Purpose: States are required to verify citizenship and identity for all applicants and recipients of Medicaid as required by WAC 388-490-0005
WAC 388-490-0005
Effective July 5, 2006
WAC 388-490-0005 The department requires proof before authorizing benefits for cash, medical, and Basic Food.
This rule applies to cash, medical, and Basic Food.
When you first apply for benefits, the department may require you to provide proof of things that help us decide if you are eligible for benefits. This is also called "verification". The types of things that need to be proven are different for each program.
After that, we will ask you to give us proof when:
You report a change;
We find out that your circumstances have changed; or
The information we have is questionable, confusing or outdated.
Whenever we ask for proof, we will give you a notice as described in WAC 388-458-0020.
You must give us the proof within the time limits described in:
We will accept any proof that you can easily get when it reasonably supports your statement or circumstances. The proof you give to us must:
Clearly relate to what you are trying to prove;
Be from a reliable source; and
Be accurate, complete, and consistent.
We cannot make you give us a specific type or form of proof.
If the only type of proof that you can get costs money, we will pay for it.
If the proof that you give to us is questionable or confusing, we may:
Ask you to give us more proof, which may include providing a collateral statement. A "collateral statement" is from someone outside of your residence who knows your situation;
Schedule a visit to come to your home and verify your circumstances; or
Send an investigator from the Division of Fraud Investigations (DFI) to make an unannounced visit to your home to verify your circumstances.
By signing the application, eligibility review, or change of circumstances form, you give us permission to contact other people, agencies, or institutions.
If you do not give us all of the proof that we have asked for, we will determine if you are eligible based on the information that we already have. If we cannot determine that you are eligible based on this information, we will deny or stop your benefits.
For all Medicaid programs, you must provide proof of citizenship and identity as specified at Section 6036 of the Deficit Reduction Act of 2005 (PL 109-171 amending USC 1396b).Exempt from this requirement are recipients of :
Medicaid (Title XIX) applicants and recipients that declare they are U.S citizens or U.S Nationals are required to verify their citizenship and identity.
Who is exempt from Citizenship Requirements?
The following Medicaid applicants /recipients are exempt from the citizenship and identity requirements:
People who receive Supplemental Security Income (SSI) or who have received SSI in the past.
People who receive Social Security Disability based on their own disability.
People who are entitled to or enrolled in Medicare.
People who are not U.S. citizens or U.S. Nationals, regardless of immigration status.
Newborn children, born to a mother on Medicaid, and automatically eligible for one year.
Children receiving Foster Care.
Children receiving SCHIP (Title XXI).
Requirements for Applicants
Effective July 1, 2006, all Medicaid applicants declaring they are U.S. citizens or U.S. Nationals must verify their citizenship and identity before they are approved for benefits.
Applicants who meet all other eligibility factors except for citizenship and identity are approved for Medicaid if they provide the verification or complete the “Citizenship Documentation and Identity Declaration” form (DSHS13-789).
Any applicant who does not provide either the verification or the “Citizenship Documentation and Identity Declaration” form will be denied Medicaid using the correct citizenship/identity codes in ACES. Worker procedures at application are:
Review client’s electronic case record (ECR) for acceptable citizenship and identity verification and update ACES with correct citizenship/identity codes.
For each person applying for Medicaid who does not have citizenship and/or identity verification available in the ECR, do the following.
For citizenship:
If client is born in WA, worker will verify citizenship through DOH vital statistic look-up, print out verification and send to the electronic case record (ECR).
If client does not have verification of citizenship, and is born out of state or verification cannot be found in the DOH look-up, request the “Citizenship Documentation and Identity Declaration” form.
For identity:
If client is 15 or younger and the signed application includes city/state of birth or client completes the “Citizenship Documentation and Identity Declaration”, identity is verified.
If client is 16 or older the “Citizenship Documentation and Identity Declaration” can be used to approve Medicaid and the central unit will follow up with the client for verification.
EXAMPLE
Family Medical application is received for mom, dad and two children ages 10 and 15. Mom and Dad provided their ID and birth certificates. The children were born in Washington State and the city/state field is completed. Citizenship is verified through the Department of Health (DOH) look-up for the children, but they have no picture ID. The application will meet the identity requirement for the two children under age 16.
