Page 159

UPDATED: JUNE 2010

596

OTHER ELIGIBILITY REQUIREMENTS CITIZENSHIP AND IMMIGRATION STATUS

CITIZENS

• Evidence of U.S. civil service employment before 6/1/1976; • Military record of service showing U.S. place of birth (i.e., DD- 214); or • Evidence of qualifying for U.S. citizenship under the Child Citizenship Act of 2000.

Third Level Documents which Establish Citizenship but are less reliable than Secondary Documents (Also requires an identity document) • Extract of hospital record on hospital letterhead. The record must have been established at the time of birth and the extract must have been created at least 5 years before the Medicaid application date (or, for children younger than 16, near the time of birth) and must show a U.S. place of birth; • Life, health or other insurance record, if it shows a U.S. place of birth and was created at least 5 years prior to the application date (or, for children younger than 16, near the time of birth); • Religious record recorded in the U.S. within 3 months of birth showing a U.S. place of birth and either the date of birth or the individual’s age at the time the record was made; or • Early school record showing date of admission, a U.S. place and date of birth and names and places of birth of the applicant’s parents.

Fourth Level Documents which Establish Citizenship but are the least reliable and should only be used in rarest of circumstances (Also requires an identity document) • Federal or State census record showing U.S. citizenship or a U.S place of birth; or • The following other documents are acceptable if they indicate a U.S. place of birth and were created at least 5 years prior to the application date (or, for children younger than 16, near the time of birth): o Medical (clinic, doctor, or hospital) record; o Seneca Indian tribal census; o Bureau of Indian Affairs tribal census records of the Navajo Indians; o U.S. State Vital Statistics official notification of birth registration; o Delayed U.S. public birth record that is recorded more than 5 years after the person’s birth; (MRG)