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August 1, 2019 Division of TennCare 6

Aged, Blind and Disabled Section: Non-Financial Eligibility Requirements Policy Manual Number: 100.010 Chapter: ABD Citizenship and Immigration

shows the child’s name and U.S. place of birth; 9. Evidence of U.S. Civil Service employment before June 1, 1976; 10. U.S. Military Record showing a U.S. place of birth; 11. A data match with the SAVE program or any other process established by the U.S. Department of Homeland Security to verify that an individual is a citizen; 12. The following documentation demonstrating that a child meets the requirements of Section 101 of the Child Citizenship Act of 2000 as amended (8 USC 1431): a. The child’s birth certificate or record; b. Marriage certificate of child’s parents (if applicable); c. If the child’s parents were married before their marriage to each other, proof of termination of any previous marriage of each parent (e.g., death certificate or divorce decree); d. Evidence of U.S. citizenship of parent, (i.e., birth certificate; naturalization certificate; FS-240, Report of Birth Abroad; a valid unexpired U.S. passport; or certificate of citizenship); e. If the child was born out of wedlock, documents verifying legitimation according to the laws of the child’s residence or domicile or father’s residence or domicile (if applicable); f. In case of divorce, legal separation, or adoption, documentation of legal custody; g. Copy of Permanent Resident Card/Alien Registration Receipt Card or other evidence of lawful permanent resident status (e.g. I-551 stamp in a valid foreign passport or Service-issued travel document); h. If adopted, a copy of the full, final adoption decree and, if the adoption was outside of the U.S. and the child immigrated as an IR-3 (orphan adopted abroad by U.S. citizen parent(s)), evidence that the foreign adoption is recognized by the state where the child is permanently residing; and i. Evidence of all legal name changes, if applicable, for the child and U.S. citizen parent; 13. Medical records, including, but not limited to, hospital, clinic, or doctor records or admission papers from a nursing facility, skilled care facility, or other institution that indicate a U.S. place of birth; 14. Life, health, or other insurance record that indicates a U.S. place of birth; 15. Official religious record recorded in the U.S. showing that birth occurred in the U.S.; 16. School records, including pre-school, Head Start and daycare, showing the child’s name and U.S. place of birth; 17. Federal or state census record showing U.S. citizenship or a U.S. place of birth; and 18. If the applicant does not have one of the documents listed in 1-17 of this section, she may submit an affidavit signed by another individual under penalty of perjury who can reasonably attest to the applicant’s citizenship, and that contains the applicant’s name, date of birth, and place of U.S. birth. The affidavit does not have to be notarized.

iii. Evidence of Identity

1. TennCare must accept the following as proof of identity, provided such document