6. Citizenship/Immigration Status
page 6-1
6. Citizenship/Immigration Status
If all other eligibility requirements are met, citizenship or immigration status determines the level of
Medi-Cal (MC) benefits the client is eligible for; restricted-scope MC or full-scope MC.
6.0.1
Scope of Coverage
Full-scope MC Benefits
Individuals declaring United States (U.S.) citizenship, Legal Permanent Resident status and/or children
under 19 years old status who meet all other eligibility requirements are eligible for full-scope MC
benefits.
Restricted-scope MC Benefits
Individuals who do not provide proof of U.S. Citizenship, who have legal temporary resident status or
who are undocumented who meet all other eligibility requirements are eligible for restricted-scope MC
benefits.
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Update #15-34
page 6-2
6. Citizenship/Immigration Status
6.1 Status/Medi-Cal Entitlement Chart
6.1
Status/Medi-Cal Entitlement Chart
Table 1: Citizenship/Immigration Scope of Coverage
Status
Required Verification
Covered California
Eligibility
Medi-Cal
Eligibility
APTC
CSR
QHP
U.S. Citizen
Client’s statement, birth Certificate or
naturalization papers
Full-scope
Yes
Yes
Yes
Lawfully Permanent
Resident (LPR)
USCIS Form I-551, earlier Forms I-151,
AR-3, and AR-3a (Alien Registration
Receipt Card).
NOTE: IRCA aliens with an I-551 have
one of the following class codes: R16,
R26, S16, S26, W16, W26, W36.
Foreign passport stamped with evidence of
lawful permanent residence is valid until I-551
received. If more than one year since
date of entry or date is expired or date is
blank:
Full-scope
Yes
Yes
Yes
Full-scope
Yes
Yes
Yes
1. Ask for I-551, or
2. A Secondary SAVE.
Asylee
• I-94 with stamp showing Section 208
or 208(a) of the INA
• I-94 with VISA 93 (or V-93)
• I-94 with AS-1, AS-2, or AS-3
• I-688B annotated with 274a.12(a)(5)
• I-766 annotated “A5”
• Grant letter from USCIS or Asylum
Office
• Order of an immigration judge granting
asylum under INA Section 208
Asylum Applicant
I-94 annotated as asylum applicant/I-589
applicant. Application for asylum still
pending.
Restricted-scope
Yes
Yes
Yes
Children under the age
19
none (or expired documentation)
Full-scope
*
*
*
Revised: 10/21/2016
Update #15-34
page 6-3
6. Citizenship/Immigration Status
6.1 Status/Medi-Cal Entitlement Chart
Table 1: Citizenship/Immigration Scope of Coverage
Status
Covered California
Eligibility
Medi-Cal
Eligibility
Required Verification
APTC
CSR
QHP
Citizen of Micronesia,
the Marshall Islands,
and Palau
“permanent nonimmigrants” should have
an Arrival-Departure Record, USCIS
Form I-94, annotated either CFA/FSM or
CFA/MIS
Restricted-scope
Yes
Yes
Yes
Documented client
claiming PRUCOL
(Category 1-15)
MC 13 and/or Satisfactory Immigration
Documentation (i.e. DACA, Temporary
Protected Status, etc.)
*
*
*
*
Lawful temporary
resident
I-94 (Noted with any letter A-L)
Restricted-scope
Yes
Yes
Yes
Non-citizen has applied
for adjustment to
permanent status
I-181A, Notice to non-citizen from USCIS.
Application for LPR status has been
accepted as “properly - filed.”
Restricted-scope
Yes
Yes
Yes
Non-citizen's request for
adjustment to permanent
status has been
approved
I-181B, Notice to Alien from USCIS.
Granted LPR status and will be issued an
USCIS Form I-551.
Full-scope
Yes
Yes
Yes
Refugee/Entrant/
Parolee lawfully
admitted with I-94 or
I-945(Must not have
letter A-L)
I-94 annotated with conditional entry;
political asylum, refugee, parolee.
Full-scope
Yes
Yes
Yes
Survivors of Human
trafficking
T Visa, T Visa Applicant, intent to file for
T Visa
Full-scope
Yes
Yes
Yes
Survivors of Serious
Crime
U Visa, U Visa Applicant
Full-scope
Yes
Yes
Yes
Undocumented
Immigrant
None
Restricted-scope
No
No
No
Undocumented
Immigrant claiming
PRUCOL (Category 16)
MC 13
Full-scope
No
No
No
Visitors, students,
Temporary Visas
Temporary unexpired visa, foreign
passport
Restricted-scope
Yes
Yes
Yes
* Potentially Eligible, case specific information is required to determine eligibility, Secondary SAVE may also be required.
“[Refer to Chapter 10, "Immigration”]; [Refer to Chapter 11, "Noncitizen Categories”]; [Refer to Chapter
12, "United States Citizenship and Immigrant Status (USCIS) Codes”]; and [Refer to Chapter 13,
"Immigration Documents”], for complete non-citizen information.
Revised: 10/21/2016
Update #15-34
page 6-4
6. Citizenship/Immigration Status
6.2 U.S. Citizens
6.2
U.S. Citizens
U.S. citizenship is granted to:
• U.S Born Citizens and Nationals, including individuals born in:
•
•
•
•
•
•
•
•
Any of the 50 states in the United States,
District of Columbia,
Puerto Rico,
Guam,
Virgin Islands of the U.S. (St. John, St. Croix and St. Thomas)
American Samoa
Swain's Island
Commonwealth of the Northern Mariana Islands
• Naturalized Citizens, including individuals born in another country who have met the U.S.
residency requirements and have filed for an application to be naturalized U.S. citizens.
Naturalized U.S. citizens typically obtained a legal permanent immigration status prior to
naturalization.
• Foreign-born children, under age 18, residing in the U.S. with their birth or adoptive parents, at
least one of whom is a U.S. citizen by birth or naturalization;
• Derived Citizens, certain individuals may have derived their U.S. citizenship as children prior to
their 18th birthday because one or both of their parents became citizens through naturalization.
• Acquired Citizens, individuals born in another country to U.S. citizen parent(s) may ACQUIRE
U.S. citizenship by filing an application at USCIS.
Persons with derived or acquired citizenship should present originals of one of the following documents:
• A Certificate of United States Citizenship (USCIS Form N-560).
• A United States Citizen Identification Card (USCIS Form I-197). (Not issued since February,
l981.)
• An Identification Card for the Use of Resident Citizen in the United States (USCIS Form I-179).
(Last issued in February, 1974.)
• A Northern Mariana Identification Card issued by USCIS to persons born in the Northern
Mariana Islands before November 3, 1986 who are now U.S. citizens.
• A letter, on USCIS stationery, written by an USCIS official, which states that a foreign-born
woman who married a U.S. citizen before September 22, 1922 thereby automatically became a
U.S. citizen herself.
Revised: 10/21/2016
Update #15-34
6. Citizenship/Immigration Status
page 6-5
6.2 U.S. Citizens
• A valid U.S. Passport issued by the Department of State.
• A Report of Birth: Child Born Abroad of American Parent or Parents (Dept. of State Form
FS-240) issued by U.S. embassies and consulates to United States citizens born abroad.
• A Certification of Birth Abroad (Dept. of State Form FS-545) issued by U.S. embassies and
consulates to United States citizens born abroad.
• A Certification of Birth Abroad (Dept. of State Form DS-1350) issued to United States citizens
born abroad.
No Documentation
Persons who believe that they qualify for derived or acquired citizenship should
contact either the passport office or their District USCIS office:
Passport Office of the U.S. Department of State
525 Market St.
San Francisco, CA 94105
Immigration and Naturalization Service
630 Sansome St.
San Francisco, CA 94111
Reminder:
Foreign born children of U.S. citizens must apply to USCIS or to the Department of State for
approval and documents. U.S. citizenship is not automatic. Persons who lack documentation
may not have applied for or may not have been granted citizenship. Adoptive parents must also
apply to USCIS for naturalization of their adopted child.
Citizenship Verification for Aged Persons
Citizenship records for aged individuals may no longer be available (especially if they entered the U.S.
before USCIS was established in 1924).These individuals must be referred to USCIS for
documentation.
Verification that USCIS conducted a search of its records and the outcome of the search must be
scanned in the case record when other documentation is not available. Scan a copy in IDM. No further
action is required from the Eligibility Worker (EW).
Revised: 10/21/2016
Update #15-34
6. Citizenship/Immigration Status
page 6-6
6.3 Verification Requirements for U.S. Citizens
6.3
Verification Requirements for U.S. Citizens
The federal Deficit Reduction Act of 2005 (DRA) requires U.S. Citizens and U.S. Nationals to provide
proof of citizenship and identity as a condition of eligibility for states to receive federal funding. The DRA
requirements do not apply to individuals receiving State-only MC benefits.
6.3.1
Verification of U.S. Citizenship and Identity
Acceptable verification of citizenship status and identity must be obtained for all non-exempt U.S.
citizens/U.S. national applicants and clients. If verification from the Federal Data Services Hub (Federal
Hub) or MEDS can be obtained, no other verification is required from the client. [Refer to “Federal Data
Services Hub,” section 18.5]
Note:
Children born in the U.S. to foreign sovereigns or diplomatic officers are not U.S. citizens.
Reminder:
The U.S. citizenship and identity verification requirements do NOT apply to non-citizens
including undocumented immigrants or persons receiving State only MC benefits.
Proof Already Provided
If the applicant or client’s proof of citizenship/identity is on file (i.e. applicant provided acceptable proof
at initial intake interview), but it was not previously entered, it must be entered into CalWIN and sent to
MEDS. If the DRA requirement was previously provided on a different case, that information must be
entered into the current case without the need for the client to provide the documents again. This will
satisfy the DRA requirements.
A birth record match for California-born individuals can be requested at any time. A successful birth
record match will not be overwritten by a verified or an unverified SSA Citizenship/Identity result.
6.3.2
Electronic Verification
The EW must grant full-scope benefits, without delay to clients who claim to be U.S. citizens/nationals,
or to have satisfactory immigration status if all other eligibility criteria are met (i.e. income, residency,
etc.)
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Update #15-34
6. Citizenship/Immigration Status
page 6-7
6.3 Verification Requirements for U.S. Citizens
Verified by Federal Hub
Citizenship and Identification information are now verified through the Federal Hub. When an
application is submitted or a critical data element is changed the information is checked against the
Federal Hub. The verifications status will display Pass, Fail, Pending or, Not Verified, depending on
whether the citizenship and identification can be verified electronically through the Federal Hub.
Not Verified by Federal Hub
The following process must be followed if the client’s citizenship/immigration
status cannot be initially verified via CalHEERS through the federal data hub:
Table 2: Citizenship and Identification Electronic Verification
Step
1.
If Citizenship/Immigration Status...
Cannot be initially verified via CalHEERS
through the federal data hub (i.e. because
the hub is down) or the application
information is not “reasonably compatible”
with information from the Federal Hub,
Then the EW Must...
• First use the information provided on the
application to attempt verification of
citizenship or satisfactory immigration status.
• Submit a Secondary SAVE verification request.
• Submit a copy of the manual SAVE results and
documents to be scanned into the case’s IDM file.
2.
Cannot be verified through Secondary
SAVE process,
• Provide the applicant a 90-day ROP to resolve
the inconsistency.
• Grant full-scope MC benefits while verification
of citizenship or immigration status is being
obtained to otherwise eligible applicants.
• If citizenship or immigration status cannot be
verified within the 90-day ROP, then the scope
of benefits must be reduced (to
restricted-scope) until the verification is
provided.
NOTE: This does not apply to children under the
age of 19. [Refer to “SB75,” section 6.11]
6.3.3
Electronic Birth Record Match
The Department of Health Care Services (DHCS) has implemented a process to perform an automated
birth record match with the California Department of Vital Records database for persons born in
California. Information from Medi-Cal Eligibility Data System (MEDS), Statewide Client Index (SCI) and
CalWIN is used to obtain an electronic record of U.S. citizenship.
The “Request for California Birth Record” (DHCS 0004) is used to obtain the necessary information
from the client to initiate an electronic birth record match. It may be completed by the client or by the
EW over the phone.
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Update #15-34
6. Citizenship/Immigration Status
page 6-8
6.3 Verification Requirements for U.S. Citizens
Note:
The DHCS 0004 must be scanned into IDM.
[Refer to UGSS Chapter 2.8.1 “Batch AP19 Process,” ]
6.3.4
Social Security Number Data Match
DHCS implemented a Social Security Number (SSN) matching process to verify the citizenship and
identity of MC applicants and clients who are subject to the citizenship/identity requirements.
A successful SSN data match fulfills the citizenship AND identity requirements. No further verification
is needed from the applicant or client.
The EW does not have to complete the “Proof of Acceptable Citizenship or Identity Documents” (DHCS
0011) when there is a successful SSA Citizenship/Identity verification match.
Note:
After approving full-scope MC for an eligible non-exempt applicant, review SSN data match
results available on MEDS two business days later before requesting acceptable
citizenship/identity documentations from the individual.
6.3.5
Frequency of Verification
Verification of citizenship and identity is only required once for MC. Once verification is provided or
verified electronically, it does not need to be requested again, even if the client moves from one county
to another, has a break in aid, or can show that he or she has already verified citizenship and identity in
another state’s Medicaid program (the equivalent to Medi-Cal in California).
Reminder:
PRUCOL is not an immigration status and must be verified at intake, annual redetermination
and if the client reports a change in citizenship/immigration.
6.3.6
Acceptable Citizenship/Identity Documents
To establish U.S. citizenship, an acceptable document must show a U.S. place of birth or that the
person is a U.S. citizen or national.
