Page 172
the following rules apply: • There must be at least two affidavits by two individuals who have personal knowledge of the event(s) establishing the applicant’s or recipient’s claim of citizenship (the two affidavits could be combined in a joint affidavit). • At least one of the individuals making the affidavit cannot be related to the applicant or recipient. Neither of the two individuals can be the applicant or recipient. • In order for the affidavit to be acceptable, the persons making them must be able to provide proof of their own citizenship and identity. • If the individual making the affidavit has information which explains why documentary evidence establishing the applicant’s claim of citizenship does not exist or cannot be readily obtained, the affidavit should contain this information as well. • IMA must obtain a separate affidavit from the applicant/recipient or other knowledgeable individual (guardian or representative) explaining why the evidence does not exist or cannot be obtained. • The affidavits must be signed under penalty of perjury. Evidence of Identity (Chart 5) When primary evidence of citizenship described in Chart 1 is not available, a document from charts 2 through 4 may be presented when accompanied by an identity document from this chart. Chart 5 – Evidence of Identity Documents to Establish Identity Explanations and Notes on Documentation Certificate of Degree of Indian Blood, or other US American Indian/Alaska Native tribal document. Acceptable if the document carries a photograph of the applicant or recipient or has other personal identifying information relating to the individual. Any identity document described in section 274A(b)(1)(D) of the Immigration and Nationality Act Use 8 CFR 274a.2(b)(1)(v)(B)(1). This section includes the following acceptable documents for Medicaid purposes: • 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 • US military card or draft record • Identification card issued by the Federal, State, or local government with the same information included on driver’s licenses • Military dependent’s identification card • Native American Tribal document