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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M02 July 2024 Subchapter Subject Page ending with Page M0220.000 CITIZENSHIP & ALIEN REQUIREMENTS M0220.001 1 M0220.000 CITIZENSHIP & ALIEN REQUIREMENTS M0220.001 GENERAL PRINCIPLES A. Introduction This subchapter explains in detail how to determine if an individual is a citizen or alien eligible for full Medicaid benefits (referred to as “full benefit aliens”) or emergency services only (referred to as “emergency services aliens”). The federal Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) made major changes to the Medicaid eligibility of non- citizens of the United States. These changes eliminated the “permanently residing under color of law” (PRUCOL) category of aliens. The Medicaid benefits for which an alien is eligible are based upon whether or not the alien is a “qualified” alien as well as the alien’s date of entry into the United States. With some exceptions, the Deficit Reduction Act of 2005 (DRA) required applicants for Medicaid and Medicaid recipients to verify their United States citizenship and identity to be able to qualify for Medicaid benefits. The citizenship and identity (C&I) verification requirements became effective July 1, 2006. The Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) allows additional exemptions from the C&I verification requirements and provides states with the option to verify C&I through the use of an electronic data match with the Social Security Administration (SSA). It also requires states to enroll otherwise eligible individuals prior to providing C&I verification or immigration status, and grant them one or more “reasonable opportunity” periods after enrollment to provide documentation, if necessary. The policy and procedures for determining whether an individual is a citizen or a “full-benefit” or “emergency services” noncitizens are contained in the following sections: M0220.100 Citizenship & Naturalization; M0220.200 Alien Immigration Status M0220.300 Full Benefit Aliens M0220.400 Emergency Services Aliens M0220.500 Aliens Eligibility Requirements M0220.600 Aliens Entitlement & Enrollment M0220, Appendix 9 Emergency Services Aliens Entitlement & Enrollment B. Declaration of Citizenship/Alien Status The Immigration Reform and Control Act (IRCA) requires as a condition of eligibility that the adult applicant who is head of the household (with exceptions below) declare in writing under penalty of perjury whether or not the individual(s) for whom he is applying is a citizen or national of the United States, and if not, that the individual is a lawfully admitted alien. For children under 18 years of age, the declaration is made by an adult family member. The declaration statement is on the application form. EXCEPTION: An individual who is an “unqualified” alien (as defined in section M0220.410) does NOT complete the declaration. Individuals who are required to sign the declaration and who fail or refuse to sign are NOT eligible for any Medicaid services.