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Eligibility Requirement for Full Medicaid
Individuals eligible to receive full Medicaid services, QMB, SLMB, or QI benefits include the following. All others may only receive emergency Medicaid services, described in Section 205-6.
U. S. citizens. See Section 205-1.
Qualified Aliens. See Section 205-2.
SSI recipients living in the U.S. on August 22, 1996 and meeting the criteria for one of the grand-fathered SSI recipient alien groups. See Section 329.
Proof of Citizenship and Identity
As of July 1, 2006, U.S. Citizens must document their Citizenship and Identity. (See Table IV)
Applicants: Do not delay or deny benefits when an individual declares to be a US Citizen or US National, and there is no evidence that contradicts their claim.
If otherwise eligible, provide Medicaid coverage and give the client reasonable time to provide the documentation.
“Reasonable time” is defined as (at least) 30 days. A client needs to either provide the documentation by the end of the time-frame given, or provide proof they are working to obtain the documentation. If the client still needs more time, give the client at least another 30 days to obtain it.
If the client has been given reasonable time and does not provide the documentation or proof they are working on obtaining it, the client is removed from the Medicaid coverage with proper notice.
EXAMPLES
Citizenship/Identity Documentation Exceptions
The following individuals are EXEMPT and do not have to meet the Cit/ID documentation requirement. If the individual loses an exempt status they must meet the Cit/ID requirement at their next scheduled review.
SSI recipients and those in an SSI Protected group
SS-DI recipients
Medicare recipients
Children in receipt of Title IV-B or Title IV-E Subsidized Adoption Assistance
Children in receipt of Title IV-B or Title IV-E Foster Care Payments
Qualifying Aliens*
Clients only eligible for Emergency Medicaid
Household members who are not receiving Medicaid benefits
*Workers are to follow the same procedures for Qualifying Aliens as they did prior to July 1, 2006.
Children Born to a Medicaid Eligible Mom: A child born to a mother who verifies she was on Medicaid at the time of the child’s birth is deemed to have met the Cit/ID documentation requirement. Workers can make a collateral contact with the applicable State Medicaid agency to verify the mother's claim.
The mother could have received Medicaid in any US State, District of Columbia or US Territory.
Once the agency has verification of the mother’s eligibility, the child never has to provide Cit/ID documentation again. See Table IV, Chart 1 for acceptable verification.
EXAMPLES
Documentation Requirements:
States must obtain satisfactory
documentary evidence of an applicant’s or recipient’s, citizenship
and identity.
Table IV in Medicaid policy (Charts 1, 2, 3, 4) outlines a descending order of acceptable Citizenship documentation based on the reliability of the documentation source. Attempt to get documentation from the highest source the client can access.
Chart 5 on Table IV describes the acceptable sources of identity documentation.
State are allowed to match with the States Verification and Exchange System (SVES) via the Social Security Administration (SSA) interface. A match satisfies the citizenship and identity requirement. See 3C below for additional information.
States are allowed to match with the State Vital Statistics to obtain birth verification.
When a client born in Utah does not have an original birth certificate, workers are to do an electronic search for birth years that have been computerized. For years that have not been computerized, they are to submit a Form 125 to Utah State Vital Records to obtain verification that a birth record is on file with the state.
Authentication of Documents:
Workers are required to see original documentation, photocopy it and then authenticate each page of a document, if multiple pages. Each document is to be separately authenticated. For a document to be “authenticated,” it must have a permanent notation on the document that the worker certifies the photocopy is made from the original document, the date the copy was made, and the worker’s name.
The authentication must be readable and not cover up or obscure pertinent information on the document.
Only authenticate original Cit/ID documents that are being returned to the client. Electronic matches with Utah State Vital Records, Form 125, SAVE interface through eFIND, and Form 61-IC do not have to be authenticated.
Copies, notarized copies and facsimile copies CANNOT be authenticated.
The originals may be provided in person by the client or anyone they wish to bring it to the workers. Originals may be mailed in, though we do not encourage it because of risk of loss of the document in the mail.
Only employees of DCFS working with Child and Family Services or Juvenile Justice Services, and DWS have authority to authenticate Citizenship/ID documents. The only exception is when the Dept. of Health or DWS has given authority to other specific individuals to act as the agency’s authorized representative to receive verifications from clients. Those authorized representatives must have specific permission from the department and have no conflict of interest regarding Medicaid eligibility. For example, a DSPD case manager is not authorized to see the original citizenship document, photocopy it and authenticate it for the Medicaid eligibility worker.
State Verification and Exchange System (SVES)
SVES verifies information regarding the person's claim of US citizenship or nationality.
The client's name, SSN and date of birth compares with data in the SSA Master File of SSN Holders (Numident).
The interface is daily and responses are received the next day.
One of three responses is possible: positive, inconsistency with SSA records and no match with SSA records.
A positive response satisfies the Citizenship and Identity requirement. See Table IV, Chart 1.
The data submitted is consistent with SSA records.
No additional information is required from the client.
An inconsistency or no match response indicates the data submitted to SSA does not match. (IE, misspelled name, incorrect SSN, incorrect DOB or incorrect citizenship declaration.)
The agency first makes a reasonable effort to identify and resolve the cause of the inconsistency. For example, typographical or other clerical error.
When an inconsistency is identified and corrected, resubmit the request.
When an inconsistency is not found by the agency, OR if the second request result is the same, the client has 90 days to provide proper citizenship documentation.
The 90 days starts with the date the client receives the notice.
Medicaid benefits remain open during the 90 day verification period.
If the case closes for any reason during the 90 day verification period, the 90 days continues to run.
Once the 90 day verification period has expired, it cannot be extended or repeated.
If proper citizenship documentation has not been provided by the end of the 90 day verification period, remove the individual from coverage at the end of the month for which 10-day notice can be given.