Verification of Citizenship and Identity

Review the applicants in Gateway. If the A/R was previously known to Gateway:

Ensure his/her SSN has been federally verified– if it has NOT been federally verified, use the SSN correction process to resolve any discrepancies; verification of citizenship through SVES is directly tied to federal verification of the SSN

If the A/R has previously verified citizenship/ID, do not request again (SVES match will be submitted)

If the A/R has not previously verified citizenship/ID, check to see if the A/R was ever eligible for Medicaid as a “deemed newborn”, If so, do not request citizenship/ID again (SVES match will be submitted) If not, go to next step

For A/Rs not found in EMPI or the A/R was never eligible for Medicaid as a “deemed newborn” and not previously verified citizenship/ID, request verification of Citizenship – follow Reasonable Opportunity policy for Medical Assistance and Good Cause policy for Food Stamps and TANF. If a SVES citizenship match is returned, the A/R will not appear on the ROP report, no additional action is needed.

When there is no SVES match, additional documentary evidence for citizenship or identity must be requested.

Effective May 1, 2016, original documentation of citizenship or identity is no longer required for Medicaid or PeachCare for Kids® eligibility determinations. When documents are provided, file the copy of the document in the case record or Document Imaging System (DIS). For DIS, the document should be tagged with both the Client ID of the client for whom it is for and the AU ID(s) of the case(s) impacted. Document GATEWAY where the verification is located, either in the case record or DIS.

Although some documents contain a statement, DO NOT COPY, authorizing agencies may copy and file these documents in the case file for the official purpose of establishing Medical Assistance eligibility.

The following agencies are authorized to make copy of citizenship/identity documents:

Department of Community Health (DCH)

Division of Family and Children Services (DFCS)

Right from the Start Medicaid (RSM)

Department of Public Health (DPH) including Women, Infants and Children (WIC)

Qualified Provider (QP). QPs include Federally Qualified Health Centers and Rural Health Centers.

MAXIMUS

Georgia Cares

CHIPRA Grantees

Authorized agencies are not limited to the State of Georgia; other state and federal agencies, outside of Georgia, which are reasonably equivalent to those noted above, are considered authorized.

Authorized agencies do not include cost recovery agencies; schools; nonprofit agencies such as March of Dimes or American Lung Association; faith-based organizations such as a church; Healthy Mothers/Healthy Babies, etc.

If DFCS staff has any doubts about the copy, they should request that the individual send in or bring in the original documents for verification.

If an individual receives Medical Assistance, and it is determined that documents are inconsistent with pre-existing information, are counterfeit or altered, the Division of Family and Children Services shall investigate for potential fraud and abuse and refer to Special Investigations Unit with Office of Inspector General; in Metro Atlanta (404) 463-7590, and statewide at (1-800-533-0686). However, if the case is denied because the citizenship criteria was not met or income discrepancies could not be resolved, then no referral is required. If an applicant or recipient tries to present documentation but is unable to do so because the documents are not available, the eligibility worker should assist the individual in securing evidence of citizenship.

The following groups are exempt from further citizenship/identity verification requirements: Persons entitled to or enrolled in Medicare Persons currently receiving, or have received, SSI cash benefits as long as the citizenship indicator on SDX states they are a citizen or qualified immigrant Individuals on Social Security disability, including a disabled child, widow, or widower receiving disability benefits on the account of a worker Children receiving Title IV-B Foster Care benefits Children receiving Title IV-E Foster Care benefits Children receiving Title IV-E Subsidized Adoption benefits Children who meet deemed newborn status

Any assistance unit (AU) member who fails or refuses to cooperate in determining his/her own citizenship/immigration/identity status is ineligible for any ABD or Family Medical Assistance COA.

Situations where individuals provide documents verifying citizenship and identity but for whom SVES does not return a match should be investigated to ensure that the SSN, first and last names, and date of birth have been entered correctly in Gateway.