Page 182

UPDATED: NOVEMBER 2009 619

OTHER ELIGIBILITY REQUIREMENTS SATISFACTORY IMMIGRATION STATUS

QUALIFIED ALIENS

Category 2: Qualified Aliens continued

Category

Documentation WMS ACI Code Federal Financial Participation (FFP)

Social Security Number (SSN) Requirement (from previous page)

(from previous page) ►I-94 or Foreign passport annotated CR1, CR2, CR6, CR7 with credible evidence of battery and/or abuse (Request permission to refer to DVL); or; ►I-688B Employment Authorization Card annotated:274a.12(a)(9)- spouse/children of USC or LPR (K or V visa); 274a.12(a)(15)-spouses and dependents of LPR (K or V visa); 274a.12(c)(10)-applicant for suspension of deportation with credible evidence of battery or abuse (Request alien’s permission to refer to DVL); or ; ►I-766 Employment Authorization Document annotated A9, A15 or C10 with credible evidence of battery and/or abuse (Request alien’s permission to refer to DVL).

NOTE: Referral to a domestic violence liaison (DVL): Medicaid-only offices may refer alien applicants and recipients who must demonstrate that they are credible victims of domestic violence to be considered qualified for Medical assistance as “battered aliens” to the DVL for a credibility assessment. Those applicants and recipients who cannot document eligibility in any other category and cannot document that the United States Citizenship and Immigration Services (USCIS) or immigration court has determined the alien has in fact been subject to battery or extreme cruelty will need to see the district/s DVL for a credibility determination. If districts are unable to verify that an acceptable immigration document has been filed with USCIS, districts can accept the alien’s written attestation and then refer the alien to an immigration attorney or legal services for assistance. The DVL does not have the authority to determine eligibility for assistance.

REVISED 03/03/08

(MRG)