For in-office interview:
If all other verification except citizenship and/or identity is available to approve Medicaid, have client complete the “Citizenship Documentation and Identity Declaration” in the interview.
If pending for other verification and client has verification at home, include request for citizenship and/or identity verification in pend letter.
For mail–in applications send 10 day pend letter for required citizenship and/or identity verification or a completed “Citizenship Documentation and Identity Declaration”.
Applications for pregnant women are not denied or pended when the only missing verification is for citizenship and/or identity. The CCU will follow up with the pregnant client to provide needed verification.
EXAMPLE
A pregnant woman mails in her application for medical. The ECR has no citizenship or identity documentation. The CSO sends a letter for both income and citizenship and identity verification. She returns the income verification and her photo ID but fails to include citizenship verification. As long as the client is otherwise eligible, the application is approved and the CCU will request the missing verification.
Applicants for Temporary Assistance for needy Families (TANF/F01) and General Assistance (GA/X/G02) must provide citizenship and identity verification or complete the “Citizenship Documentation and Identity Declaration” before they can be approved for Medicaid.
When approving cash benefits for any individual who doesn’t have or refuses to provide citizenship and /or identity verification or the “Citizenship Documentation and Identity Declaration”:
Enter the appropriate codes in the citizenship and/or identity fields on the clients DEM2 screen in ACES.
TANF (F01) client’s will continue on cash and not receive Medicaid.
For GA/X/G02 clients, redetemine GA cash and G01 medical coverage (Citizenship and identity are not requirements for these state funded programs).
If the client provides the required citizenship and/or identity verification necessary to establish Medicaid eligibility after cash has been approved:
Update the client’s citizenship and/or identity fields on the ACES DEM2 screen with the correct citizenship/identity codes.
Medicaid eligibility shall begin the 1st of the month that the client provides the documentation.
Effective July 1, 2006, all Medicaid recipients declaring they are U.S. citizens or U.S. Nationals must verify their citizenship and identity but have a reasonable opportunity to provide verification.
Citizen recipients of Medicaid who meet all other eligibility factors except citizenship and/or identity will be recertified benefits and the Citizenship Central Unit (CCU) will follow up with the recipient to provide needed verification. Worker procedures at review are:
1.Review client’s electronic case record (ECR) for acceptable citizenship and identity verification.
b.If the record does not contain acceptable verification for citizenship and/or identity, leave existing coding in the citizenship field and update the identity field with “P – Pending identity verification”.
2.At eligibility review, only pend for citizenship and/or identity verification or a completed “Citizenship Documentation and Identity Declaration” when pending for other verification.
NOTE:
If all verification is provided except citizenship and/or identity and the client is otherwise eligible, recertify eligibility and the CCU will follow up with the recipient to provide needed verification.
Citizenship Central Unit (CCU)
Health & Recovery Services Administration (HRSA) established the Citizenship Central Unit (CCU) to follow-up with applicants and recipients to obtain citizenship and/or identity documentation.
The CCU reviews monthly reports of all approved Medicaid applications where citizenship has been coded with any code other than T1 or T2 and identity is any code other than verified.
The CCU reviews monthly reports of all recipients approved at review that are not coded with acceptable citizenship and/or identity verification.
CSO staff is not required to forward documents in the clients ECR to the CCU. The CCU will review the clients ECR when working from the monthly reports.
Clients are not expected to pay for any documents necessary to verify their citizenship and/or identity status. The CCU will request and pay for out of state birth certificates using the information on the “Citizenship Documentation and Identity Declaration”.
Staff with questions regarding specific cases can contact the CCU by calling the Medical Assistance Customer Service Center:
By phone at 1-800-562-3022 and choosing option 5.
By mail at Mail Stop 45534, attention Citizenship Central Unit.
By fax at 1-800-374-5313.
Reinstatements
If the client provides citizenship and identity verifications after termination, medical will be reinstated the first of the month eligibility ended if:
For children, the verification is provided within the continuous eligibility period.
For cash grants (F01, G02) the AU is still active.
NOTE:
CCU or CSO staff can reinstate clients once verification has been provided.
Modification Date: November 19, 2007
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