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Page 3 of 7 § 10:71-3.3 Citizenship; alien status-documentation requirements 9. A member of an Indian tribe as defined in section 4(e) of the Indian Self-Determination and Education Assistance Act; 10. An alien who is admitted to the United States as an Amerasian immigrant pursuant to section 584 of the Foreign Operations, Export Financing, and Related Programs Appropriations Act of 1988; 11. An alien who is honorably discharged or who is on active duty with the United States Armed Forces and his or her spouse and the unmarried dependent children of the alien or spouse; and 12. Certain aliens who are victims of domestic violence as specified in (c)12 above, but only after the alien has been present in the United States for five years. (e) Any alien who is not an eligible alien as specified in (c) and (d) above is ineligible for full Medicaid benefits. Any such alien, if a resident of New Jersey and if he or she meets all other Medicaid eligibility requirements, is entitled to Medicaid coverage for the treatment of an emergency medical condition only. 1. An emergency medical condition is one of sudden onset that manifests itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in: i. Placing the patient's health in serious jeopardy; ii. Serious impairment to bodily functions; or iii. Serious dysfunction of any bodily organ or part. 2. An emergency medical condition includes all labor and delivery for a pregnant woman. It does not include routine prenatal or post-partum care. 3. Services related to an organ transplant procedure are not covered under services available for treatment of an emergency medical condition. (f) Persons claiming to be citizens and eligible aliens shall provide the county social service agency with documentation of citizenship or alien status. (g) As a condition of eligibility, all applicants for Medicaid (except for those applying solely for services related to the treatment of an emergency medical condition) shall sign a declaration under penalty of perjury that they are a citizen of the United States or an alien in a satisfactory immigration status. In the case of a child or incompetent applicant, another individual on the applicant's behalf shall complete the same written declaration under penalty of perjury. 1. The following are acceptable documentation of United States citizenship: i. A birth certificate; ii. A religious record of birth recorded in the United States or its territories within three months of birth. The document must show either the date of birth or the individual's age at the time the record was created; iii. A United States passport (not including limited passports which are issued for periods of less than five years); iv. A Report of Birth Abroad of a Citizen of the U.S. (Form FS-240); v. A U.S. Citizen I.D. Card (USCIS Form-197, Nationality Certificate (USCIS Form N-550 or N- 570); vi. A Certificate of Citizenship (USCIS Form N-560 or N-561); vii. A Northern Mariana Identification Card (issued by the USCIS to a collectively naturalized citizen of the United States who was born in the United States before November 3, 1986); viii. An American Indian Card with a classification code "KIC" (issued by the USCIS to identify U.S. citizen members of the Texas Band of Kickapoos);