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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M01 January 2021 Subchapter Subject Page ending with Page M0130 APPLICATION PROCESSING M0130.200 8

Individuals who, on June 30, 1997, were Medicaid-eligible and were residing in long-term care facilities or participating in home and community-based waivers, and who continue to maintain that status (eligible for Medicaid and reside in long-term care facilities or participate in home and community-based waivers) are exempt from this requirement. Non-citizens applying for Medicaid payment limited to emergency services are not subject to the legal presence requirement. An individual who is applying on behalf of another and is not requesting assistance for himself is not subject to the legal presence requirement. 2. Documents That Demonstrate Legal Presence An applicant may demonstrate legal presence by presenting one of the following documents: • valid evidence of U.S. citizenship; • valid evidence of legal permanent resident status; • valid evidence of conditional resident alien status; • a valid SSN verified by SSA; • a U.S. non-immigrant visa; • a pending or approved application for legal asylum; • a refugee or temporary protected status document; or • a pending application for an adjustment of residence status. 3. Failure to Provide Proof of Legal Presence An applicant who cannot provide documentation that he is a citizen or legally present at the time of application must sign an affidavit under oath attesting that he is a U.S. citizen or legally present in the U.S. in order to meet the requirement for proof of legal presence for either: • a period of 90 days or until it is determined that he is not legally present in the U.S., whichever is earlier; or • indefinitely if the applicant provides a copy of a completed application for a birth certificate that has been filed and is pending and being actively pursued in accordance with federal or state law. Such extension shall terminate upon the applicant’s receipt of a birth certificate or determination that a birth certificate does not exist because the applicant is not a U.S. citizen. The affidavit form is on the intranet at https://fusion.dss.virginia.gov/bp/BP- Home/Medical-Assistance/Forms. NOTE: The individual’s address on the affidavit form must be the individual’s residence address, not the mailing address. 4. Relationship to Other Medicaid Requirements Providing proof of legal presence or submitting a signed affidavit meets the legal presence eligibility requirement. To be eligible for Medicaid, however, the individual must meet all other state and federal Medicaid eligibility requirements. Submission of the affidavit without proof of application for an SSN as required by M0130.200 D. does NOT meet the SSN requirement. F. Third Party Liability (TPL) Applicants must be asked to provide information about any health insurance they may have. Verification of health insurance information is not required.