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Medical record Doctor, clinic, or hospital records for children under age 19 only. Motor Vehicle Data Exchange This is a data exchange update with the Division of Motor Vehicles or when verifying an individual’s identity through the DOT Driver License Status Check website. Multiple Identity documents An individual may provide two or more corroborating ID documents to verify their identity. Examples include marriage license, divorce decree, high school or college diploma, or an employer ID card. Other MA Program Verified Identity An individual has already provided proof of identity while they were receiving Wisconsin Medicaid outside of CARES. For example, use this for members previously enrolled through the Katie Beckett program. State ID Paid by Agency Must have the same information as is included on driver license. School Identification card School identification card with a photograph of the individual or other identifying information. Statement of Identity for Children Under 18 Years of Age (Form F-10154)

If the applicant cannot produce the accepted documents verifying identity for children under 18 years of age, a completed F-10154 is acceptable documentation of identity. The form must be signed under penalty of perjury by a parent, guardian, or caretaker relative stating the date and place of birth of the child. The form doesn't need to be notarized. Written Affidavit (Form F-10161) If the applicant cannot produce the accepted documents verifying identity, a written affidavit may be used. The affidavit must: • Be signed under penalty of perjury an individual other than the applicant, who can reasonably attest to the applicant’s identity. • Contain the applicant’s name, and other identifying information such as, age, sex, race, height, weight, eye color, or address. The affidavit doesn't need to be notarized. The "Identity Statement" section of the Statement of Citizenship and/or Identity (F-10161) may be used for the affidavit.

4.2.4.4 Reasonable Opportunity Period for Verification of Citizenship Applicants who are otherwise eligible for BadgerCare Plus or other health care benefits and are only pending for verification of citizenship (and identity when needed) must be certified for health care