Page 17

TITLE 16 HEALTH AND SAFETY DELAWARE ADMINISTRATIVE CODE 17 1. Federal or State census record showing U.S. citizenship or a U.S. place of birth. Census records from 1900 through 1950 contain certain citizenship information. The census record must also show the applicant's age. 2. One of the documents listed that shows a U.S. place of birth and was created at least 5 years before the application for Medicaid. For children under age 16, the document must have been created near the time of birth or 5 years before the date of application. This document must be one of the following and show a U.S. place of birth: a) Seneca Indian tribal census record. b) Bureau of Indian Affairs tribal census records of the Navajo Indians. c) U.S. State Vital Statistics official notification of birth registration. d) A delayed U.S. public birth record that is recorded more than 5 years after the person's birth. e) Statement signed by the physician or midwife who was in attendance at the time of birth f) The Roll of Alaska Natives maintained by the Bureau of Indian Affairs. 3. Institutional admission papers from a nursing facility, skilled care facility, or other institution created at least 5 years before the initial application date that indicates a U.S. place of birth. Admission papers generally show biographical information for the person including place of birth. The record can be used to establish U.S. citizenship when it shows a U.S. place of birth. 4. Medical (clinic, doctor, or hospital) record created at least 5 years before the initial application date that indicates a U.S. place of birth. For children under age 16, the document must have been created near the time of birth or 5 years before the date of application. Medical records generally show biographical information for the person including place of birth. The record can be used to establish U.S. citizenship when it shows a U.S. place of birth. (Note: An immunization record is not considered a medical record for purposes of establishing U.S. citizenship.) 5. Written affidavit. Affidavits should only be used in rare circumstances. If the documentation requirement needs to be met through affidavits, the following rules apply: a) 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. b) 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. c) The persons making the affidavits must be able to provide proof of their own citizenship and identity. d) 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. e) The applicant or representative must make a separate affidavit explaining why the evidence does not exist or cannot be obtained. f) The affidavits must be signed under penalty of perjury and need not be notarized. E. Documentation of identity. 1. Identity documents described in 8 CFR 274a.2(b)(1)(v)(B)(1). Exception: Do not accept a voter's registration card or Canadian driver's license as listed in 8 CFR 274a.2(b)(1)(v)(B)(1). a) Driver's license issued by a 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. b) School identification card with a photograph of the individual. c) U.S. military card or draft record. d) Identification card issued by the Federal, State, or local government with the same information included on drivers' licenses. e) Military dependent's identification card. f) Certificate of Degree of Indian Blood, or other American Indian/Alaska Native Tribal document with a photograph or other personal identifying information relating to the individual such as age, weight, height, race, sex, and eye color. g) U.S. Coast Guard Merchant Mariner card. 2. A cross match with Office of Vital Statistics.