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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 (2 of 4)

(a) U.S. public birth certificate showing birth in one of the 50 states (including the District of Columbia, Puerto Rico (if born on or after January 13, 1941), Guam, the U.S. Virgin Islands (if born on or after January 17, 1917), American Samoa, Swain’s Island, or the Commonwealth of the Northern Mariana Islands (CNMI) (if born after November 4, 1986, CNMI local time). The birth record may be issued by the state, commonwealth, territory, or local jurisdiction. However, if the document shows the individual was born in Puerto Rico, the U.S. Virgin Islands, or the CNMI before these areas became part of the U.S., the individual may be a collectively naturalized citizen; (b) cross-match with the Massachusetts Registry of Vital Statistics that documents a record of birth; (c) Certification of Report of Birth, issued to U.S. citizens who were born outside the U.S.; (d) Report of Birth Abroad of a U.S. Citizen; (e) certification of birth; (f) U.S. Citizen I.D. card; (g) Northern Mariana Identification Card, issued to a collectively naturalized citizen who was born in the CNMI before November 4, 1986; (h) final adoption decree showing the child’s name and U.S. place of birth, or, if the adoption is not final, a statement from state-approved adoption agency that shows the child’s name and U.S. place of birth; (i) evidence of U.S. civil service employment prior to June 1, 1976; (j) U.S. military record showing a U.S. place of birth; (k) data match with the Systematic Alien Verification for Entitlements (SAVE) Program or any other process established by the U.S. Department of Homeland Security to verify that an individual is a citizen; (l) documentation that the child meets the requirements of section 101 of the Child Citizenship Act of 2000 (8 U.S.C. 1431); (m) medical records, including, but not limited to, hospital, clinic, or doctor records or admission papers from as nursing facility, skilled-care facility, or other institution that indicate place of birth; (n) life, health, or other insurance records that indicate a U.S. place of birth; (o) official religious records recorded in the U.S. showing that the birth occurred in the U.S.; (p) school records, including preschool, Head Start, and day care, showing the child’s name and U.S. place of birth; (q) federal or state census records showing U.S. citizenship or a U.S. place of birth; and (r) if an individual does not have one of the documents listed in 130 CMR 504.005(A)(2)(a) through (q), he or she may submit an affidavit signed by another individual, under penalty of perjury, who can reasonably attest to the individual’s citizenship, and that contains the individual’s name, date of birth, and place of U.S. birth. The affidavit does not have to be notarized.