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Update #15-34
6. Citizenship/Immigration Status
page 6-9
6.3 Verification Requirements for U.S. Citizens
Acceptable verification for citizenship and identity are grouped as follows:
• Tier one (or Level 1) evidence is the most reliable and establishes both citizenship and identity.
• Tiers two through four are less reliable groups of documentation of citizenship only. Evidence of
identity must also be provided.
• Tier five includes identity documents.
[Refer to “Identity Proofing and Verification Examples,” page 5-40]
Note:
Expired documents are acceptable proof of citizenship/identity.
If a client originally provided a less reliable document (Tier 3 or 4) but later provides a document of
higher reliability (Tier 1 or 2), the case information must be updated to reflect the higher level of
verification
Table 3: DRA Citizenship Document Tiers 1-4
Hierarchy of Reliability of Citizenship Documents
Evidence of Highest Reliability<<<<<<<<<<<<<<>>>>>>>>>>>>>>Evidence of Lowest Reliability
Primary Documents
(Tier 1)
Establishes both
Citizenship & Identity
Revised: 10/21/2016
Secondary Documents
(Tier 2)
Must be Provided with
Identity Document
Third Level Documents
(Tier 3)
Must be provided with
Identity Document
Fourth Level Documents
(Tier 4)
Must be Provided with
Identity Document
Update #15-34
page 6-10
6. Citizenship/Immigration Status
6.3 Verification Requirements for U.S. Citizens
Table 3: DRA Citizenship Document Tiers 1-4
• U.S. passport issued
without limitation
• Certificate of
Naturalization (DHS
Forms N-550 or N-570)
• Certificate of
Citizenship (DHS Form
N-560 or N-561)
• U.S. Public Birth Record
issued before age 5 (1)
• Certification of Report of
Birth (DS-1350)
• Certification of Birth
issued by the Department
of State (Form FS-545 or
DS-1350)
• Report of Birth Abroad of
a U.S. Citizen
(FS-240)
• U.S.Citizen ID Card (Form
I-197 or I-179)
• American Indian Card
(I-872)
• Northern Mariana
Identification Card
(I-873)
• Final Adoption Decree (2)
• Evidence of Civil Service
employment by U.S.
Government showing
employment before 6/1/76
• U.S. Military Record (2)
• Extract of a Hospital
Record on Hospital
Letterhead Established at
the time of Birth (2,3)
• Life or health or other
insurance record (2,3)
• Federal or State Census
Record showing U.S.
Citizenship or a U.S. place of
birth (Generally for persons
born 1900-1950) (4)
• Seneca Indian tribal
census record (2,3)
• Bureau of Indian Affairs tribal
census record of the Navaho
Indians (2,3)
• U.S. State Vital Statistics
official notification of birth
registration (2,3)
• Amended U.S. public birth
record amended more than 5
years after the person’s birth
(2,3)
• Statement signed by the
physician or midwife who
was in attendance at the
time of birth (2,3)
• Institutional admission
papers from a nursing
facility, skilled care facility or
other institution
• Medical (clinic, doctor or
hospital) record (excludes
immunization records)(2,3)
• Written Affidavit (5)
(1) Must show birth in: one of the 50 U.S. States; District of Columbia, America Samoa, Swain’s Island; Puerto Rico (DOB on or after 1/13/41); Virgin Islands of the U.S. (DOB on or after 1/17/17), Northern Mariana Islands (DOB after 11/4/86, NMI local time); or, Guam (DOB on or after
4/10/1899).
(2) Must show U.S. Place of Birth
(3) Must have been created at least 5 years before the Medi-Cal application, unless applicant is a child under the age of 5
(4) Must show applicant’s age
(5) Affidavits should only be used in rare circumstances. An Affidavit by at least two individuals of whom one is not related to the applicant/beneficiary and who have personal knowledge of the event(s) establishing the applicant’s/beneficiary’s claim of citizenship. The person(s) making the
affidavit must be able to prove his/her own citizenship and identity for the affidavit to be accepted. A second affidavit from the applicant/beneficiary or other knowledgeable individual explaining why documentary evidence does not exist or cannot be readily provided must also be obtained.
Table 4: DRA Identity Document Tier 5
Acceptable Verification of Identity for Citizens and Nationals who do not Provide a Tier 1 Citizenship
Document
(Tier 5)
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Update #15-34
6. Citizenship/Immigration Status
page 6-11
6.3 Verification Requirements for U.S. Citizens
Table 4: DRA Identity Document Tier 5
•
•
•
•
•
•
•
•
•
•
•
Certificate of Degree of Indian Blood, or other U.S. American Indian/Alaska Native Tribal
document. (Acceptable if the document carries a photograph of the applicant or beneficiary, or has other personal identifying information relating to the individual.)
Driver’s license issued by State or Territory either with a photograph of the individual or other identifying
information of the individual such as name, age, sex, race, height, weight or eye color.
School identification card with a photograph of the individual
U.S. military identification card or draft record
Identification card issued by the Federal, State, or local government with the same identifying information
included on driver’s licenses
U.S. military dependent’s identification card
Native American Tribal document
U.S. Coast Guard Merchant Mariner card
For children under 16, school records may include nursery or day-care records
An affidavit to establish identity of children under 18 is only acceptable if signed under penalty of perjury by
a parent or guardian stating the date an place of birth of the child, and cannot be used if an affidavit for citizenship was provided (The affidavit of identity is permanently valid)
A U.S. Passport, current or expired, even if issued with limitation.
NOTE: Expired identity documents are acceptable for proof of identity.
6.3.7
Original Documents
All documents provided as verification of citizenship and identity must either be originals or copies
certified by the issuing agency. Uncertified copies or notarized copies do not meet the DRA
requirements. Clients may provide original documents in person, by mail or by an authorized
representative.
Use of Affidavits for Citizenship
Affidavits may be used in situations where no other acceptable proof of
citizenship is available. Affidavits may not be used for both citizenship and identity. In order for an
affidavit to be acceptable to establish citizenship, the following requirements must be met:
• No other evidence of citizenship can be obtained by the applicant/client.
• The affidavit(s) must be signed under penalty of perjury by at least two individuals who have
personal knowledge of the event(s) establishing the applicant’s or client’s claim of citizenship
• At least one of the individuals providing an affidavit must not be related to the applicant/client.
• The applicant/client and the individuals completing the affidavit must provide proof of their own
citizenship and identity.Copies of the witnesses original documents and forms must be scanned
into IDM.
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Update #15-34
page 6-12
6. Citizenship/Immigration Status
6.3 Verification Requirements for U.S. Citizens
• If the affidavits do not explain why other evidence is unavailable, an additional affidavit (which
provides the reason for unavailability), signed by the applicant or client or other knowledgeable
individual, must be obtained.
The following forms are used as affidavits:
• “Affidavit of Reasonable Effort to Get Proof of Citizenship” (DHCS 0003)
• “Affidavit of Identity for U.S. Citizen Children Under 18” (DHCS 0009)
• “Affidavit of Citizenship” (SCD 101 CZ).
Note:
Most children born in California should meet the documentation requirements based on a birth
record match and a signature on the application form.
Use of Affidavits for Identity
An affidavit to establish the identity of children under 18 is only acceptable if it is signed under penalty of
perjury by a parent or guardian stating the date and place of birth of the child. An affidavit for identity
cannot be used if an affidavit for citizenship was provided. If the child is 18 or older, an affidavit is not
acceptable to document the identity of the child.
The “Affidavit of Identity for U.S. Citizen Children Under 18” (DHCS 0009) may be used as verification
of identity for children under age 18.
6.3.8
Original Document Certification Forms
The “Proof of Citizenship or Identity Received” (DHCS 0005) is completed for
each individual and signed by clerical staff to certify that a document submitted for verification of
citizenship or identity is an “original” document or certified copy from the issuing agency.
• A copy of the DHCS 0005 receipt must be given to the client as a receipt that an original or
certified copy was provided.
• If an original document is received by mail, staff must immediately make a copy and date stamp
the COPY. The DHCS 0005 must be completed. The original document along with a copy of the
DHCS 0005 must be returned to the client via CERTIFIED mail with a return receipt. The copy of
the documents and the  DHCS 0005 are given to the EW and also scanned into IDM
• The original signed DHCS 0005 must be scanned into IDM - Permanent Verifications and given to
the EW along with a copy of the document(s) submitted.
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Update #15-34
6. Citizenship/Immigration Status
page 6-13
6.3 Verification Requirements for U.S. Citizens
• The EW will determine if the document submitted is acceptable or not acceptable and notify the
client of the determination.
• The “Proof of Acceptable Citizenship or Identity Documentation” (DHCS 0011) must be completed
by the EW to notify the client that they have submitted an acceptable citizenship and/or identity
document.
• The DHCS 0011 must be given to the client in person or mailed to the client after the document(s)
are reviewed by the EW.
• If the document submitted is not acceptable, the EW will inform the client that another form of
verification is necessary.
• A copy of the DHCS 0011 must be scanned into IDM under Permanent Verifications.
Note:
If a client provides documents directly to the EW either in person or by mail, ONLY the DHCS
0011 needs to be completed and given/mailed to the client.
Document Certification by CAAs
Employees of Disproportionate Share Hospitals (DSH) and Federally Qualified Health Centers (FQHC)
are qualified to view and certify original documents and complete the DHCS 0005. This includes
Certified Application Assistors (CAAs) employed by Santa Clara Valley Health and Hospital Systems
(HHS). ADHCS 0005 signed by a CAA employed by HHS is valid and is acceptable proof that the
original document was viewed.
6.3.9
Reasonable Opportunity Period
All applicants and clients must be given a “reasonable opportunity” period to provide citizenship and
identity documents. This period is defined as the time needed for the client to obtain acceptable
verification of citizenship/identity based on:
• the individual’s circumstances,
• ability to obtain the verification, and
• the Good Faith Effort.
EWs must initially allow for 90 days for the individual to provide the necessary documentation, case
comment that documentation is pending, and follow up at the end of th 90 day period. If the individual
has not provided documentation at the end of the 90 day period, the EW must explore what actions the
individual has taken to obtain the documentation. The EW must extend the ROP date if the individual is
Revised: 10/21/2016
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6. Citizenship/Immigration Status
page 6-14
6.3 Verification Requirements for U.S. Citizens
making a Good Faith Effort to obtain the proper documentation. The EW must record all actions taken
by the individual and the EW to obtain the appropriate documentation.
The “Proof of Citizenship or Identity Needed for MC Applicants and Clients Who Are U.S. Citizens or
Nationals” (DHCS 0006) is used to request verification of citizenship and/or identity from the client. The
DHCS 0001 for applicants or the DHCS 0002 for clients or the “Medi-Cal Rules Have Changed” (SCD
265) in the appropriate language must also be included, as the DHCS 0006 does not include a list of
acceptable citizenship/identity documents.
6.3.10
Clients with Mismatching SSN Results
Applicants and clients who fail the SSN data match must be sent the Information Notice “Unable to
Verify U.S. Citizenship/Identity Through the Social Security Administration” (MC 239 DRA-6). They
have 90 days from the date they receive the notice to resolve the mismatch. The 90-day period starts
seven (7) calendar days after the date of the Information Notice.
If acceptable proof of citizenship/identity is not provided or the inconsistency is not resolved with SSA,
the applicant or client’s MC must be reduced from full-scope MC to restricted-scope MC benefits with a
timely ten-day NOA.
Resolving Mismatches
If the non-exempt individual’s SSN data match is unsuccessful make a reasonable effort to address the
mismatch by checking for correctable errors (i.e. confirm SSN with client, is the date of birth correct, is
the gender correct, is the name correct, etc.) and update CalWIN with the correct information.
If mismatch cannot be resolved as described above, request the client to provide acceptable
citizenship/identity documentation OR refer the client via form MC 194 to SSA to have the inconsistency
resolved.
6.3.11
Documents Received After Restricted-scope Benefits are Granted
For applicants or clients whose benefits are reduced from full-scope MC to restricted-scope MC for
failure to provide evidence of citizenship/identity, their full-scope MC benefits may be restored back to
the month restricted-scope MC benefits began, if they provide required verification within one year of
the date of application or redetermination and any applicable retroactive months if good cause exists.
If documents are provided more than one year after the application or redetermination date, or if good
cause does not exist, grant full-scope MC eligibility effective the first of the month in which the
verification is provided.
Revised: 10/21/2016
Update #15-34
page 6-15
6. Citizenship/Immigration Status
6.3 Verification Requirements for U.S. Citizens
6.3.12
Adding a Person to an Existing Case
When adding a person who is not currently receiving MC to an existing case, that person is considered
a new applicant and full-scope MC benefits must be granted during the ROP while the individual obtains
verification of citizenship and identity.
When adding a person who was already eligible for MC, he/she is considered a client and continues to
receive ongoing MC during their ROP, if all other eligibility factors are met.
6.3.13
Good Faith Effort
An applicant/client is making a good faith effort if he/she dis trying to provide acceptable documents to
meet the citizenship/identity requirements. If a client is making a good faith effort to provide documents,
the allowable time for completing the necessary contacts and follow up to assist them must be
extended. The EW must thoroughly explain “Good Faith Effort” to the client so the client is aware that
they will be granted additional time if necessary.
Examples of good faith effort include, but are not limited to:
• Providing a copy of a request for a document sent to the appropriate agency such as, a photocopy
of a letter, a copy of an e-mail or a receipt for the requested document from the agency who will
issue the document.
• Providing copies of documents along with verification that an original or certified copy of an
acceptable document has been ordered (i.e. receipt).
Note:
If the client was born in California, initiate an AP 19 transaction for an electronic birth record
match before requiring the client to provide an original document.
