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COMAR 10.09.24.05

514

State of Maryland Medical Assistance Manual Revised July 2012

2. For a child younger than 16 years old, the document must have been created either near the time of birth or at least 5 years before the initial application date for MA or MCHP. 3. An immunization is not acceptable

One of the following records showing a U.S. place of birth, if created at least 5 years before the initial application date for MA or MCHP: 1. An amended U.S. birth certificate (public birth record) that was amended more than 5 years after the person’s birth. 2. A U.S. State Vital Statistics official notification of birth registration. 3. Signed statement by a physician or midwife who attended the birth. 4. Institutional admission papers (e.g., nursing facility). 5. Seneca Indian tribal census record. 6. Bureau of Indian Affairs tribal census records of the Navajo Indians.

(d) Affidavits for Documenting Citizenship If none of the previously discussed documents are available within the time limit for determining eligibility, written affidavits may be used to document citizenship. Affidavits should only be used in rare circumstances. The affidavits must be signed under penalty of perjury. The signer must be able to provide proof of his/her own citizenship and identity. There must be a least two written and signed affidavits by citizens who have personal knowledge of the event(s) (e.g., birth, naturalization) establishing the applicant/recipient’s (A/R’s) claim of citizenship. One of the affidavits must be signed by someone who is not related to the A/R. If the individual signing the affidavit has information explaining why documentary evidence establishing the A/R’s claim of citizenship does not exist or cannot be readily obtained, the affidavit should contain this information as well. A third affidavit must be signed by the A/R, another knowledgeable individual (representative, parent, or guardian), or explain why the required documentary evidence does not exist or cannot be readily obtained.