UPDATED: APRIL 2008
453.6
OTHER ELIGIBILITY REQUIREMENTS
CITIZENSHIP AND IMMIGRATION STATUS
CITIZENS
Category 1: U.S. Citizens
Category
Documentation
U.S. Citizen
Primary Documents
(Includes the 50 States,
the District of Columbia,
Puerto Rico, Guam, U.S.
Virgin Islands, Northern
Mariana Islands and
Samoa or Swain’s Island
for purposes of Medicaid)
(No other document required)
►U.S. Passport;
►Certificate of Naturalization (N-550 or N-570);
►Certificate of Citizenship (N-560 or N-561);
Note: Listed are the most
common documents used
to prove citizenship. The
list is not exhaustive and
there are other
documents that can
establish citizenship.
CITIZENSHIP
REMINDERS:
A birth certificate
can no longer be
accepted as proof
of both citizenship
and identity. If the
birth certificate is
presented as proof
of citizenship, the
worker must obtain
another form of
identity document
from the Identity
Documentation list
such as a driver’s
license; and
All documents must
be either originals or
copies certified by
the issuing agency.
Workers are required
to see original
documents or
documents certifies by
the issuing agency.
WMS Federal ACI code Financial
Participation
C
YES
SSN Requirement YES
Secondary Documents
(When primary documents are unavailable
secondary documentation also requires one
Identity document)
►U.S. Birth Certificate;
►Consulate Report of Birth Abroad of a U.S.
Citizen(FS-240);
►Certification of Report of Birth Abroad (DS-1350);
►Certification of Birth Abroad (FS-545);
►U.S. Citizen I.D. Card (I-197 or I-179);
►American Indian Card (I-872);
►Northern Mariana Card (I-873);
►Final Adoption Decree;
►Evidence of civil service employment by the U.S.
government;
►Official Military record of service (DD-214);
►Extract of hospital record on hospital letterhead
indicating a U.S. place of birth (must be established
at the time of birth and was created at least 5 years
prior to the application date);
►Life or health insurance record showing a U.S.
place of birth and was created at least 5 years prior
to application date).
►Federal or State census record showing U.S.
citizenship or a U.S. place of birth (generally for
persons born 1900 through 1950);
►Other document showing U.S. place of birth and
created at least 5 years prior to date of application:
•
Seneca Indian tribal record;
•
Bureau of Indian Affairs tribal census
records of the Navaho Indians;
•
U.S. State Vital Statistics official
notification of birth registration;
•
An amended 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.
(MRG)
C
YES
YES
UPDATED: APRIL 2008
453.7
OTHER ELIGIBILITY REQUIREMENTS
CITIZENSHIP AND IMMIGRATION STATUS
CITIZENS
Category 1: U.S. Citizens continued
Category
Secondary Documents (continued)
(When primary documents are unavailable
secondary documentation also requires one
Identity document)
U.S. Citizen (Includes the 50 States,
the District of Columbia,
Puerto Rico, Guam, U.S.
Virgin Islands, Northern
Mariana Islands and
Samoa or Swain’s Island
for purposes of Medicaid)
WMS
ACI
code
Federal
Financial
Participation
SSN
Requirement
Institutional admission papers from a nursing home, skilled nursing care facility or other institution indicating a U.S. place of birth and was created at least 5 years prior to application date . ►Medical (clinic, doctor, or hospital) record
indicating a U.S. place of birth and was created
at least 5 years prior the initial application date.
Written Affidavit: Should only be used in
rare circumstances.
•
•
•
•
•
•
A written affidavit by two people, one
of whom is not a relative of the
applicant/recipient (A/R);
Who have personal knowledge of the
events establishing the A/R’s claim of
citizenship;
The persons making the affidavit must
be able to prove his/her own
citizenship and identity for the affidavit
to be accepted;
If the person(s) making the affidavit
have information which explains why
documentary evidence does not exist
or cannot be obtained, the affidavit
should contain this information as
well.
It must be signed under penalty of
perjury by the persons making the
affidavit.
A second affidavit from the A/R or
other knowledgeable individual
explaining why documentary evidence
does not exist or cannot be obtained
must also be requested.
(MRG)
C
YES
YES
UPDATED: APRIL 2008
453.8
OTHER ELIGIBILITY REQUIREMENTS
CITIZENSHIP AND IMMIGRATION STATUS
CITIZENS
Category 1: U.S. Citizens continued
Category
Identity Documents
(One identity document must be used with
secondary citizenship documentation)
U.S. Citizen
(Includes the 50 States,
the District of Columbia,
Puerto Rico, Guam, U.S.
Virgin Islands, Northern
Mariana Islands and
Samoa or Swain’s Island
for purposes of Medicaid)
WMS
ACI
code
Federal
Financial
Participation SSN
Requirement
Certificate of Degree of Indian Blood, or
other U.S. American Indian/Alaska Native
tribal document;
►Any identity document described in
section 274A(b)(1)(D) of the Immigration
and Nationality Act (INA):
Use 8 CFR 274a.2(b)(1)(v)(B)(1). This
section includes acceptable identity
documents for Medicaid purposes:
•
•
•
•
•
•
•
Driver’s license issued by State or
Territory either with a photograph of
the individual or other identifying
information such as name, age, sex,
race, height, weight or eye color;
School identification card with
photograph of the individual;
U.S .military card or draft record;
Identification card issued by Federal,
State, or local government with same
information as driver’s licenses;
Military dependent’s identification
card;
Native American Tribal Document;
U.S. Coast Guard Merchant Mariner
Card.
(MRG)
C
Not Applicable
Not Applicable
To Identity
To Identity
documentation
documentation