• Written or verbal statements of effort to obtain citizenship documents, such as an “Affidavit of
Reasonable Efforts to Get Proof of Citizenship” (DHCS 0003).
• A written or verbal update of progress made in obtaining verification of citizenship or identity.
• A written or verbal explanation of attempts to locate two persons who could attest to the
applicant’s/client’s citizenship.
EWs must document all descriptions of a client’s good faith efforts, including dates and the expected
time the client will need to obtain documents, and the reason for the determination that a client is no
longer making a good faith effort in Maintain Case Comments.
Revised: 10/21/2016
Update #15-34
6. Citizenship/Immigration Status
page 6-16
6.3 Verification Requirements for U.S. Citizens
6.3.14
Providing Client Assistance
Staff must assist applicants/clients in obtaining verification of citizenship and identity whenever
necessary. This includes situations when a client is incapable of taking the steps necessary to obtain
the required documents due to incapacity or disability or the client is unable to provide documents for
any reason.
Examples of providing assistance include, but are not limited to:
• Reviewing and explaining acceptable verification of citizenship/identity
• Explaining how to provide proof of good faith effort to obtain documents
• Determining the possible acceptable documents that may be available to the client based on his
or her individual circumstances
• Providing any resources available such as the name, address and telephone number of the vital
statistics agency where the client can obtain the documents.
Requesting Birth Certificates
When a client is unable to provide an acceptable citizenship document and was born outside of
California, or was born in California but an electronic birth record match is unsuccessful, EWs are to
complete the “Clerical Check Sheet” (SCD 109) to request a certified copy of the client’s Birth
Certificate.
Requesting Identity Documents
When a client is unable to provide acceptable identity document, EWs are to complete and issue the
“Verification for Reduced Fee Identification Card” (DL 937) to the client to obtain a California ID from the
Department of Motor Vehicles at a reduced cost. Allow the client 10 days to provide the ID.
Note:
The DL 937 and DL933 are shelf stock forms from the DMV, copies will not be accepted. The
Office Management Coordinator (OMC) for each office maintains the supply of these forms.
There are two versions of these forms:
• DL 937 (Blue)- Reduced Fee
• DL 933 (Gold)- No Fee (only for homeless clients)
The following are guidelines on some of the ways staff can provide assistance:
Revised: 10/21/2016
Update #15-34
6. Citizenship/Immigration Status
page 6-17
6.3 Verification Requirements for U.S. Citizens
Example 1
Client born outside of California (Tier 3)
A mother is applying for herself and her child, both U.S. citizens born in another
state. Only the child has an original birth certificate. The mother has a California
Drivers License and she listed a life insurance policy on her MC application. The
EW should determine if the life insurance policy was issued over five years ago and
indicates a U.S. place of birth. If yes, the life insurance policy is acceptable proof of
her citizenship if she does not have more reliable proof. The EW will need to view
and copy the original life insurance policy.
Example 2
Lost Naturalization Papers in a Fire (Tier 2)
A family applies for MC and both parents indicate they are naturalized U.S.citizens
but have lost their naturalization certificate/papers. Prior MC case records show
alien registration numbers/documents for both parents. Initiate SAVE, if
unsuccessful, the EW will refer them to the closest U.S. Citizenship and Immigration
Services office to obtain copies of their naturalization documents.
Example 3
Deemed Eligible Infants (Exempt)
A mother applies for herself and her one child. Both were born in California but the
mother does not have original birth certificates. The child was born in 2004 while on
aid and was deemed eligible for MC at that time. The EW should initiate a request
for a MEDS birth record match for the mother by obtaining information on the DHCS
0004. No evidence of citizenship or identity is required for the child since the child
was previously deemed eligible for MC.
Example 4
No Record of Birth (Tier 4)
A granddaughter is applying for her aged grandmother with Alzheimer’s, who was
born in Kansas at home. The granddaughter states that there is no record of birth.
After determining there is no other proof of citizenship available, the EW must
explain what is required to provide an affidavit as verification of citizenship.
Requirements for the affidavit must be met in order to meet the citizenship
verification requirement.
Example 5
Some Family Members Do Not Have Verification (Tier 4)
A mother applies for MC for herself, her spouse and their three children. All family
members were born in the U.S. The family has never been on aid prior to this
application. The mother provides original birth certificates for herself and her three
children. She does not have an original or certified birth certificate for her husband.
Eligibility for all family members must be granted as soon as possible without
waiting for the husband’s verification, if all other requirements are met.
The father was born in Texas. The EW provides the client with the name, address
and telephone number of the Vital Statistics agency in Texas. In addition, the EW
completes the SC 109 to request a certified birth certificate from the state of Texas.
Revised: 10/21/2016
Update #15-34
6. Citizenship/Immigration Status
page 6-18
6.3 Verification Requirements for U.S. Citizens
Note:
EWs can find the Vital Statistics office for each state at http://www.vitalrec.com
Example 6
Disabled Individual
A disabled adult man applies for MC at a mental health facility. The applicant states
he is a U.S. born citizen but does not have any citizenship or identity verification
because he is homeless. The applicant is not currently capable of providing proof of
his citizenship. If the client was born in CA, the EW must explore the option of a birth
record match by asking for the information needed on the DHCS 0004. If the data
match is unsuccessful, the EW must complete the SCD 109 to request a certified
birth certificate and the DL 937 for the client to obtain a California ID at reduced cost,
or DL 933 for homeless clients for no cost.
Example 7
Client Has No Money to Obtain Verification
A hospitalized applicant applies for MC with the assistance of a patient advocate.
The applicant is a mother with a 19-year-old son living in the home who attends a
continuation high school. The applicant states she and her son are U.S. born
citizens but she has no birth certificates. The EW explains acceptable documents
including affidavits. The applicant states they have no funds to secure the original
document and is unable to find anyone to complete the affidavit. The EW must
complete SC 109’s to request certified birth certificates for both.
Example 8
Pregnant Woman
An applicant who is two months pregnant applies for MC. She declares U.S.
citizenship, but citizenship cannot be e-verified immediately. The client will be
granted the pregnancy aid code she is eligible for (depending on income) during the
90-day Reasonable Opportunity Period (ROP). The EW initiates a MEDS AP 19 birth
record match which is unsuccessful. The EW explains acceptable documents
including affidavits. If the client is unable to provide verification, the EW completes
the SCD 109 to request a certified birth certificate.
6.3.15
Exempt Individuals
Individuals in the following groups are exempt from citizenship and identity requirements:
• Current Supplemental Security Income (SSI) clients
Revised: 10/21/2016
Update #15-34
page 6-19
6. Citizenship/Immigration Status
6.3 Verification Requirements for U.S. Citizens
Note:
When a person loses SSI (Craig v. Bontá client) and eligibility is determined for MC-only,
verification of citizenship/identity is required. [Refer to “Craig v Bontá - Loss of SSI/SSP,”
section 50.2]
• Social Security Disability Insurance (SSDI – Title II) clients
• Social Security Retirement and Survivors Insurance (RSDI – Title II) clients who receive those
benefits based on their own disability
• Current Medicare clients
• Minor Consent applicants and clients
• MC Dialysis Only Program (Aid Code 71) applicants/clients
• Total Parenteral Nutrition (aid Code 73) applicants/clients
• Medically Indigent Long Term Care (Aid Code 53) applicants/clients
• Children receiving foster care or adoption assistance, including Kinship Guardianship Assistance
Payment (Kin-GAP) recipients
• Former Foster Youth in Aid Code 4M
• Deemed eligible infants who are born in the U.S. and are citizens (including children born to
non-citizen mothers whose delivery was covered by MC)
• Infants eligible under the Abandoned Baby Program who are born in the U.S. and have no
documentation.
Presumptive Eligibility (PE) Programs
Individuals receiving MC benefits in the following programs are exempt from the citizenship/identity
requirements when PE is established:
• Presumptive Eligibility for Pregnant Women
• Presumptive MC Eligibility under the Breast and Cervical Cancer Treatment Program (BCCTP)
• Child Health and Disability Prevention (CHDP) Gateway program
• MC Accelerated Enrollment at the Single Point of Entry National School Lunch Program.
Revised: 10/21/2016
Update #15-34
6. Citizenship/Immigration Status
page 6-20
6.3 Verification Requirements for U.S. Citizens
Note:
Clients must be placed in the appropriate aid code for ongoing MC eligibility as soon as they are
found to be otherwise eligible, if they are making a good faith effort to obtain DRA
citizenship/identity documents.
6.3.16
Citizenship Verification Process
For more information refer to Applications Chapter 5, table 5-1.
IF...
AND...
THEN...
Client Declares U.S.
Citizenship,
Client is not exempt from DRA
requirement, proof of citizenship
is not on file, and no data is on
[INQE] screen in MEDS,
The citizenship must be verified.
NOTE: Once Citizenship verification is
provided or verified electronically, it
does not need to be requested again,
even if the client moves from another
county in CA.
EW attempts to verify
citizenship via the
Federal Hub,
The results from the Federal
Hub are reasonably compatible,
The citizenship documentation
requirement is met.
Citizenship is not verified
via the Federal Hub,
A successful SSN data match is
found (INQE after 2 business
days),
OR
A successful Electronic Birth
Match (California born
individuals) is updated INQE
The citizenship documentation
requirement is met.
NOTE: A successful SSN data match
fulfills the citizenship AND identity
requirements.
Citizenship is not verified
via Federal Hub,
Cannot be verified via an
Electronic Birth Match or SSN
Data Match,
The client is eligible for full-scope MC
benefits, if all other eligibility
requirements are met, while making a
good faith effort to provide citizenship
verification.
SSN Data Match is
unsuccessful,
The EW checked for correctable
errors (i.e. typographical errors,
confirms SSN, etc) and the
mismatch cannot be resolved,
The EW refers the client to the Social
Security Administration via MC 194 to
have the inconsistency resolved.
The client is unable to
provide one of the
acceptable documents,
The client was born outside of
California, or was born in
California but an Electronic Birth
Match was unsuccessful,
The EW must request a certified copy of
the client’s birth certificate from the
agency in the state where the client was
born using the “Verification of Birth,
Death, Marriage, Divorce” (SCD 109).
(Chart page 1 of 2)
Revised: 10/21/2016
Update #15-34
6. Citizenship/Immigration Status
page 6-21
6.3 Verification Requirements for U.S. Citizens
IF...
AND...
THEN...
The Reasonable
Opportunity Period
Ends,
The client is otherwise eligible
and has not provided DRA
citizenship/identity
documentation,
Medi-Cal benefits must be reduced to
restricted-scope benefits (emergency,
pregnancy-related, state-only Long
Term Care benefits) with a timely
10-day NOA.
NOTE: The EW must clearly document
the reason for the determination that the
individual is not making a good faith
effort to obtain verification.
Documents are provided
within one year of the
application date,
The client has good cause for
not providing documentation
sooner,
Full-scope MC benefits must be
restored starting from the month that
the limited benefits began.
Documents are provided
within one year of the
application date,
The client does not have good
cause for not providing
documentation sooner,
The EW must grant full-scope MC
benefits
(Chart page 2 of 2)
6.3.17
Single Point of Entry Applications
When an application is received from Single Point of Entry (SPE), children may have presumptive
eligibility under Accelerated Enrollment or CHDP Gateway; however, citizenship/identity requirements
must be met during the application process when the EW determines ongoing eligibility for MC.
(Deemed Eligible Infants are exempt from DRA requirements.) Although SB75 grants full-scope MC to
all children, the DRA requirements still apply and verifications requested, however, the MC benefit will
not be affected if the client cannot provide verification if the client is less than 19 years old. If an
individual turns 19 years old and does not have appropriate DRA documentation the benefits will
reduce from full-scope MC to restricted-scope MC benefits.
Note:
The EW must send the “Proof of Citizenship and Identity” (DHCS 0002) to the client to inform
them of the citizenship/identity requirements along with the other required Intake informing
notices when processing an SPE application.
• If the application includes a copy of the child’s birth certificate, along with a completed DHCS
0005 that was signed by a CAA from Health and Hospital Systems certifying the original birth
certificate was viewed, no further documentation is required. The application, signed under
penalty of perjury is sufficient to meet the identity requirement for the child.
• If a birth certificate is not included with the application, and MEDS [INQE] does not contain
citizenship information, the EW must explain acceptable verification of citizenship and identity and
give an ROP to provide it.
Revised: 10/21/2016
Update #15-34
6. Citizenship/Immigration Status
page 6-22
6.3 Verification Requirements for U.S. Citizens
• If the child is under 18 and there was a MEDS birth record match or citizenship information is on
the MEDS [INQE], no further documentation is required because the application, signed under
penalty of perjury is sufficient to meet the identity requirement for the child.
• If the child is 18 or older and there was a MEDS birth record match or citizenship information is on
the MEDS [INQE] screen, the parent or guardian must still provide proof of identity for the child.
• If the client is unable to provide acceptable documents and the birth record match is unsuccessful,
the EW must complete the SCD 109 to request a certified copy of the birth certificate.
Reminder:
An affidavit is not acceptable to document the identity of a child 18 or older.
6.3.18
CalWORKs Cases
The CalWORKs citizenship and identity verification requirements fulfill the MC requirements while clients
are receiving CalWORKs. Once a client transitions to an MC only program, citizenship and identity
verification must be reported to MEDS via AP19 or a birth record match must be requested if the MEDS
[INQE] screen fields are blank. Therefore, it is recommended to report citizenship and identity
verification to MEDS for all CalWORKs clients whenever possible, as once verified, it will not need to be
requested again if CalWORKs benefits end.
6.3.19
Medi-Cal Performance Standards
The 45-day (for regular applications) or 90-day (for applications based on disability) requirement is
considered to be met if the EW has completed the eligibility determination, except for
citizenship/identity verification within 45 or 90 days.
