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State of Wisconsin |
HISTORY |
The policy on this page is from a previous version of the handbook.
7.2.1 Documenting Citizenship and Identity Introduction
7.2.2 Reserved
7.2.3 Reserved
7.2.4 Hierarchy of Documentation
7.2.4.1 Levels of Documentation
7.2.4.3 Agencies Paying for Documentation
7.2.4.4 Tribes With an International Border
7.2.5 Policy for Special Populations
7.2.6 Situations Which Require Special Documentation Processing
7.2.6.2 Individuals Without Verification and Affect on Household Eligibility
7.2.6.3 Individuals Gaining Citizenship Through the Child Citizenship Act of 2000
7.2.6.5 Individuals in Institutional Care Facilities
The Federal Deficit Reduction Act of 2005 requires persons applying for or receiving Medicaid, BadgerCare Plus, or FPOS benefits, who have declared that they are a U.S. citizen, to provide documentation of their U.S. citizenship and identity.
Agencies must comply with the Medicaid requirement to document citizenship and identity in order for the state to obtain federal matching funds. As part of ongoing DHS quality assurance initiatives, periodic quality control reviews will be done on randomly selected cases throughout the state to monitor agency compliance. Cases will be examined to determine if proper documentation was used to verify citizenship/identity and if the proper verification code was used. DHS will work with noncompliant agencies to achieve compliance.
Any document used to establish U.S. citizenship must show either a birthplace in the U.S. or that the person is otherwise a U.S. citizen. In addition, any document used to establish identity must show identifying information that relates to the person named on the document. For a list of all the allowable documentation, see Process Help Section 68.3 Acceptable Citizenship and Identity Documentation.
If an individual has provided proof of citizenship in a state other than Wisconsin, the IM worker can either request that the individual resubmit the documentation or request and obtain a copy or electronic copy of the original documentation reviewed by the other state to keep on file in Wisconsin.
Agencies may accept citizenship and identity documents from a woman whose last name has changed due to marriage or divorce if the documentation matches in every way with the exception of the last name. If there is any doubt, the agency may request that the individual provide an official document verifying the change such as a marriage license or divorce decree. If an individual has changed his or her first and last name, he or she must produce documentation from a court or governing agency documenting the change.
A document issued by a federally recognized Indian tribe evidencing membership or enrollment in or affiliation with the tribe (such as a tribal enrollment card or certificate of degree of Indian blood) is now considered a "Level 1" form of documentation of citizenship and identity.
Applicants who are otherwise eligible and are only pending for verification of citizenship and identity must be certified for health care benefits, within the normal application processing time frame (30 days from the filing date), as long as the applicant has notified the worker that he or she is taking steps to obtain the necessary documentation or has asked for the worker’s assistance to obtain it.
The applicant will have 95 days after the request for verification to provide the requested documentation. If the requested verification is not provided by the end of the 95 days, the eligibility will be terminated with Adverse Action notice unless the eligibility worker believes a good-faith effort is being made by the applicant or member and the worker chooses to extend the good-faith period. This 95 day period applies to applications, reviews, and person adds. An individual can only receive one 95-day good-faith effort period in his or her lifetime.
Once the citizenship and identity requirement is met, it need not be applied again, even if the person loses Medicaid at some point and later re-applies. A person should ordinarily be required to submit evidence of citizenship and identification only once, unless other information is received causing the evidence to be questionable.
Note: Do not re-verify identity for a person who has had his or her identity verified through the signing of a Statement of Identity for Children Under 18 Years of Age, F-10154 (English) (Spanish).
Documentation submitted by the applicant or member to satisfy the new requirement must be maintained in the case record.
See Process Help Section 68.1 General Citizenship and Identity Verification Requirement Information for Medicaid, BadgerCare Plus, and Family Planning Only Services Benefits for tools that IM workers can use to assist applicants and members in meeting this requirement.
The citizenship and identity documentation requirement covers all non-exempt applicants and members of the following:
BadgerCare Plus
Medicaid
Katie Becket
Note: Eligibility for Katie Becket is determined by Division of Long Term Care staff, therefore they will be ensuring citizenship and identity verification.
TB -related Medicaid
WWWMA
Note: TB and WWWMA eligibility is not determined in CWW ; therefore, it is important to ensure that citizenship and identity verification is done only once.
The following populations are exempt from the new citizenship and identity documentation requirement:
Anyone currently receiving SSDI or a Disabled Adult Child benefit (SSDC).
Anyone who is currently receiving SSI benefits.
Anyone currently receiving Medicare.
Anyone currently receiving Foster Care (Title IV-E and Non IV-E).
