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130 CMR: DIVISION OF MEDICAL ASSISTANCE

Trans. by E.L. 240 Rev. 08/19/22 MASSHEALTH: CITIZENSHIP AND IMMIGRATION Chapter 504 Page 504.005 (3 of 4)

(3) Acceptable Proof of Identity. The following are considered acceptable proof of identity. (a) The following are acceptable proof of identity, provided such documentation has a photograph or other identifying information including, but not limited to, name, age, sex, race, height, weight, eye color, or address: 1. identity documents listed at 8 CFR 274a.2(b)(1)(v)(B)(1), except a driver’s license issued by a Canadian government authority; 2. driver’s license issued by a state or territory; 3. school identification card; 4. U.S. military card or draft record; 5. identification card issued by the federal, state, or local government; 6. military dependent’s identification card; or 7. U.S. Coast Guard Merchant Mariner card; (b) for children younger than 19 years old, a clinic, doctor, hospital, or school record, including preschool or day care records; (c) two documents containing consistent information that corroborates an applicant’s identity. Such documents include, but are not limited to 1. employer identification cards; 2. high school and college diplomas (including high school equivalency diplomas); 3. marriage certificates; 4. divorce decrees; 5. property deeds or titles; 6. a pay stub from a current employer with the applicant’s name and address preprinted, dated within 60 days of the application; 7. census verification containing the applicant’s name and address, dated not more than 12 months before the date of the application; 8. a pension or retirement statement from a prior employer or pension fund stating the applicant’s name and address, dated within 12 months of the application; 9. tuition or student loan bill containing the applicant’s name and address, dated not more than 12 months before the date of the application; 10. utility bill, cell phone bill, credit card bill, doctor’s bill, or hospital bill containing applicant’s name and address, dated not more than 60 days before the date of the application; 11. valid homeowner’s, renter’s, or automobile insurance policy with preprinted address, dated not more than 12 months before the date of the application, or a bill for such insurance with preprinted address, dated not more than 60 days before the date of the application; 12. lease dated not more than 12 months before the date of the application, or home mortgage identifying applicant and address; or 13. employment verification by means of W-2 forms or other documents bearing the applicant’s name and address submitted by the employer to a government agency as a consequence of employment.