Annual redeterminations (RD) are considered complete for purposes of performance standards if the
RD has been completed, except for the citizenship/identity verification.
6.3.20
Processing Intake Applications
The following outlines procedures when clients have not already provided acceptable
citizenship/identity documents.
Revised: 10/21/2016
Update #15-34
page 6-23
6. Citizenship/Immigration Status
6.3 Verification Requirements for U.S. Citizens
Face-to-face Interview
For non-exempt applicants who apply in person, follow the steps below
Table 5: Citizenship/Identity Verification at Intake Application Face-to-Face
Step
1.
Who
Intake EW
Action
•
•
•
•
Reviews the intake application and updates CalWIN appropriately.
Searches IDM and prior case records for Citizenship/Identity verification
Reviews for exemptions to Citizenship/Identity requirements
Reviews MEDS [INQE] for Citizenship/Identity coding
NOTE: If MEDS shows the client was active in another county and no data is present on
[INQE], contact the other county to request Citizenship/Identity document(s).
If verification...
Then
Is E-Verified
• Confirms that DRA information is sent to MEDS.
• Enters appropriate citizenship/immigration information into CalWIN
[Refer to UGSS Chapter 2.8.1 “Batch AP19 Process,” ]
Provided
• Completes DHCS 0011 and send to IDM to confirm that the EW
reviewed the documentation.
• Confirms that DRA information/coding is sent to MEDS
Not E-Verified
and
Not Provided
• Checks [INQE] after 2 business days to see if the client has a
successful SSN data match result (DOC TYPE = 2Z).
[Refer to “SSN Data Match for Citizenship/Identity,” section 4.9]
• If the client claims to have an acceptable document, allows an
additional 10 days if verifications are not provided within the original
10-day due date.
• If verifications are still not provided or client is unable to obtain
documents, completes the SCD109 to request a certified copy of
the client's birth certificate and/or DL 937 to request a CA ID. A
copy of the SCD 109 must be scanned into IDM under Permanent
Verifications.
• Ensures all contacts are documented in Maintain Case
Comments window.
Reminder: Cases must not be transferred out of Intake without either
an SSN Data Match, a California Birth Record Match, acceptable
citizenship/identity documents or an SCD 109/DL 937 on file.
2.
Revised: 10/21/2016
Intake EW
• Approves full-scope MC benefits, if otherwise eligible.
Update #15-34
6. Citizenship/Immigration Status
page 6-24
6.3 Verification Requirements for U.S. Citizens
Mail-In Applications
For non-exempt applicants using the mail-in process follow the steps below:
Table 6: Citizenship/Identity Verification At Intake Mail In Application
Step
Who
Action
1.
Applicant
Request MC in person or by phone.
2.
CST
•
•
•
•
•
•
3.
Applicant
• Chooses to mail in the application.
• Receives intake packet with 10 day due date.
• Returns application.
Completes SAWS 1/SC 41 process.
Gives/mails complete intake packet with SCD 1481/DHCS 0001 to client.
Informs client of Mail-In option or scheduling an appointment.
Complete CalWIN/MEDS File Clearance process.
Prints MEDS INQE screen and other necessary screens for each person.
Completes application registration process.
(Chart page 1 of 2)
Revised: 10/21/2016
Update #15-34
page 6-25
6. Citizenship/Immigration Status
6.3 Verification Requirements for U.S. Citizens
Table 6: Citizenship/Identity Verification At Intake Mail In Application
Step
4.
Who
Intake EW
Action
• Reviews application to determine which household members are citizens
• Searches IDM/case record for Citizenship/Identity verification
• Reviews for citizenship/identity exemptions
• Reviews [INQE] for Citizenship/Identity coding
• Processes Mail-In application, updates CalWIN queue as needed
• Approves full-scope MC benefits if otherwise eligible.
NOTE: If there is no data on [INQE] and MEDS shows client was active in another county,
contact the other county to request Citizenship/Identity documents.
If verification...
Then
Is E-Verified
• Confirms that DRA information is sent to MEDS.
• Enters appropriate citizenship/immigration information into
CalWIN [Refer to UGSS Chapter 2.8.1 “Batch AP19 Process,” ]
Provided
• Completes DHCS 0011 and send to IDM to confirm that the EW
reviewed the documentation.
• Confirms that DRA information/coding is sent to MEDS
Not E-Verified
and
Not Provided
• Checks [INQE] after 2 business days to see if the client has a
successful SSN data match result (DOC TYPE = 2Z). [Refer to
“SSN Data Match for Citizenship/Identity,” section 4.9]
• If the client claims to have an acceptable document, allows an
additional 10 days if verifications are not provided within the
original 10-day due date.
• If verifications are still not provided or client is unable to obtain
documents, completes the SCD109 to request a certified copy of
the client's birth certificate and/or DL 937 to request a CA ID. A
copy of the SCD 109 must be scanned into IDM under
Permanent Verifications.
• Ensures all contacts are documented in Maintain Case
Comments window.
Reminder: Cases must not be transferred out of Intake without
either an SSN Data Match, a California Birth Record Match,
acceptable citizenship/identity documents or an SCD 109/DL 937
on file.
(Chart page 2 of 2)
Revised: 10/21/2016
Update #15-34
6. Citizenship/Immigration Status
page 6-26
6.3 Verification Requirements for U.S. Citizens
Processing Annual Redeterminations
6.3.21
Face-to-Face Annual RD; CalWORKs/CalFresh/MC
Table 7: Citizenship/Identity at Redetermination Face-To-Face
Step
Who
Action
1.
EW
Prior to Face-to-Face Interview:
• Searches IDM and prior case files for citizenship/identity verification on file
• Reviews for Citizenship/Identity exemptions
• Reviews MEDS INQE for Citizenship/Identity coding
NOTE: If verification is not found and MEDS shows the client previously active in another county, the EW
must contact the other county to request documents.
• Reviews and updates RRR Appointment Letter (CSC 35) indicating which case members need to
provide Citizenship/Identity documents
Mails RD packet with DHCS 0002 included.
2.
Client
Requests a Face-to-Face appointment.
3.
EW
Updates the CalWIN queue as needed.
If verification...
Then
Is E-Verified
• Confirms that DRA information is sent to MEDS.
• Enters appropriate citizenship/immigration information into CalWIN
[Refer to UGSS Chapter 2.8.1 “Batch AP19 Process,” ]
Provided
• Completes DHCS 0011 and send to IDM to confirm that the EW
reviewed the documentation.
• Confirms that DRA information/coding is sent to MEDS
Not E-Verified
and
Not Provided
• Checks [INQE] after 2 business days to see if the client has a
successful SSN data match result (DOC TYPE = 2Z).
[Refer to “SSN Data Match for Citizenship/Identity,” section 4.9]
• If the client claims to have an acceptable document, allows an
additional 10 days if verifications are not provided within the original
10-day due date.
• If verifications are still not provided or client is unable to obtain
documents, completes the SCD109 to request a certified copy of the
client's birth certificate and/or DL 937 to request a CA ID. A copy of the
SCD 109 must be scanned into IDM under Permanent Verifications.
• Ensures all contacts are documented in Maintain Case Comments
window.
Reminder: Cases must not be transferred out of Intake without either an
SSN Data Match, a California Birth Record Match, acceptable
citizenship/identity documents or an SCD 109/DL 937 on file.
Note:
If the client does not keep the scheduled appointment for the CalWORKs/Food Stamps
face-to-face interview, the EW must mail the MC Application packet to the client with a 10-day
Revised: 10/21/2016
Update #15-34
6. Citizenship/Immigration Status
page 6-27
6.3 Verification Requirements for U.S. Citizens
due date
Mail in Redeterminations - Non-BSC
If the client does not keep the scheduled appointment for the CalWORKs/Food Stamps face-to-face
interview, the EW must mail the MC Application packet to the client with a 10-day due date.
If the client brings in original documents to the district office, follow the steps below:
Table 8: Citizenship/Identity Verification at Redetermination (not BSC)
Step
Who
Action
1.
Clerical
Follows standard procedure to notify the EW.
2.
CST
• Complete the DHCS 0005 to verify that original documents were received.
• Makes a copy of each document and date stamps the copy.
REMINDER: Do not date stamp the original Citizenship/Identity documents.
• Returns originals to the client immediately along with the DHCS 0005.
3.
EW
• Follows the Report Citizenship/Identity Data CalWIN process to send confirmation to
MEDS that the original documents were verified and recorded by the county.
• Completes the DHCS 0011 to verify that the documents were reviewed and accepted.
Mail In Originals
If the client mails in original documents, follow the steps below:
Table 9: Mail in Citizenship/Identity Documents
Step
1.
Who
Clerical
Action
• Receives the RD packet and/or original documents in the mail room.
• Immediately makes a copy and date stamps the copy.
REMINDER: Do not date stamp the original Citizenship/Identity documents.
• Complete the DHCS 0005 to verify that original documents were received.
• Scans the DHCS 0005 and copies of the documents into IDM.
• Provides the original DHCS 0005 and the original documents to the EW.
(Chart page 1 of 2)
Revised: 10/21/2016
Update #15-34
page 6-28
6. Citizenship/Immigration Status
6.3 Verification Requirements for U.S. Citizens
Table 9: Mail in Citizenship/Identity Documents
Step
2.
Who
EW
Action
• Completes the DHCS 0011 to verify that the documents were reviewed and
accepted.
• Returns original(s) and DHCS 0011 to the client via Certified Mail with a return
receipt.
• Follows the Report Citizenship/Identity Data CalWIN process to send
confirmation to MEDS that the original documents were verified and recorded by
the county.
NOTE: The document(s) and a copy of the DHCS 0011 must be scanned into IDM
under Permanent Verifications.
(Chart page 2 of 2)
Adding a Person
When adding a person to the MC case, follow the steps below:
Table 10: Citizenship/Identity Verification when Adding a Person
Step
1.
Who
Clerical
Revised: 10/21/2016
Action
Calls the EW to add a person (excluding DE newborns)
Update #15-34
page 6-29
6. Citizenship/Immigration Status
6.3 Verification Requirements for U.S. Citizens
Table 10: Citizenship/Identity Verification when Adding a Person
Step
Who
Action
2.
• Searches IDM and prior case files for citizenship/identity verification on file
• Reviews for Citizenship/Identity exemptions
• Reviews MEDS INQE for Citizenship/Identity coding
• Approves full-scope MC benefits if otherwise eligible.
NOTE: If verification is not found and MEDS shows the client previously active in another county, the
EW must contact the other county to request documents.
If verification...
Then
Is E-Verified
• Confirms that DRA information is sent to MEDS.
• Enters appropriate citizenship/immigration information into CalWIN
[Refer to UGSS Chapter 2.8.1 “Batch AP19 Process,” ]
Provided
• Completes DHCS 0011 and send to IDM to confirm that the EW
reviewed the documentation.
• Confirms that DRA information/coding is sent to MEDS
Not E-Verified
and
Not Provided
• Checks [INQE] after 2 business days to see if the client has a
successful SSN data match result (DOC TYPE = 2Z).
[Refer to “SSN Data Match for Citizenship/Identity,” section 4.9]
• If the client claims to have an acceptable document, allows an
additional 10 days if verifications are not provided within the original
10-day due date.
• If verifications are still not provided or client is unable to obtain
documents, completes the SCD109 to request a certified copy of the
client's birth certificate and/or DL 937 to request a CA ID. A copy of
the SCD 109 must be scanned into IDM under Permanent
Verifications.
• Ensures all contacts are documented in Maintain Case Comments
window.
Reminder: Cases must not be transferred out of Intake without either
an SSN Data Match, a California Birth Record Match, acceptable
citizenship/identity documents or an SCD 109/DL 937 on file.
Client at Outstation Office
If the client is scheduled for a face-to-face interview with an Outstation EW to bring in proof of
citizenship/identity follow the steps below:
Table 11: Citizenship/Identity at Outstation Offices
Step
1.
Who
Client
Action
Provides Citizenship/Identity documents.
(Chart page 1 of 2)
Revised: 10/21/2016
Update #15-34
6. Citizenship/Immigration Status
page 6-30
6.3 Verification Requirements for U.S. Citizens
Table 11: Citizenship/Identity at Outstation Offices
Step
Who
Action
2.
Outstation EW
•
•
•
•
•
•
Completes and signs the DHCS 0005 and gives a copy to the client.
Makes copies of the original Citizenship/Identity documents.
Date stamps the COPIES.
Returns the originals to the client immediately along with the DHCS 0005.
Places in basket to be returned to BSC for scanning.
Schedules another appointment with the client if there are still missing
Citizenship/Identity documents.
3.
Clerical
Assigns RD packet and/or Citizenship/Identity verifications to EW for document
processing.
4.
EW
• Enters appropriate citizenship/immigration information into CalWIN [Refer to UGSS
Chapter 2.8.1 “Batch AP19 Process,” ]
• Completes and updates the RRR in CalWIN.
5.
Outstation EW or
EW
• Completes the DHCS 0011 to certify client provided acceptable documents.
• Completes SCD 109 and/or DL 937 if client is unable to provide acceptable
documents from Tiers 1-5.
REMINDER: The DHCS 0011, SCD 109 and DL 937 must be scanned into IDM under
Permanent Verifications.
(Chart page 2 of 2)
Documents Received by Mail
If the client mails in proof of citizenship/identity, follow the steps below:
Table 12: Citizenship/Identity documents received by MAIL
Step
Who
Action
1.
Clerical
•
•
•
•
2.
EW
• Reviews copies of documents.
• Follows Report Citizenship/Identity Data CalWIN process to record
Citizenship/Identity Documents to MEDS for all case members.
