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More on Citizenship

An applicant must be a U.S. Citizen or a legally admitted alien to receive Medicaid. 42 CFR § 435.406. In that regard, HCFA 64 provides as follows:

3210.1 General Requirements.–The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L. 104-193) significantly changed Medicaid eligibility for individuals who are not citizens of the United States. Medicaid must be provided to eligible citizens or nationals of the United States. Individuals who meet the eligibility requirements of Medicaid but are not citizens or nationals of the United States are Medicaid eligible only as provided in §§3211.1 – 3211.10. Those noncitizens described in §§3211.6 – 3211.10 may be eligible to receive treatment for an emergency medical condition as defined in §3211.11 as permitted by the particular section. The documentation and verification requirements in §§3212ff. must also be met.

Submit an amendment to your approved State plan if you make any change in the eligibility of aliens whose coverage is optional, as described in §§3211.5 – 3211.7.

3210.2 United States Citizenship.–For purposes of qualifying as a United States citizen, the United States as defined in the Immigration and Nationality Act includes the 50 States, the District of Columbia, Puerto Rico, Guam, Virgin Islands, and the Northern Mariana Islands. Nationals from American Samoa or Swain’s Island are also regarded as United States citizens for purposes of Medicaid.

3211. ALIENS
Medicaid eligibility for aliens is based on whether the alien is a qualified or non-qualified alien, regardless of whether the alien entered the United States before or on or after August 22, 1996 (the date of enactment of P.L. 104-193). The previous categories of lawful permanent residents and aliens permanently residing in the United States under color of law (PRUCOL) no longer apply. For policies on eligibility for the optional program of presumptive eligibility for pregnant women, see §3570.

3211.1 Qualified Aliens.–A qualified alien is an alien who is:

    • A lawful permanent resident,
    • A refugee (§207 of INA),
    • An asylee (§208 of INA),
    • An alien who has had deportation withheld under §243(h) of the Immigration and Nationality Act (INA),
    • An alien granted parole for at least 1 year by the INS (§21(d)(5) of INA),
    • An alien granted conditional entry under §203(a)(7) of immigration law in effect before April 1, 1980, or
    • A battered immigrant, who meets certain requirements.

This definition eliminates most of the PRUCOL categories as well as PRUCOL as an eligibility classification.

 42 CFR § 435.407  and HFCA 64 list documentation acceptable for proving citizenship.

3212.2 Documentation and Verification of an Applicant’s Citizenship or Alien Status.–Citizens, nationals, and qualified alien applicants for Medicaid must:

A. Provide the State with documentation of citizenship or alien status, and

B. Sign a declaration under penalty of perjury that the applicant is a citizen or national of the United States or an alien in a satisfactory immigration status (henceforth qualified alien) as provided in §3212.1.

All non-citizen applicants for Medicaid who declare they are qualified aliens, must provide Immigration and Naturalization Service (INS) documents to establish immigration status as described in §3212.4. Examples of acceptable documentation for U.S. citizens are given in §3212.3. You must give the alien a reasonable opportunity to provide the required documentation. If the alien does not provide the requested documentation within the State’s reasonable opportunity time frame, you may deny eligibility. If the alien does provide the requested documentation within your reasonable opportunity time frame, verify the documentation with the INS using SAVE or your alternative approved system of verification as provided in §3212.9.

States are required to provide Medicaid eligibility pending verification of immigration status to an individual who meets all other non-immigration Medicaid eligibility requirements, as provided in §1137(d)(4) of the Social Security Act, and who has provided INS documents showing satisfactory immigration status or who has been given a reasonable opportunity to provide such documents to the State.

3212.3 Methods of Documenting United States Citizenship.–The following are examples of acceptable documentation of U.S. citizenship for all Medicaid applicants.

    • Birth certificate,
    • Religious record of birth recorded in the United States or its territories within 3 months of birth, which indicates a U.S. place of birth. The document must show either the date of birth or individual’s age at the time the record was made,
    • United States passport (not limited passports, which are issued for periods of less than 5 years),
    • Report of Birth Abroad of a Citizen of the U.S. (Form FS-240),
    • Certification of Birth (INS Form FS-545),
    • U.S. Citizen I.D. Card (INS Form I-197),
    • Naturalization Certificate (INS Forms N-550 or N-570),
    • Certificate of Citizenship (INS Forms N-560 or N-561),
    • Northern Mariana Identification Card (issued by the INS to a collectively naturalized citizen of the U.S. who was born in the Northern Mariana Islands before November 3, 1986),
    • American Indian Card with a classification code “KIC” and a statement on the back (issued by the INS to identify U.S. citizen members of the Texas Band of Kickapoos living near the U.S./Mexican border), or
    • Contemporaneous hospital record of birth in one of the 50 States, the District of Columbia, Puerto Rico (on or after January 13, 1941), Guam (on or after April 10, 1899), the U.S. Virgin Islands (on or after January 17, 1917), American Samoa, Swain’s Island, or the Northern Mariana Islands (unless the person was born to foreign diplomats residing in such a jurisdiction).

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