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130 CMR: DIVISION OF MEDICAL ASSISTANCE

Trans. by E.L. 240 Rev. 08/19/22 MASSHEALTH CITIZENSHIP AND IMMIGRATION Chapter 518 Page 518.005 (4 of 4)

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. (d) a finding of identity from a federal or state agency including, but not limited to, a public assistance, law enforcement, internal revenue or tax bureau, or corrections agency, if the agency has verified and certified the identity of the individual; (e) a finding of identity from an Express Lane agency, as defined in section 1902(e)(13)(F) of the Social Security Act; or (f) if the applicant does not have any document specified in 130 CMR 518.005(A)(3)(a) through (c) and identity is not verified under 130 CMR 518.005(A)(3)(d) or (e), the applicant may submit an affidavit signed, under penalty of perjury, by another person who can reasonably attest to the applicant’s identity. Such affidavit must contain the applicant’s name and other identifying information establishing identity, as described in 130 CMR 518.005(A)(3)(a). This affidavit does not have to be notarized. (4) Verification of Citizenship or Identity by a Federal Agency or Another State. The MassHealth agency may rely, without further documentation of citizenship or identity, on a verification of citizenship or identity made by a federal agency or another state, if such verification was done on or after July 1, 2006. (5) Assistance with Obtaining Documentation. The MassHealth agency will provide assistance to individuals who need assistance in securing satisfactory documentary evidence of citizenship in a timely manner.