Revised: 10/21/2016
Completes the DHCS 0005 and makes a copy.
Makes copies of original Citizenship/Identity documents.
Date stamps the COPIES.
Mails the original Citizenship/Identity documents and DHCS 0005 back to the client
via certified mail with a return receipt.
Update #15-34
page 6-31
6. Citizenship/Immigration Status
6.4 Non-citizens Eligible for Full-Scope MC Benefits
6.3.22
Follow Up Process for Pending Verifications
The following process applies to both Intake and Continuing when Citizenship/Identity verifications are
pending:
Table 13: Citizenship/Identity documentation Follow up Process
Step
Who
1.
EW
6.4
Action
• Sends DHCS 0006 with list of acceptable documents with a 10-day due date if
phone contact is not successful.
• Makes another attempt to contact the client by phone if documents are not
provided and/or there is no contact from the client.
• Extends the Reasonable Opportunity Period (ROP) if the client is making a Good
Faith Effort to obtain documents and/or the Certified copy of the Birth Certificate is
not yet received.
• Documents all contacts made in Maintain Case Comments along with any
reasonable information provided by the client which shows they are attempting to
obtain the required Citizenship/Identity verifications.
Non-citizens Eligible for Full-Scope MC Benefits
Persons Eligible
6.4.1
The following non-citizens are potentially eligible for full-scope MC benefits:
• A non-citizen who has been lawfully admitted to the United States for permanent residence.
• A non-citizen permanently residing in the United States under color of law (PRUCOL).
• Survivors of Human Trafficking or Serious Crime pursuing T Visa or U Visa status.
• Refugees & Asylees (granted Asylum)
• Deferred Action for Childhood Arrivals (DACA)
• Children up to age 19 with any immigration status
Important:
Children under age 19 cannot opt out of full-scope MC.
Revised: 10/21/2016
Update #15-34
6. Citizenship/Immigration Status
page 6-32
6.5 Inconsistent Birthdates & SAVE Process
6.4.2
Canadian Born American Indians
American-Indians born in Canada, provided that they are at least 1/2
American-Indian ancestry are considered to be lawfully admitted for permanent residence.
American-Indian ancestry must be verified by a birth or baptismal certificate issued on a Canadian
Indian reservation, tribal, or school records which establish that an American-Indian born in Canada is
of at least 1/2 American-Indian ancestry.
Note:
USCIS will issue Form I-551s to American-Indians born in Canada.
6.5
Inconsistent Birthdates & SAVE Process
Use this chart when there are birth date discrepancies between USCIS and the Social Security
Administration:
If...
6.5.1
Then...
Age is not an eligibility factor and the
non-citizen presents both USCIS and SSA
documents which show two different birth
dates.
Use the date of birth recorded by SSA and
inform the non-citizen to reconcile the
birthdate discrepancies with USCIS and SSA.
Age is the non-citizens’ only linkage with MC.
(i.e. the FPL is different for a 14 year old and a
24 year old.)
Individuals must be informed to clear up the
birthdate inconsistency with the appropriate
agency or the application will be denied or
discontinued.
Primary SAVE
Inconsistent birth dates have no effect on the primary SAVE verification process. The birthdate is not a
necessary data element in primary verifications as only the alien registration number is required.
[Refer to “Primary SAVE,” section 14.9]
6.5.2
Secondary SAVE
Inconsistent birth dates can lengthen the secondary SAVE verification process:
Revised: 10/21/2016
Update #15-34
6. Citizenship/Immigration Status
page 6-33
6.5 Inconsistent Birthdates & SAVE Process
• If the G-845 form does not have the primary verification Batch Control Number written on the form,
or
• If the photo copy of the USCIS documentation (with photographs and date of birth) is not attached
to the backside of the G-845 form.
To assist USCIS with the timely processing of the secondary verification paperwork, the EW must
indicate on the G-845 form that, “A birthdate discrepancy must be clarified because the non-citizen has
one birthdate recorded with SSA and another birthdate recorded through USCIS.”
[Refer to “Secondary SAVE,” section 14.10]
6.5.3
Acceptable Documentation
To receive full-scope MC benefits, a non-citizen’s lawful presence must be verified. If e-Verification and
SAVE are unsuccessful the client must provide acceptable documentation of satisfactory immigration
status consisting of one of the following:
I-551 Alien Registration Receipt Card
Since late August 1989, USCIS issues a USCIS Form I-551 with added antiforgery characteristics and
ten-year expiration date. The face of the card is a rose color, the laminate containing an optical variable
ink pattern reads “I-551” when the card is tilted at an angle. All codes are on the back of the I-551. The
back of the I-551 has a pink-to-blue rainbow effect shading on the top portion, the bottom portion is
white. The I-551 establishes both identity and employment eligibility for non-citizens lawfully admitted
for permanent residence.
I-151 Alien Receipt Card
The I-151 was first introduced in 1946 and has gone through sixteen revisions. The latest revision of
7/1/72 shows a photograph of either black/white or color. Some editions of the I-151 do not contain
class code information. The I-151 has been replaced by the I-551. However, the I-151 is still acceptable
proof of non-citizen status.
AR-3/AR-3a Resident Cards
These older versions of the Alien Registration Receipt Cards were issued to persons granted lawful
permanent residence. They are acceptable proof of non-citizen status, but have since been replaced by
the I-551.
I-137 Re-Entry Permit
A permit to reenter the United States.
Revised: 10/21/2016
Update #15-34
6. Citizenship/Immigration Status
page 6-34
6.5 Inconsistent Birthdates & SAVE Process
I-94-Arrival/Departure Record
Annotated with one of the following:
• Conditional Entry
• Refugee
• Cuban/Haitian Entrant
• Political Asylum
Note:
Paroled or paroleeNon-citizens are eligible for restricted-scope MC benefits only if USCIS has
not yet taken action on the application. [Refer to “Restricted-scope Benefits,” page 6-52.]
Foreign Passport Stamped
“Processed Form I-551, Temporary Evidence of Lawful Admission for
Permanent Residence valid until
Employment Authorized.” OR
“Temporary Form I-551, Admission for Permanent Residence at:
(Port)
(Date)
(Office of Issuance)
(Date)
SIGNATURE OF ISSUING OFFICIAL (TITLE)
I-181 B
Notification letter issued in connection with an USCIS Form I-181, Memorandum of Creation of Record
of Lawful Permanent Residence, which shows that an Alien Registration Receipt Card (I-551) will be
issued.
Revised: 10/21/2016
Update #15-34
6. Citizenship/Immigration Status
page 6-35
6.5 Inconsistent Birthdates & SAVE Process
G-711 Individual Fee Receipt
An Individual Fee Receipt for replacement of a lost, stolen or unreadable I-551 or I-688.
Canadian Indian Affairs Letter
A letter from the Canadian Department of Indian Affairs; a birth or baptismal record issued on a
Canadian Indian reservation; tribal or school records which establish that an American-Indian born in
Canada is of at least one-half American-Indian ancestry.
Registry Alien Status
Any person who can prove that they have lived in the U.S. continuously since before January 1, 1972
may apply to USCIS for a “Registry Alien” adjustment from undocumented status to lawful admission
for permanent residence. While the application is pending, the person has PRUCOL status.
6.5.4
Reasonable Opportunity Period
Non-citizen applicants must be given the opportunity to provide evidence of their satisfactory
immigration status (SIS). If an applicant’s immigration status cannot be initially verified through the
Federal Hub, MEDS, Primary or Secondary SAVE process the applicant must be allowed a 90-day
Reasonable Opportunity Period (ROP) to provide verification of their satisfactory immigration status.
The EW must grant full-scope MC during the ROP. If Satisfactory immigration status cannot be verified
within the 90-day ROP, the EW must reduce the benefit to restricted-scope MC.
ROP Process
Follow these steps to determine presumptive eligibility when a non-citizen applying for full-scope MC
benefits declares SIS, but lacks documentation:
1. Obtain a completed and signed MC 13 from each adult applicant or client.The non-citizen must
check the boxes indicating he/she is applying for full-scope MC benefits and that he/she has
satisfactory immigration status.
2. Inform the client to submit within 90 days, from the date the application is completed.
3. Process the full-scope MC application according to the following time frames:
Table 14: ROP Process
If the client...
Declares SIS, and is other-wise eligible, but HAS
NOT provided evidence of SIS,
Revised: 10/21/2016
Then the EW...
Grants full-scope MC benefits, follow the
Secondary SAVE process.
Update #15-34
6. Citizenship/Immigration Status
page 6-36
6.6 Eligible Immigration Status Indicator
Table 14: ROP Process
If the client...
Then the EW...
Submits documentation of permanent residence
status as outlined in the section within 90 days,
Continues to grant client full-scope MC benefits;
non-citizen verification requirements “acceptable
documentation” met. Initiate Primary SAVE.
Submits documentation showing that:
He/she is living in the U.S. with USCIS knowledge
and permission, and USCIS does not plan to
deport him/her. Non-citizen has declared SIS
under PRUCOL, checks category 1 - 15 on the
MC13, within 90 days,
Forwards the documents, with completed form
G-845 to USCIS for verification of SIS. Initiate
Secondary SAVE process.
Submits the MC 13 with category 16 selected,
Approve full-scope MC benefits, no further action
required.
Does not submit the documents within the 90-day
ROP,
Sends a timely 10-day Notice of Action
discontinuing full-scope MC benefits and reduce to
restricted-scope MC benefits. [Refer to
“Restricted-scope Benefits,” section 6.12]
Reminder:
Children under the age 19 should NOT be placed onto restricted-scope MC aid codes.
Restricted-scope MC aid codes with an age range of 0-21 should only be used for individuals age
19-21.
6.6
Eligible Immigration Status Indicator
The Eligible Immigration Status field on the Collect Non-Citizen Detail window must be filled out
correctly to grant MC and Covered California eligibility appropriately. If the EW enters NO in the
Eligible Immigration Status [Y/N] field the client might get deny in error. The EW should mark YES to
any of the lawfully present immigration statuses below:
• Humanitarian statuses or circumstances (including Temporary Protected Status, Special Juvenile
Status, asylum applicants, Convention Against Torture, victims of trafficking) Valid non-immigrant
visas.
• Lawful Permanent Resident (LPR/Green Card holder)
• Asylee (granted Asylum)
• Refugee
• Cuban/Haitian Entrant
Revised: 10/21/2016
Update #15-34
6. Citizenship/Immigration Status
page 6-37
6.6 Eligible Immigration Status Indicator
• Paroled into the U.S.
• Conditional Entrant Granted before 1980
• Battered Spouse, Child, and Parent
• Victim of Trafficking and his/her Spouse, Child, Sibling or Parent
• Granted Withholding of Deportation or Withholding of Removal, under the immigration laws or
under the Convention against Torture (CAT)
• Individual with Non-immigrant Status includes worker visas (such as H1, H-2A, H-2B), student
visas, U-visa, T-visa, and other visas, and citizens of Micronesia, the Marshall Islands, and Palau
• Temporary Protected Status
• Deferred Enforced Departure (DED)
Exception:
Deferred Action for Childhood Arrivals (DACA) is not an eligible immigration status for applying
for a Covered California health plan.
• Lawful Temporary Resident
• Administrative order staying removal issued by the Department of Homeland Security
• Member of a federally-recognized Indian tribe or American Indian Born in Canada
• Resident of American Samoa
Revised: 10/21/2016
Update #15-34
6. Citizenship/Immigration Status
page 6-38
6.6 Eligible Immigration Status Indicator
The following table summarizes how an individual’s answers in CalHEERS relate to the Eligible Immigrant Indicator
in CalWIN and whether those answers qualify an individual for full-scope MC or restricted-scope MC.
Table 15: Eligible Immigration Status Based on CalHEERS Entries
Immigration
Document Type
Selected
Immigration Status
Selected
Eligible
Immigrant
Indicator in
CalWIN
MC Scope (if all other
eligibility criteria are
met)
Any document type
except “Document or
status not listed”
Any status except
“Document or status not
listed”
YES
Full-scope (conditionally
eligible if status is not
e-verified)
Any document type
except “Document or
status not listed”
“Document or status not
listed”
YES
Full-scope (conditionally
eligible if status is not
e-verified)
“Document or status not
listed”
Any status except
“Document or status not
listed”
NO
Full-scope (conditionally
eligible if status is not
e-verified)
“Document or status not
listed”
“Document or status not
listed”
NO
Restricted-scope
(conditionally eligible- client
must complete an MC 13)
Revised: 10/21/2016
Update #15-34
page 6-39
6. Citizenship/Immigration Status
6.7 MC13
6.7
MC13
The MC13 is a tool for clients who are requesting full-scope MC but do not have documentation
indicating that they have a status which is eligible for full-scope MC AND the immigration status cannot
be verified electronically. Applicants requesting only restricted-scope MC services do not have to
disclose their citizen/non-citizen status or have it verified.
Reminder:
A non-citizen applying for restricted-scope MC benefits is not required to sign the MC 13.
If the immigration status cannot be e-verified the MC 13 must be completed at the following times:
• Application
• Reapplication
• Restoration, or whenever there is a break in aid.
• Whenever a change in non-citizen status is reported, whether or not it affects eligibility.
• A new MC 13 is not required at each redetermination unless there is a change in level of benefits
requested, or a change in non-citizen status.
• Whenever a client is requesting to change benefit level, e.g., restricted-scope MC to full-scope
MC and e-Verification or SAVE are unsuccessful.
Exception:
Children will continue to receive full-scope MC under SB75 even without an MC 13.
