Page 10
Medical Services – Appendix C, Verification of Citizenship, Alien Status and SSN Enumeration Revised (05/18) action field with the next possible steps. If information is sufficient to determine eligibility, no further verification is needed. Third Step Verification will be initiated if eligibility cannot be determined based on the code received. • Third Step Verification - is an electronic process initiated by the agency. The agency must submit photocopies (front and back) of the applicant’s relevant immigration documents using the scan and upload function. • Close Case – After a response has been received with enough information to make an eligibility determination, or all electronic methods of verification have been exhausted, the USDHS SAVE case should be closed through the SAVE program. IV. Alien Documentation Chart The chart below shows the types of documentation that can be used to verify alien status, and additional verification that certain aliens must provide to verify that they are eligible for Medicaid (e.g., the date they were admitted to the U.S., or the date a particular alien status was granted or adjusted). NOTE: USDHS Form I-94 is processed electronically and can be retrieved online at www.cbp.gov/I94. Alien Status Acceptable Documentation of Alien Status Medicaid Status Amerasian Immigrant • USDHS Form I-551, Permanent Resident Card, annotated AM6, AM7 or AM8. • Unexpired temporary I-551 stamp in a foreign passport annotated AM1, AM2 or AM3. • USDHS Form I-94, Arrival/Departure Record, annotated AM1, AM2 or AM3. Eligible Regardless of U.S. entry date