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Example Mr. Rhoe entered the country on April 3, 1999. He was found eligible for RMA on May 15. He is eligible for RMA through November 30, 1999, regardless of whether his income increases above the Medically Needy Income Level before November 30.

TANF and Medicaid Eligibility Must Be Considered First 7.5.4

Immigrants in the categories listed above who are eligible for TANF or Medicaid under the rules of those programs are ineligible for Refugee Cash and Refugee Medical Assistance.

CITIZEN/ALIENAGE DECLARATION FORMS 7.6 ALL There are two forms which must be filled out by all groups using the Combined Application. The first form, the Immigration and Citizenship Initial Declaration Form (see Exhibit IV-1), provides a list of the immigration categories in which non-citizens must fall in order to be eligible for TANF, FS, GC, IDA, or Medicaid (except emergency services). That is, the form lists all 'qualified' immigration categories as well as the three immigration categories described in Section 7.3.1: Exceptions in this Chapter. The PI must fill out this form and attest to which of the following groups each household member belongs: U.S. citizen or national; not a U.S. citizen or national and individual’s immigration status falls into one of the categories listed on the form (which means that s/he is potentially eligible for benefits); or not a U.S. citizen or national and individual’s immigration status does not fall into one of the categories listed on the form (which means that s/he is not eligible for TANF, FS, GC IDA, or Medicaid, except emergency Medicaid services). For TANF and FS applicants, each household member that generally would be required to be in the assistance unit must be listed on the form and his/her citizenship/immigration status attested to. For Medicaid applicants, only those household members applying for Medicaid must be listed on the form. If at least one person was listed on the Immigration and Citizenship Initial Declaration form as an immigrant whose status matched one of those listed on that form, a second form, the Citizen/Alienage Declaration (CAD) form, must be completed by the PI. This form requires additional information, such as an individual’s SSN and alien number.

Example 1 Ms. Hernandez and her two children, Maria (14) and Jose (4), apply for TANF, FS, and Medicaid. Mrs. Hernandez must fill out an Immigration and Citizenship Initial Declaration Form listing herself and her two children. On the form, she indicates that she and Maria are not citizens or nationals and their immigration status does not match any of the categories listed on the form. On the form, she indicates that Jose is a U.S. citizen. Based on this information, Ms. Hernandez does not need to fill out a CAD form. Jose, who is a Example 1 Ms. Suarez and her two children arrive in the United States as refugees on March 14, 1999. The family has no income and comes to an IMA service center to apply for assistance. Because refugees are eligible for TANF and Medicaid and Ms. Suarez and her children meet the non-financial eligibility requirements for TANF and Medicaid, Ms. Suarez and her children should be considered for standard TANF and Medicaid eligibility. Example 2 Mr. Poks enters the United States as a refugee. He has no other family in the United States and applies for assistance. As a non-disabled single individual with no children, Mr. Poks is ineligible for TANF and Medicaid. Thus, he should be considered under the RCA and RMA programs.