The MC 13 form is not required if an applicant meets one of the two conditions below:
1. Attest to being a U.S. citizen/national or to having satisfactory immigration status on the MC
application,
OR
2. Are secondary adults on a case who did not sign the application and the primary applicant
attests the individual is a U.S. citizen/national,
Revised: 10/21/2016
Update #15-34
6. Citizenship/Immigration Status
page 6-40
6.8 PRUCOL
AND
Whose citizenship/ immigration status is verified via electronic means including the federal data hub,
California birth match, or the Social Security Administration citizenship verification process.
Applicants/clients who fail to complete the MC 13 must be denied/discontinued for non-cooperation,
failure to comply with requirements.
Immigration Questions
Non-citizens who have questions regarding immigration and/or the consequences of an application
should be advised to contact the individual or attorney who is helping them with the legalization process,
or they can contact:
Catholic Charities Immigration Program
2625 Zanker Rd., Suite 201
San Jose, CA 95134
Phone:(408) 944-0691
6.8
PRUCOL
PRUCOL is a public benefits eligibility category for clients requesting MC. PRUCOL is not an
immigration status (such as Lawful Permanent Resident, Refugee, etc.) and does not imply a legal
non-citizen status, no immigration benefits result from claiming PRUCOL status. PRUCOL is used only
for benefit entitlement purposes (i.e., MC). Undocumented individuals 19 years old or older are not
entitled to full-scope MC benefits, unless they are eligible under PRUCOL and claiming to have SIS.
Reminder:
All children under age 19 receive full-scope MC, if otherwise eligible.
As a result of the court-ordered permanent injunction issued in the Ruiz v. Kizer lawsuit, PRUCOL
procedures must be initiated by the EW for non-citizens who have declared and provided adequate
documentation of SIS or who claim PRUCOL by completion of the MC 13. Full-scope MC benefits are
granted to otherwise eligible non-citizens during the time PRUCOL status is being determined by
USCIS.
Important:
Staff must never offer legal advice to persons about PRUCOL and/or their MC case.
Revised: 10/21/2016
Update #15-34
6. Citizenship/Immigration Status
page 6-41
6.8 PRUCOL
Instead, refer individuals to legal aid or to a center for immigrants' rights. The EW should NEVER advise
a client to claim PRUCOL. Just as an EW would not sign the MC13 for a client, the worker should not
advise a client to claim or not to claim any particular status. That is a decision that the client must make
on his or her own. Workers should be able to explain what PRUCOL and any other SIS category are
when a client asks. PRUCOL can be claimed for a deceased person and for children.
Undocumented individuals are not entitled to full-scope MC benefits UNLESS they are eligible as
PRUCOL AND they are claiming to have SIS. If a client provides documentation of SIS, follow the
process for the status provided (i.e., USCIS documents with a non-citizen #, initiate SAVE, institute
secondary verification., etc.). If the client does not have any documentation that supports SIS or does
not have any documents but states that he/she has SIS through completion of the MC 13, then, the MC
13 is sufficient to initiate PRUCOL. If a client checked “Yes” on #4 of Section B, one of the options on #5
must also be checked “Yes” to indicate the PRUCOL status category, thus declaring USCIS knows that
they are in the U.S. and does not intend to deport him/her, either because of the person’s status
category or individual circumstance.
Important:
When clients claim PRUCOL through completion of the MC 13, they are doing this under rules
and regulations. The EW must explain to the client that claiming SIS through completion of the
MC 13 is signed under penalty of perjury. Further explain that for PRUCOL categories 1 - 15, the
EW will seek PRUCOL determination from USCIS.
Benefit Level for PRUCOL Clients
PRUCOL is a claim of SIS and is treated like any other claim of SIS. The person claiming PRUCOL,
who is otherwise eligible, receives full-scope MC benefits until:
• Unfavorable response is received from USCIS
• The client is discontinued from MC for any reason.
• There is a change in SIS reported.
Do not to reduce benefits from full-scope MC to restricted-scope MC while we are waiting for a
PRUCOL response from the USCIS.
Reminder:
PRUCOL is not an immigration status and must be reviewed at every MC RD. The MC 13 is
only required again at RD if there is a change in status or scope of MC requested.
Revised: 10/21/2016
Update #15-34
page 6-42
6. Citizenship/Immigration Status
6.8 PRUCOL
PRUCOL Definition
PRUCOL status is not recognized by the USCIS as a real or implied legal non-citizen status. USCIS
has agreed to determine PRUCOL status for full-scope MC eligibility purposes only.
USCIS will use SAVE secondary verification to process PRUCOL requests with three variations:
• USCIS Agents, rather than USCIS status verifiers, review and act on PRUCOL requests.
• USCIS does not discuss the reasons for particular PRUCOL determinations.
• Additional information is required with USCIS form G-845, Document Verification Request.
6.8.1
Types and Categories of PRUCOL
There are three types of PRUCOL:
• Undocumented individuals in long-term care (LTC) PRUCOL
• Undocumented individuals receiving renal dialysis PRUCOL
• Other presumptive PRUCOL.
Reminder:
A person does not have to be in long-term care (LTC) or on Renal Dialysis to claim PRUCOL. If
PRUCOL cannot be applied, undocumented immigrants are still eligible for LTC, Renal Dialysis
and Foster Care funded solely by the state.
Note:
There are specific and different procedures for EWs to follow regarding undocumented
non-citizens in LTC/Renal Dialysis compared to other presumptive PRUCOL category.[Refer to
“PRUCOL for Undocumented Individuals in LTC or Receiving Renal Dialysis,” section 6.8.2]
There are 16 PRUCOL categories (MC13).
(1) A conditional entrant admitted to the United States before April 1, 1980
(2) An alien paroled into the United States, including Cuban/Haitian entrants
(3) An alien subject to an Order of Supervision
(4) An alien granted an indefinite stay of deportation
Revised: 10/21/2016
Update #15-34
page 6-43
6. Citizenship/Immigration Status
6.8 PRUCOL
(5) An alien granted an indefinite voluntary departure
(6) An alien on whose behalf an immediate relative petition (INS Form I-130) has been
approved and who is entitled to voluntary departure
(7) An alien who has properly filed an application for lawful permanent resident status
(8) An alien granted a stay of deportation for a specific period
(9) An alien granted asylum
(10) A refugee admitted to the United States since April 1, 1980
(11) An alien granted voluntary departure who is waiting issuance of a visa
(12) An alien in deferred action status
(13) An alien who entered and has continuously resided in the United States since before
January 1, 1972, who would be eligible for an adjustment of status to lawful permanent
resident pursuant to INQ Section 249 (Eligible as a Registry Alien)
(14) An alien granted a suspension of deportation whose departure INS does not contemplate
enforcing
(15) An alien granted withholding of deportation pursuant to INA Section 243(h)
(16) An alien, not in one of the above categories, who can show that: (1) INS knows he/she is
in the United States; and (2) INS does not intend to deport him/her, either because of the
person’s status category or individual circumstances
Category 1-15
For PRUCOL statuses 1 - 15, a Secondary SAVE must be manually completed for persons who will be
approved for full-scope MC. All Category 1-15 PRUCOL granted determinations are provisional and
must be initiated by the EW for non-citizens who have declared and provided adequate documentation
of SIS or who claim PRUCOL by completion of the MC 13. Full-scope MC benefits are granted to
otherwise eligible non-citizens during the time PRUCOL status is being determined by USCIS within
one year from the day that USCIS annotates the G-845.
Category 16
An individual may claim PRUCOL status by checking the box 16 on the MC 13, no further
documentation/verification required.
Revised: 10/21/2016
Update #15-34
6. Citizenship/Immigration Status
page 6-44
6.8 PRUCOL
Examples of PRUCOL individuals
• Abused aliens who have self-petitioned under VAWA but not yet received a “Notice of Prima
Facie” eligibility.
• Abused aliens who are a relative of a U.S. citizen with an approved I-130 petition but not meeting
the other requirements of battered immigrants.
• Applicants for adjustment of status.
• Applicants for cancellation of removal.
• Applicants for suspension of deportation.
• Applicants for withholding of deportation or removal.
• Cancellation of removal granted. (Note: If a person is granted cancellation of removal based on
having been abused they are a “qualified alien,” not PRUCOL.)
• Deferred action granted. (Note: If a person is granted deferred action based on having an
approved self-petition as an abused alien, they are a “qualified alien,” not PRUCOL.)
• Deferred enforced departure granted.
• Family Unity granted.
• “K” status granted. “K,” “S,” “U,” or “V” statuses, designated on a person's visa, allow holders to
work and eventually to adjust to Lawful Permanent Resident (LPR) status.
• Lawful temporary residents under the amnesty program of the Immigration Reform and Control
Act (IRCA), including those admitted under Sections 210 (“special agricultural workers”) and 245A
of the INA.
• Citizens of the Marshall Islands. These individuals have special rights under Compacts of Free
Association and are lawfully allowed to enter, reside, and work in the U.S. but are not U.S.
Nationals.
• Order of suspension granted.
• Citizens of Palau. (See Citizens of the MC Islands, above.)
• Paroled (the procedure by which USCIS allows a non-citizen to enter the U.S. without granting
him or her “admission.” It is different from the use of term in the criminal justice system) into the
U.S. for a period of one year or less.
• Residing in the U.S. since prior to January 1, 1972.
Revised: 10/21/2016
Update #15-34
6. Citizenship/Immigration Status
page 6-45
6.8 PRUCOL
• Eligible to petition as special immigrant juveniles. These are juveniles who have been declared a
“dependent of the state” and eligible for long-term foster care due to abuse, neglect, or
abandonment.
• Stay of deportation granted.
• Stay of removal granted.
• Suspension of deportation granted. (Note: If a person is granted suspension of deportation based
on having been abused they are a “qualified alien,” not PRUCOL.)
• Voluntary departure granted - definite time.
• Voluntary departure granted - indefinite time.
6.8.2
PRUCOL for Undocumented Individuals in LTC or Receiving Renal
Dialysis
Per Senate Bill 175, Ruiz v. Kizer, and Crespin v. Kizer, the following PRUCOL procedures must be
followed for undocumented non-citizens who apply for or receive full or restricted-scope benefits
because they are in LTC or are receiving renal dialysis.
Do NOT request these special PRUCOL procedures for:
• Undocumented non-citizens who are not currently in LTC or receiving renal dialysis services.
• Any patient currently on a waiting list for dialysis. They are not entitled to full-scope MC benefits.
The client must already be in an LTC facility, not waiting to get in.
• Undocumented non-citizens who check the last PRUCOL category, Section B #5 of the MC 13.
The client’s situation must be considered whether the client has already met the LTC status and is
already in LTC facility. LTC status is defined as inpatient medical care which lasts for more than the
month of admission and is expected to last for at least one full calendar month after the month of
admission. An LTC facility is defined as a medical institution or nursing facility, including: acute care
hospitals (i.e. VMC), psychiatric hospitals, intermediate care facilities and skilled nursing facilities.
Important:
Transfers from one nursing home or medical institution to another do not affect long-term care
status, as long as the patient does not go home or to board and care. (e.g. patient admitted to
VMC 0n 2/17 and discharged to nursing home on 3/4 and is expected to remain through 3/31 or
longer.)That means, PRUCOL can be granted as soon as the client has met the LTC status and
is in LTC facility per above definitions.
• Non-linked non-citizens eligible for State-Only LTC Aid Code 53 benefits.
Revised: 10/21/2016
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6. Citizenship/Immigration Status
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6.8 PRUCOL
• Non-citizens who claim to have citizenship or lawful resident status, but who do not have
documentation. They shall be treated according to PRUCOL procedures [Refer to “Reasonable
Opportunity Period,” section 6.3.9].
PRUCOL Procedures for Undocumented Individuals in LTC or Renal Dialysis
The following procedures apply to undocumented individuals who check any box from 1 - 15 in Section
B5 of the MC 13:
PRUCOL for New Applicants
Table 16: PRUCOL for New Applicants in LTC or Renal Dialysis
Step
Action
1.
Have the applicant read the “Applicant PRUCOL Notification Letter” SC 1627, prior to
completion of the MC 13.
2.
The applicant must complete the MC 13 as follows:
• Request full benefits.
• Claim PRUCOL status by checking any box from 1 - 15 in Section B 5.
3.
The applicant (or representative) must complete the “G-845 PRUCOL” (MC 845).
4.
Allow the applicant 30 days, or the period of time it takes to clear eligibility, whichever is
longer, for the return of the MC 845.
• Review MC 845 to ensure the client/representative supplied requested information and
documents (if any). No sections can be let blank.
• If the MC 845 is completed and returned within 30 days, and MC is subsequently
approved, establish full benefits once eligibility is cleared.
• If the MC 845 is not returned within 30 days, nor by the time eligibility is cleared after
30 days, establish restricted-scope benefits.
• Notify the applicant that the MC 845 must be completed and returned so that full
benefits can be granted.
• If the MC 845 is completed and returned after the 30 days, or after eligibility is cleared,
change to full-scope MC benefits effective the first of the month that the MC 845 is
received.
• Spltr 484 is available for use when the MC 845 must be returned to the client for more
information.
5.
Submit the completed MC 845 to USCIS with the Document Verification Request,
(G-845).
• Check “other” in Box 8 of the G-845 and write PRUCOL REQUEST” in the open space.
• Do not check any other square within Box #8.
• Send the original forms to USCIS, following the standard secondary SAVE
6.
Scan a copy of the MC 845. If the verification is e-Verified, confirm that DRA information
is sent to MEDS. If the verification is NOT e-Verified, continue to step 4.-845S in IDM.
Set a case alert for a 30-day follow up.
