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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M02 January 2021 Subchapter Subject Page ending with Page M0210 NONFINANCIAL ELIGIBILITY REQUIREMENTS M0210.200 4

• a refugee or temporary protected status document; or • a pending application for an adjustment of residence status. C. Failure to Provide Proof of Legal Presence At the time of application, an applicant who cannot provide documentation that he is a citizen or legally present must sign an affidavit under oath attesting that he is a U.S. citizen or legally present in the United States 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 within the United States or its territories that has been filed and is pending. The affidavit’s validity 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 citizen of the United States. The Affidavit Of United States Citizenship Or Legal Presence In The United States is available 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. D. 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.

M0210.200 COVERED GROUPS

A. Introduction An individual who meets the nonfinancial eligibility requirements must also meet the definition for a Medicaid covered group. Covered groups include individuals who are age 65 or older, blind, disabled, under age 19, pregnant women, and the parent(s) or caretaker-relative of a dependent child. Medicaid financial eligibility requirements vary depending upon the covered group for which eligibility is being determined. See chapter M03 for the covered groups’ definitions, policy and procedures.