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Title 8: Medicaid Page 14 Iowa Department of Health and Human Services Employees’ Manual Chapter C: Nonfinancial Eligibility Citizenship Revised October 10, 2025 Documentation Process Form 470-4909 or 470-4909(S), Request for Proof of Citizenship and Identity and Comm. 258, Verifying Citizenship and Identity will be system- generated and sent to a person who:  Is approved on the system,  Has all 9s or all 0s in the social security number field, and  The system indicates documentation has not been provided. NOTE: If a person with all 9s or all 0s later provides a social security number, entry of the social security number will cause a request for proof of citizenship and identity to be sent via electronic data sources. If acceptable proof is provided during the 90-day ROP, record the documentation on the system. See Retroactive Eligibility for additional information. If proof is provided but is questionable or not acceptable:  Contact the person by phone or by mail.  Explain why the proof submitted is not acceptable, how acceptable proof can be obtained, and, if appropriate, offer to assist in obtaining the proof.  Document phone contacts in the case file. Do not cancel the person’s Medicaid due to lack of proof of citizenship and identity during the 90-day ROP. If the person has not provided acceptable documentation within 90 days, the system will:  Cancel the individual with timely notice.  Send a WISE alert to tell you to deny retroactive eligibility, if applicable. See Retroactive Eligibility for additional information about retroactive Medicaid coverage and citizenship and identity requirements. Acceptable Documentation Legal reference: 42 CFR 435.407, 441 IAC 75 (Rules in Process), P. L. 111-3 Policy: Documents that are acceptable verification of U.S. citizenship and identity are categorized as either primary or secondary. Primary documents are acceptable proof of both citizenship and identity. When secondary documents are used to verify citizenship, separate proof of identity is also required. See the ROP Reference Guide for a list of documents that are acceptable as verification of citizenship and identity.