PRUCOL for Continuing Cases
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6. Citizenship/Immigration Status
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6.8 PRUCOL
Persons who are receiving restricted-scope benefits and who are in LTC or are receiving renal dialysis
must be changed to full benefits:
• Effective the first of the month that SIS status based on PRUCOL is claimed.The non-citizen must:
• Complete an MC 13 requesting full benefits, and
• Check the last PRUCOL box Section B, #5 on the MC 13.
• Follow procedural requirements for completion and referral of the MC 845 to USCIS as discussed
in “PRUCOL for New Applicants.” if one of the boxes 1-15 is checked on Section B 5 of the MC
13.
6.8.3
Other Presumptive PRUCOL
Individuals who claim SIS based on PRUCOL, with or without documentation, fall in the category of
“other presumptive PRUCOL.” For this category, there is no 30-day time frame as the client is not
required to produce a document. However, there are instances where the individual claims that he/she
is able to produce or have documentation of SIS and must be given time to submit such within 30 days.
If later, he/she fails to provide, then his/her claim for PRUCOL via completion of MC 13 is sufficient to
grant full-scope MC if other eligibility requirements are met.
Individuals who initially declared undocumented status who later seek PRUCOL status, must be
allowed to complete a new MC 13 declaring PRUCOL status by checking Yes” on #4 of Section B and
one of the options on #5 must also be checked.
Table 17: Other Presumptive PRUCOL
Step
Who
Action
1.
Client
• Requests full-scope MC benefits
• Completes the MC 13 or Submits documentation of SIS:
• The documentation does not need to be a USCIS document, it can be a
statement from an attorney or someone who is helping the applicant
adjust/obtain their documentation.
• The documents must indicate that the applicant is in the U.S. with USCIS
knowledge and permission, and that USCIS does not plan on initiate
deportation action.
• Checks the “yes” in section B #4 and checks one of the options on #5
category 1-16.
2.
EW
IMPORTANT: For individuals who select category 16 on the MC 13, do not
complete the G845 process.
• Completes a G845, check Other in Box #8 and write “PRUCOL Request” in
the fillable area. (Do not check any other square within Box #8. Attach a
copy of the document provided.
• Send a copy of the G845 to IDM.
• Sent the original G845 form and documentation to USCIS, following the
Secondary SAVE process.
(Chart page 1 of 2)
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6. Citizenship/Immigration Status
6.8 PRUCOL
Table 17: Other Presumptive PRUCOL
Step
3.
Who
Client
Action
Continues to receive full-scope MC benefits until there is a negative
determination or a change in status.
(Chart page 2 of 2)
6.8.4
USCIS Responses on the G 845
The USCIS will response to the G845 with the following entries:
• USCIS will list in Box 8 the USCIS case number (e.g., LOS-17-0123). The middle digits indicate
the current year.
• USCIS will check Box #14 if they cannot respond with the information submitted. (USCIS will ask
the EW to provide additional information, and to resubmit the G-845.)
• Upon a PRUCOL determination, USCIS will check Box 17 or 18.
• The “Stamp” box at the bottom of page 1 will have the date, location and signature of the USCIS
verifier.
• USCIS should respond to the PRUCOL request within 30 days. Set up a case alert for a 30-day
response follow up.
• If USCIS determines that they did not receive the PRUCOL request, complete a new G-845,
attach a copy of the MC 845 and resubmit to USCIS. (Set another 30-day tickler for follow-up.)
PRUCOL Approved
When box #18 of the G845 is checked by USCIS, the statement “USCIS is not actively pursuing the
expulsion of an non-citizen in this class/category at this time” means that the client is PRUCOL.
• The client is entitled to receive full-scope MC benefits, if he/she remains otherwise eligible.
• Scan the returned G-845 into IDM (Permanent Verification) as proof of PRUCOL based on SIS.
PRUCOL Denied Aid Code
When box #17 of the G-845S is checked by USCIS, the statement “USCIS actively pursues the
expulsion of a non-citizen in this class/category” means that the client is NOT PRUCOL. [Refer to User
Guide to State Systems Update 2008-7 New Alpha-Numeric Aid Codes – C1 to C9 and D1 to D9].
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6.9 Expiration of Documents
PRUCOL for Documented Applicants
When a documented individual claims the last PRUCOL category on the MC 13, the EW
must contact the MC Program Coordinator who will refer the applicant to the State for a review
to ensure they receive the correct level of benefits based on their known immigration status
or other relevant information i.e., survivors of domestic violence, trafficking or other serious
crimes.
6.9
Expiration of Documents
Expired USCIS documents of any kind are acceptable verification of non-citizen status.
Exception:
DACA status cannot be verified using expired documentation.
6.10
DACA
On June 15, 2012, Deferred Action for Childhood Arrivals (DACA) was approved. Individuals who
qualify under DACA may refer to themselves as “part of the Dream Act”, “Dreamers”, or “Immigrant
Youth”.
Participants must:
• Have arrived in the U.S. before the age of 16
• Have lived in the U.S., continuously, since June 15, 2007
• Be under the age of 31 as of June 15, 2012
• Not have lawful immigration status as of June 15, 2012
• Be pursuing education or military service
• Not have any prior convictions (felony or significant misdemeanor)
• Be Physically present in the U.S. on June 15, 2012 and at the time of requesting DACA
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6.11 SB75
DACA individuals, if otherwise eligible for MC, are eligible to receive full-scope MC benefits. However,
DACA individuals are not eligible for Advanced Premium Tax Credit (APTC), Cost Sharing Reduction
(CSR) or a Qualified Health Plan (QHP). DACA individuals are considered Category 12 PRUCOL
individuals on the MC13, “an alien in deferred action status”.
If the individual claims DACA status but is unable to provide verification of that immigration status the
EW must allow a 90-day ROP for verification. Full-scope MC benefits must be granted to the individual
while the DACA immigration status is verified, if the individual is otherwise eligible for MC.
6.11
SB75
State of California Senate Bill 75 (SB75) grants full-scope MC for all children under age 19, who do not
have satisfactory immigration status or who are unable to verify satisfactory immigration status or
citizenship.
Individuals under 19 years old cannot opt-out of full-scope MC benefits under SB75.
DRA and SIS verification requirements are federal regulations that still apply. If an individual under 19
years old is unable to provide DRA or SIS verifications he or she will be eligible for full-scope MC under
state funded SB75. DHCS will track clients who have failed to provide DRA/SIS documents with the
citizenship indicator on the Medi-Cal Eligibility Data System (MEDS).
Reminder:
If a child is potentially an Unaccompanied Refugee Minor (URM) who has not yet received the
certification letter from the Office of Refugee Resettlement (ORR) the child should be evaluated
for regular MC. Once granted the URM status the client should be forwarded to Foster Care (FC).
[Refer to MC Unaccompanied Refugee Minor (URM) and FC Unaccompanied Refugee Minor
(URM)].
Note:
Restricted-scope MC aid codes are not available to individuals under age 19. The
restricted-scope MC aid codes with an age range up to 21 will still be used for individuals age 19
to 21 years old.
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6.11 SB75
6.11.1
SB75 Age Policy
SB75 grants full-scope MC to children under age 19. Children who turn 19 years old are no longer
eligible for full-scope MC under SB75. If a client continues to meet all other eligibility requirements for
MC, the first full month that he/she is 19 years old the client will return to restricted-scope MC.
19 Year Old Household Income
The household income must be below 138% for a client to switch from full-scope MC to
restricted-scope MC automatically following the 19th birth date.
Clients who turn 19 and have income over 138% are eligible for Soft Pause. Ongoing eligibility must be
determined before the client can be discontinued from MAGI MC.
Example:
Manuel turns 19 years old on 7/8/2016 and the household income is less than 138% FPL.
Manuel will receive restricted-scope MC on 8/1/2016.
Example:
Sami turns 19 years old on 7/8/2016 but the household income is 200%FPL. Sami will be
placed on Soft Pause as of 8/2016, to allow the EW time to screen for any other programs Sami
may be eligible for.
19 Year Old NOA
If an individual turns 19 and did not receive a timely notice the EW can restore eligibility for the
individual manually using aid code 38 to continue full-scope MC, until restricted-scope MC is granted (if
eligible) and a timely notice is provided.
6.11.2
Income changes (Under 19 Years Old)
If household income goes above the income limit for MC for children under 19, the child will lose
full-scope MC eligibility. Affected children should be evaluated for other programs they may be eligible
for including Non-MAGI, APTC, and/or QHP. Initially the child may be placed onto Soft Pause at which
point they should be evaluated for Continuous Eligibility for Children (CEC). Undocumented clients are
not eligible for Covered California health plans (APTC/QHP), the client should be offered restricted-scope
MC with Share of Cost (SOC), or referred to Healthy Kids, Kaiser Kids, Valley Kids, Ability to Pay, or
directed to health insurance carriers directly.
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6.12 Restricted-scope Benefits
Example:
Merica is 13 and she is undocumented. The household income increases to 300% FPL. The
EW updates CalWIN with the increased income and the clients are placed onto Soft Pause. The
EW completes an ex-parte review and/or sends the Non-MAGI MC Screening Packet to the
clients; however, the parents decline a Non-MAGI MC evaluation or do not provide the
information. The EW refers the clients to Healthy Kids and terminates the CalWIN case.
6.11.3
Managed Care/Fee-For-Service
Children receiving full-scope MC under SB75 clients are subject to Managed Care requirements and
will receive the Health Care Options choice packet; new enrollees can select the Managed Care plan by
calling or returning the packet. If no plan is chosen, DHCS will assign a plan.
Note:
Fee-for-Service (FFS) refers to the way providers are paid by the state. Clients with FFS MC are
responsible for asking the provider if they will accept payment from MC before services are
received. Not all providers accept MC.
6.12
Restricted-scope Benefits
Restricted-scope MC benefits are limited to emergency care and pregnancy-related services.
Individuals can apply for and maintain restricted-scope MC year round, even if a current emergency or
pregnancy does not exist.
Non-citizens eligible to receive restricted-scope benefits include the following persons:
• A non-citizen 19 years old or older with no documentation to prove SIS.
• A non-citizen 19 years old or older legally admitted to the U.S. for a limited period (i.e. temporary
visa).
• A U.S. citizen applicant/client 19 years old or older who has not provided acceptable proof of
citizenship/identity at the end of the reasonable opportunity period (ROP).
6.12.1
Eligibility
Individuals applying for restricted-scope MC must:
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6. Citizenship/Immigration Status
6.12 Restricted-scope Benefits
• Be a California Resident. or have intent to reside in CA.
• Meet all other requirements for program eligibility.
6.12.2
SSN Requirement
Social Security numbers are not required for anyone who is only applying or eligible for restricted
benefits.
• If the client's SSN is known from other means, i.e., already on file, on MEDS, on earnings
statements, etc., it must be used for IEVS and for any other MC related purpose.
• Follow current pseudo number procedures if the SSN in unknown. [Refer to “Allowable Changes,”
section 3.3.2]
Reminder:
If an individual has an SSN and chooses to give this information or it is known from other
means, the EW must record the SSN in Display Individual Demographics Detail window. An
IEVS applicant transaction is then generated.
Note:
An SSN is not required for Victims of Human Trafficking and Serious Crimes to receive MC
benefits. [[Refer to “TCVAP (T Visa/U Visa),” section 40.14]
6.12.3
Emergency Care
The medical provider, not the EW, determines if the medical service is an “emergency”. The emergency
must be certified by a physician or other appropriate medical provider. DHCS may review the provider's
decision that an emergency existed and that certain follow-up treatment services were medically
justified.
A medical emergency is generally defined as “a medical condition manifesting itself by acute symptoms
of sufficient severity, including severe pain, which in the absence of immediate medical attention could
reasonably be expected to result in any of the following:
• Placing the patient's health at risk,
• Serious damage to bodily functions, or
• Serious harm to any bodily organ or part.”
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6.13 Questions and Answers
6.12.4
Pregnancy Services
Pregnancy related services include prenatal care, labor and delivery, 60-day postpartum services and
family planning services which may continue after the sixty-day postpartum period.
6.12.5
Undocumented Non-citizens and Visas
Undocumented non-citizens and non-citizens with unexpired temporary visas (students or visitors) may
qualify for restricted benefits if they:
• Are otherwise linked and eligible for MC, and
• Also meet California residency requirements.
Example:
A single adult undocumented non-citizen, age 50, applies for MC. He claims to be disabled, has
income less than 138% FPL and meets all other MC eligibility requirements, including intent to
remain in California. A DDSD packet is completed; and he is approved on a restricted-scope
MAGI MC aid code.
Reminder:
Undocumented non-citizens age 19 years or old are not entitled to full-scope MC benefits
unless they are eligible under PRUCOL and they are claiming to have SIS.
6.12.6
Undeclared Status
Any person who does not wish to declare or verify citizenship, immigration status, social security
number or birthplace may only receive restricted-scope benefits.
6.13
Questions and Answers
The following are commonly asked questions related to citizenship/identity verification:
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6.13 Questions and Answers
Automated Birth Record Matches
Question 1:
Does an application signed under penalty of perjury need to indicate a child’s date
and place of birth to be acceptable proof of identity for a child under 18?
Answer 1:
Yes, a signed application must include the date and place of birth, to be accepted as
an affidavit of identity for children under 18.
Question 2:
If a person provides a Passport or other Tier 1/Tier 2 citizenship verification and has
not yet posted to MEDS, is there a need to request a birth record match?
Answer 2:
No. If a person provides a Passport or other acceptable verification, MEDS must be
updated with the information. A birth record match is not required if an applicant or
client provides other acceptable evidence of citizenship. MEDS has been modified
to automatically check for a birth record match when a transaction contains
information indicating a client was born in California and includes the client’s birth
name. This automatic check will occur even if a birth record match has not been
specifically requested.
