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UPDATED: NOVEMBER 2009

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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.)

Fourth Level Documents (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): ƒ Medical (clinic, doctor, or hospital) record; ƒ Seneca Indian tribal census; ƒ Bureau of Indian Affairs tribal census records of the Navajo Indians; ƒ U.S. State Vital Statistics official notification of birth registration; ƒ Delayed U.S. public birth record that is recorded more than 5 years after the person’s birth; ƒ Statement signed by the physician/midwife who was in attendance at the time of birth; or ƒ Bureau of Indian Affairs Roll of Alaska Natives; ►Institutional admission papers from a nursing facility, skilled care facility or other institution (created at least 5 years before the application date) showing a U.S. place of birth; or ►Written affidavit (to be used only in rare instances). The affidavit must contain the following information under the following circumstances: • There must be at least two affidavits by two individuals who have personal knowledge of the event(s) establishing the applicant’s or recipient’s claim of citizenship. • The two affidavits can be combined in a joint affidavit. • At least one of the individuals making the affidavit cannot be related to the applicant or recipient. • The person(s) making the affidavit must be able to provide proof of his or her own citizenship and identity for the affidavit to be accepted. • The affidavit must also be signed under penalty of perjury by the person making the affidavit, but need not be notarized. A separate affidavit from the applicant/recipient or other knowledgeable individual (guardian or representative) explaining why documentary evidence does not exist or cannot be readily obtained must also be obtained.

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)