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UPDATED: NOVEMBER 2009 601

OTHER ELIGIBILITY REQUIREMENTS CITIZENSHIP AND IMMIGRATION STATUS

CITIZENS

Category 1: U.S. Citizens continued Category Documentation WMS ACI Code Federal Financial Participation (FFP) Social Security Number (SSN) Requirement U.S. Citizen (Includes the 50 U.S. States, the District of Columbia, Puerto Rico, Guam, U.S. Virgin Islands, and American Samoa, Swain’s Island and the Northern Mariana Islands for purposes of Medicaid eligibility.)

Third Level Documents (When a primary or secondary document is not available; 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); (When a primary or a secondary document is not available: also requires ONE identity document.) ►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.

C

YES

A SSN is an eligibility requirement for all citizens applying for Medicaid or FHP.

Note: Pregnant women are excluded from this requirement.

(MRG)