Exempt Persons
Question 3:
Are Former Foster Care Children exempt from the DRA requirement?
Answer 3:
Yes, they are exempt while in Aid Code 4M.
Question 4:
Which exempt categories are exempt indefinitely and which are not?
Answer 4:
An individual is exempt from the DRA citizenship and identity requirement only if
they are currently in an exempt status, with the exception of the following:
a. Deemed eligible infants who are born in the U.S. (includes children born
to non-citizen mothers and whose delivery was covered by MC); and
b. Infants eligible under the Abandoned Baby Program who are also born in
the U.S. and have no documentation.
Question 5:
What is Retirement and Survivors Disability Insurance (RSDI) that is received based
on a person's own disability?
Answer 5:
Recipients receiving RSDI based on their own disability are those who have not
worked the required quarters themselves but are entitled to receive retirement or
survivor’s benefits based on a spouse’s or parent’s work quarters and are
determined disabled by SSA. This group includes Disabled Adult Children and
Disabled Widows/Widowers. These recipients are between the ages of 18 and 65.
This group may be hard to identify with their Award letter as their eligibility can shift
over time (for instance they may start receiving retirement based Social Security
after age 60 or 62 if they have accrued work quarters of their own). If it is not clear
whether a recipient is receiving Social Security benefits because of their own
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6.13 Questions and Answers
disability after viewing the Award letter, the EW must contact SSA. This is necessary
because there is no reliable information in MEDS to identify persons receiving RSI
based on their own disability.
Question 6:
Are recipients of Railroad Retirement benefits exempt?
Answer 6:
No. However, individuals who are receiving or eligible to receive railroad retirement
benefits can be eligible for Medicare. Individuals receiving Medicare are exempt.
Question 7:
If an applicant is not exempt from citizenship/identity requirements at the time of
application, but meets one of the exemption criteria while they are making a good
faith effort, do we grant full-scope MC back to the date of application?
Answer 7:
Yes.
Question 8:
When a foreign-born applicant or client claims to be a U.S. citizen and is exempt
from citizenship/identity requirements based on current receipt of Supplemental
Security Income (SSI) or Medicare, is it necessary to obtain verification of
citizenship?
Answer 8:
No. The EW must not require citizenship or identity verification for any individual who
claims to be a U. S. citizen and is exempt from the requirement.
Question 9:
If a MC applicant without a birth certificate is in pending status for three months, and
then starts receiving Social Security Disability Insurance, should the EW approve the
case with full-scope benefits from the date of application and obtain proof of their
status as verification for those few months?
Answer 9:
Approve full-scope MC from the date of application including eligible retroactive
months. If SSDI is approved while the application is pending, no additional
verification of citizenship identify is required for the months before SSDI benefits are
approved. Proof of citizenship/identity is not needed if an applicant has met SSA
requirements for SSDI.
Question 10:
Are children in Foster Care (aided under Aid Code 45) exempt from the DRA
citizenship/identity requirements?
Answer 10:
Yes.
Question 11:
Are former SSI/Medicare recipients exempt?
Answer 11:
No. Former SSI or Medicare recipients are not exempt from citizenship/identity
requirements. Individuals who are no longer receiving those benefits are not
exempt. If a MC client's DRA exemption status changes to non-exempt, they must
be treated as a client for purposes of DRA citizenship/identity requirements and
must continue to receive full-scope MC during the reasonable opportunity period.
Question 12:
Revised: 10/21/2016
When a person is terminated from SSI for citizenship reasons, will SSA update
MEDS data to indicate the person has not provided required information?
Update #15-34
6. Citizenship/Immigration Status
page 6-57
6.13 Questions and Answers
Answer 12:
Yes. The “N13” value in the Payment Status field of the INQX screen in MEDS
indicates that the client is “Not a citizen or is an ineligible alien.”
Question 13:
For a former SSI client who is no longer exempt, but has filed a timely appeal with
Social Security, when does this individual have to comply with citizenship/identity
requirements?
Answer 13:
The client must comply once an outcome of the appeal is determined. If they
remain on SSI, there would be no need to provide DRA verification. If they lose their
SSI appeal, and are not exempt on some other basis, they are treated as a client
and proof of citizenship/identity must be requested immediately. The client must
continue to receive full-scope MC during the reasonable opportunity period.
Presumptive Eligibility: Accelerated Enrollment
Question 14:
When is proof of citizenship/identity required for children who are on Accelerated
Enrollment (AE) and Child Health and Disability Prevention (CHDP)?
Answer 14:
The EW must ask for proof of citizenship/identity when evaluating ongoing MC
eligibility. However, children on AE and CHDP Gateway must stay in an AE or CHDP
Gateway Aid Code until the EW makes a determination of MC eligibility. The
AE/CHDP benefits continue until the end of the reasonable opportunity period or
until the determination of ongoing MC eligibility.
Question 15:
Is a person who is presumptively disabled exempt from citizenship/identity
requirements?
Answer 15:
No. Presumptive disability is not a basis for an exemption from citizenship/identity
requirements. Presumptive disability is not the same as Presumptive Eligibility.
Acceptable Documents
Question 16:
Is a hospital Birth Confirmation Report acceptable as a Birth Record for DRA
citizenship purposes?
Answer 16:
No, it is not acceptable as a Birth Record for DRA purposes; however it is
acceptable as a Tier 3 “extract of a hospital record.”
Question 17:
Is a passport card an acceptable document for citizenship/identity purposes under
the DRA rules?
Answer 17:
Yes, a passport card is acceptable as a Tier 1 document under DRA rules. It must
be treated the same as a passport without limitations and coded as a “1A” document
type in MEDS.
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6.13 Questions and Answers
Question 18:
Children approved for free school lunches can apply for MC using the National
School Lunch Program (NSLP) application [Refer to “Express Enrollment for
Children in the National School Lunch Program,” section 5.24]. Since the application
is completed under penalty of perjury, is the signature on the NSLP application the
equivalent of a signature on the SSApp for verification of identity for children under
18?
Answer 18:
No, the NSLP application is not acceptable proof of identity for DRA purposes. An
identity document must show the date and place of birth of the child and signed
under penalty of perjury. The NSLP application does not meet these requirements.
The NSLP application is used to establish presumptive eligibility for MC.
Question 19:
Are birth registration cards from the office of vital statistics, with an official seal that
indicates a place of birth acceptable for citizenship verification?
Answer 19:
Yes. Birth registration cards from the office of vital statistics, with an official seal that
indicates a place of U.S. birth are acceptable.
Question 20:
Is an Abstract of Birth from a County acceptable proof of citizenship?
Answer 20:
Yes. An abstract of birth showing a U.S. place of birth is acceptable verification of
citizenship if it is an original or certified copy.
Question 21:
If an individual provides a document that is not listed in any of the tiers of acceptable
proof, the EW must forward a copy to the MC Coordinator for a state decision. If the
state confirms it is acceptable, how do we code this on MEDS?
Answer 21:
Question 22:
Answer 22:
Only the state can enter the Document Type code in MEDS.
If citizenship is verified through SAVE for an immigrant who is now a naturalized
citizen, can we can grant full-scope benefits back to the month of application and
cover any retro months for which the applicant is eligible?
Yes
Question 23:
Is a marriage certificate that indicates a U.S. place of birth and date of birth an
acceptable document for citizenship?
Answer 23:
No. A marriage certificate cannot be used as an acceptable document for
citizenship. However an original or certified copy of a marriage certificate along with
two other corroborating identity documents may be used to establish identity.
Question 24:
Does a parent, guardian or caretaker relative signature on the SAWS 2 Statement
of Facts serve as proof of identity for a child under 16?
Answer 24:
Revised: 10/21/2016
Yes.
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6.13 Questions and Answers
Reasonable Opportunity Period (ROP)
Question 25:
Are persons receiving MC under Craig v. Bonta treated as applicants or clients for
purposes of citizenship identity requirements?
Answer 25:
Persons receiving MC under Craig v. Bontá are considered clients for purposes of
meeting the DRA requirements. Their MC benefits must continue during the
reasonable opportunity period.
Use of Affidavits
Question 26:
Can a relative other than a parent who is not a MC recipient verify identity for a
child under 16?
Answer 26:
Yes, but only a parent, guardian or caretaker relative can sign the affidavit of
identity for children under 16. For children under 16, the application is considered
acceptable documentation of identity, so the need to sign a separate affidavit for this
purpose should be rare.
Question 27:
Is the affidavit of identity valid indefinitely?
Answer 27:
Yes, the affidavit of identity is valid indefinitely. That is even if the child becomes an
adult applying for himself.
Question 28:
Can we use an affidavit of identity for a 16 or 17 year old who is not in school and
who does not have a driver’s license?
Answer 28:
Yes. An affidavit or signed application may be used to document the identity of a
child under 18 if all of the following conditions are met: (1) an affidavit was not used
to document citizenship for the child, and (2) the child cannot obtain a school ID card
and (3) the child does not have a driver’s license.
CalWORKs Cases
Question 29:
CalWORKs does not require children age 16-18 to provide proof of identity. Is proof
of identity required for these children to be eligible for MC in the CalWORKs case?
Answer 29:
No. Persons, including children, who are determined eligible for federal CalWORKs
benefits are automatically eligible for no-cost MC effective the date of their
Cal-WORKS eligibility. Citizenship/identity requirements do not affect MC eligibility
that is established based on ongoing CalWORKs eligibility.
Question 30:
Do individuals who were CalWORKs eligible in the past need to provide verification
to establish MC eligibility?
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6.14 Citizen/Alien Indicator
Answer 30:
Individuals who have met the citizenship and identity requirements for ongoing
CalWORKs eligibility do not have to provide that information again to establish MC
eligibility in the future. However, EWs must update MEDS to indicate how the MC
citizenship and identity requirements were met if that information is not already in
MEDS.
Question 31:
Would a CalWORKs client who gets CalWORKs during the 90 days have to provide
documents and then loses eligibility because eligibility wasn’t met need to provide
evidence of citizenship right away or at redetermination?
Answer 31:
They are treated as clients and should provide proof of citizenship right away since
they since CalWORKs eligibility was not established. Do not wait until the next RD to
request proof of citizenship in this situation. Other than that, they are treated the
same as clients. If they stop making a good faith effort to obtain documents, they are
not eligible for full-scope MC and must be reduced to restricted scope benefits if the
reasonable opportunity period ends.
Question 32:
Do we need to complete the DHCS 0011 “Proof of Acceptable Citizenship or
Identity Documentation” to validate the individual has met the Citizenship/Identity
requirements when CalWORKs is discontinued and ongoing MC is established?
Answer 32:
No. MEDS will be populated by the state for those who are CalWORKs eligible that
they have met the citizenship/identity requirements.
Question 33:
Are clients being discontinued from CalWORKs required to verify citizenship at the
next MC redetermination?
Answer 33:
No. The only exception would be if a CalWORKs client claiming to be a U.S. citizen
loses CalWORKs because they did not verify their citizenship.
6.14
Citizen/Alien Indicator
Citizen/Alien Indicators sent to MEDS indicate the following:
Table 18: Citizen/Alien Indicator for MEDS per MEDS quick Reference Guide
Citizen/Alien Indicator
Description
A
Proven U.S. Citizen
B
Alleged U.S. Citizen
C
Conditional entrant admitted under INA Section
203(a)(7)
(Chart page 1 of 3)
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6.14 Citizen/Alien Indicator
Table 18: Citizen/Alien Indicator for MEDS per MEDS quick Reference Guide
Citizen/Alien Indicator
Description
D
Deportation withheld admitted under INA section 243(h)
or 241(b)(3)
E
Amerasian refugee admitted under INA Section 207
F
Refugee admitted under INA Section 207 or 203(a)(7)
G
Parolee admitted under INA Section 212(d)(5)
H
Silva vs. Levi alien
K
Lawful Permanent Resident (LPR)
L
Asylee admitted under INA Section 208 but not Kurdish
or Iraqi Asylee
M
Residents of the Northern Mariana Islands
N
identity and citizenship of the individual verified by the
Numident interface (Code was previously A or B)
O
Victim of Severe Forms of Trafficking who has been
certified by ORR or who has been granted a T Visa
P
Pre-January 1, 1972 alien (presumed lawfully admitted
for permanent residence)
Q
Alleged born in U.S., supported by a U.S. birthplace
shown on online Numident
R
Other refugee admitted under INA Section 207 but not
Amerasian or Indochinese refugee
S
Other documented immigrants eligible for full scope
benefits (includes DACA)
T
Last PRUCOL Category (Category 16)
U
Undocumented Individuals eligible for State Only
Funded Long Term Care (Denied PRUCOL)
restricted-scope MC eligibility
V
Visitor/Student/etc. individuals with temporary
documentation
W
Parolee admitted under INA Section 212(d)(5) with a
period of parole over one year
X
Indochinese refugee admitted under INA Section 207
Y
Parolee admitted under INA Section 212(d)(5) with a
period of parole less than one year
Z
Kurdish or Iraqi Asylee admitted under INA Section 208
0
Other alien (not 1, 5, 7, 8 or 9)
(Chart page 2 of 3)
Revised: 10/21/2016
Update #15-34
6. Citizenship/Immigration Status
page 6-62
6.14 Citizen/Alien Indicator
Table 18: Citizen/Alien Indicator for MEDS per MEDS quick Reference Guide
Citizen/Alien Indicator
Description
1
Indochinese refugee admitted under INA Section 207
2
Lawfully present not a qualified immigrant
5
Citizen child born to refugee parent(s)
7
Other refugee
8
Cuban/Haitian entrant
9
Aged alien (Medicare ineligible alien and not 1, 7 or 8)
(Chart page 3 of 3)
Revised: 10/21/2016
Update #15-34