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Adopted children automatically become U.S. citizens if the children meet all the above conditions and any of the following: • Adopted under the age of 16 and has been in the legal custody of and has resided with the adopting parent or parents for at least two years. • Adopted while under the age of 18 and has been in the legal custody of and has resided with the adopting parent or parents for at least two years and is a sibling of another adopted child who is under 16. • Orphans adopted while under the age of 16, who have had their adoption and immigration status approved by the USCIS (Form I-171, "Notice of Approval of Relative Immigrant Visa Petition”). These children need not have lived with the adoptive parents for two years. • Orphans adopted under the age of 18, who have had their adoption and immigration status approved by the USCIS and are siblings of another adopted child who is under the age of 16. These children need not have lived with the adoptive parents for two years. 4.1.2 Citizens of the Compacts of Free Association Countries Citizens of the Compacts of Free Association countries are not considered U.S. citizens or nationals. The Compacts of Free Association countries include the Republic of the Marshall Islands, the Federated States of Micronesia and the Republic of Palau. Citizens of the Compact of Free Association (COFA) countries have a special status with the U.S. that allows them to enter the country, work here, and acquire an SSN without obtaining an immigration status. As of December 27, 2020, COFA citizens may be eligible for health care if they meet all other eligibility requirements. In addition, COFA citizens are not subject to the five-year waiting period. However, COFA citizens who adjust their status and become Lawful Permanent Residents are subject to the five-year waiting period. This page last updated in Release Number: 21-02 Release Date: 8/30/2021 Effective Date: 12/27/2021 4.2 Verifying U.S. Citizenship U.S. citizenship must be verified for persons applying for or receiving Medicaid (MA), BadgerCare Plus, or Family Planning Only Services (FPOS) benefits and who have declared that they are a U.S. citizen, unless they are exempt from this requirement (see SECTION 4.2.2 EXEMPT POPULATIONS). Citizenship verification for health care must first be attempted using the real-time data exchanges with the Social Security Administration, birth record query, and Systematic Alien Verification for Entitlements (SAVE) before requesting documentation of citizenship from applicants (see SECTION 4.2.3 U.S. CITIZENSHIP VERIFICATION THROUGH THE SOCIAL SECURITY ADMINISTRATION (SSA) DATA EXCHANGE). Only those who are not exempt and for whom verification was not available through a data exchange may be required to submit documentation of their citizenship (see SECTION 4.2.4 OTHER METHODS OF CITIZENSHIP VERIFICATION). Once citizenship has been verified for a person, verification may never again be required to receive health care benefits unless previously verified information becomes questionable. 4.2.1 Covered Programs The U.S. citizenship verification requirement applies to all non-exempt applicants and members of the following programs: