsection (a) of this section that establishes both identity and citizenship or alien status, unless the person:

(1) receives Supplemental Security Income (SSI) or has ever received SSI and was not denied due to citizenship;

(2) is entitled to or enrolled in any part of Medicare, as determined by the Social Security Administration (SSA); or

(3) is entitled to federal disability benefits based on SSA disability criteria.

 

D-5200 Citizenship

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 States

Revision 11-4; Effective December 1, 2011

 

Persons from the Compact of Free Association States (CFAS) are not considered U.S. citizens or nationals. The CFAS includes the Republic of the Marshall Islands, the Federated States of Micronesia and the Republic of Palau. Citizens of the CFAS have a special status with the U.S. that allows them to enter the country, work here and acquire a Social Security number without obtaining an immigration status. They are not eligible for Medicaid, unless they have obtained a qualifying immigration status. Those CFAS citizens who do not have one of the immigration statuses listed in Section D-8000, Alien Status, may qualify only for ME-A and D-Emergency.

 

D-5300 Acceptable Documentation of Citizenship and Identity

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
  • identity.

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.

 

D-5400 Notification

Revision 09-4; Effective December 1, 2009

 

Notify a person applying for Medicaid about the requirement to provide proof of citizenship and identity. A person receiving Medicaid must also be notified at their next annual redetermination, if proof of citizenship and identity is not already in the case record.

Use Appendix XV, Notification to Provide Proof of Citizenship and Identity, to provide information about the requirement and some of the common acceptable sources of documentation of citizenship and identity.

Add a copy of Appendix XV to each application and redetermination packet. If documentation is already in the case record (for example, SOLQ/WTPY showing Medicare entitlement or enrollment), do not add a copy of Appendix XV to the application or redetermination packet.

 

D-5500 Reasonable Opportunity to Provide

Revision 09-4; Effective December 1, 2009

 

Inform an applicant or recipient of the reasonable opportunity to provide documentation of citizenship and identity. The reasonable opportunity to provide is different for applicants and recipients. Case action will be different if the person indicates that acceptable documentation does not exist, as opposed to refusing to furnish the documentation.

 

D-5510 Initial Request at Time of Application

Revision 14-4; Effective December 1, 2014

 

Allow an applicant a reasonable opportunity to provide documentation. If the person makes a good faith effort to provide documentation of citizenship and is unable to locate or does not provide the documentation by the application due date, but meets all other eligibility criteria, do not deny the application based on the lack of documentation of citizenship. If the applicant meets all other eligibility factors except for verification of citizenship, do not delay certifying the application. Form TF0001, Notice of Case Action, instructs the applicant to submit documentation of citizenship within 95 days for each of the individuals listed on the form.

If the person refuses to provide documentation of citizenship within the 95 days, deny the application based on failure to furnish.

 

D-5520 Initial Request at Time of Redetermination

Revision 09-4; Effective December 1, 2009

 

Reminder: Because Medicare is one of the eligibility criterion for Medicare Savings Programs (MSP), documentation of citizenship is not required for MSP.

If proof of citizenship and identity is not in the case record at the time of redetermination, allow the Medicaid recipient a reasonable opportunity to provide documentation. If the person is making a good faith effort to provide documentation of citizenship and identity and is unable to locate or does not provide the documentation, do not deny eligibility based on the lack of documentation for citizenship or identity at this complete redetermination. Send a notice to the person upon completion of the redetermination informing the person that documentation must be provided by the next complete redetermination in order to continue receiving benefits.

If the person refuses to provide documentation of citizenship and identity, deny based on failure to furnish.

If a Medicaid recipient is denied for failing to provide proof of documentation of citizenship after a reasonable opportunity to provide is given, and the person later reapplies, consider the person as a new applicant when allowing a reasonable opportunity to provide documentation of citizenship and identity.

 

D-5600 Providing Assistance

Revision 09-4; Effective December 1, 2009

 

If a person is unable to provide documentary evidence of citizenship and identity in a timely manner because of incapacity of mind or body or the lack of an authorized representative to assist, assist the person in obtaining documentary evidence of citizenship and identity by referring the person to appropriate entities.

The following is a nonexclusive list of entities that may be able to provide assistance:

  • Department of Family and Protective Services, Adult Protective Services
  • Legal Aid
  • Social Security Administration
  • 2-1-1

Dialing 2-1-1 will connect persons with community-based organizations that may be able to help.

For persons born out of state, some sources to obtain a birth certificate are:

When assisting a person in providing documentary evidence of citizenship and identity, request available documents, regardless of the level of evidence. Ensure the case record comments address the situation.