Anyone currently receiving Adoption Assistance.
Inmates applying for or receiving BadgerCare Prenatal Program benefits.
All persons who have ever been eligible for Wisconsin Medicaid or BadgerCare Plus as a CEN, are now exempt from ever having to provide documentation of citizenship.
Former Supplemental Security Income and Medicare Recipients
States cannot consider individuals who received Medicare or SSI in the past to be exempt. An individual is not required to be a citizen to receive these benefits. Since SSA does not share information regarding the reason benefits were lost, it is not possible to determine if the termination was due to citizenship status or not.
Note: Confirm the receipt of SSI, SSDI, and Medicare through the following data exchanges:
For SSI: use DXSX.
For SSDI: use DXSA.
For Medicare: use DXSA.
The list of valid documents used to verify citizenship and identity is divided into five levels in accordance with federal regulations. Level 1 consists of documents of the highest reliability and can prove both citizenship and identity. Levels 2 through 4 consists of documents that can prove citizenship only with level 2 being the most reliable and level 4 the least reliable. Level 5 consists of documents that can prove identity only. Applicants and members must provide documentation from the highest level available that can be obtained during the reasonable opportunity period.
If an individual needs to verify citizenship and/or identity at the point of application or renewal, he or she should try to fulfill the requirement with proof he or she already has available. If an applicant or member contacts the agency, work with him or her to check documentation levels 1 through 5 to determine if anything on the list is readily available to the applicant or member. If an applicant or member was born in Wisconsin, use the online Birth Query to verify citizenship.
In certain circumstances the agency can authorize payment of documentation for an applicant or member (see Section 7.2.4.3 Agencies Paying for Documentation).
See Process Help Section 68.3 Acceptable Citizenship and Identity Documentation.
Level 1 — Evidence of Citizenship and Identity
Primary evidence documents both citizenship and identity. Primary evidence of citizenship and identity is the most reliable way to establish that the person is a U.S. citizen. If an individual presents documents from level 1, no other information is required; however, relatively few Medicaid applicants and members may be able to provide documents from this group.
Level 2 — Evidence of Citizenship
Secondary evidence of citizenship is the next most reliable way to establish someone is a U.S. citizen. Many Medicaid applicants and members will be able to present documents from level 2 during the reasonable opportunity period and should be encouraged to do so. Note, however, that a document from this group is evidence of U.S. citizenship only and must be accompanied by evidence of identity.
Note: Completing an online birth query (level 2 documentation) can be done for all persons born in Wisconsin. Enter TRAN code MNOS on CARES mainframe screen, hit enter, then F2. There is no cost to the agency to use this method of verification.
Level 3 — Evidence of Citizenship
Third level evidence of U.S. citizenship is acceptable and may be presented by applicants and members who are unable to obtain level 1 or level 2 evidence during the reasonable opportunity period. As with level 2 evidence, a document from this group is evidence of U.S. citizenship only and must be accompanied by evidence of identity.
Level 4 — Evidence of Citizenship
Fourth level evidence of U.S. citizenship is acceptable evidence of the lowest reliability. While most Medicaid applicants and members will be able to present documents at this level, they should do so only if unable to obtain evidence of citizenship from the other levels during the reasonable opportunity period. As with second and third level evidence, a document from this group is evidence of U.S. citizenship only and must be accompanied by evidence of identity.
Level 5 — Evidence of Identity
Level 5 documentation can only be used to verify identity. Documentation of citizenship from levels 2 through 4 must be accompanied by evidence of the applicant’s or member’s identity.
The applicant may provide three or more corroborating documents, such as a marriage license, divorce decree, high school or college diploma, property deed or title, death certificate, or employer ID card, to prove identity. This option can only be used if the applicant submitted level 2 or 3, not level 4, citizenship documentation. The applicant may not use a document that was also used for citizenship verification.
Naturalized citizens must provide level 1 or 2 citizenship documentation. The Citizenship Affidavit is also available for this population if no document from level 1 or 2 is available. This group cannot use level 3 or 4 documentation.
The worker can authorize payment for a birth certificate from the state where the applicant was born and/or a Wisconsin state ID if an applicant or member:
Has no documentation from levels 1-5.
Needs either an out-of-state birth certificate and/or has no identity documentation, and
Requests financial assistance.
Note: If a member has obtained and already paid for his or her own documentation and later asks the IM agency for reimbursement of those costs, the IM agency should not provide reimbursement. If an individual has requested and paid for documentation before applying but does not yet have the documentation, do not confirm program eligibility for this individual. Eligibility can only be granted once the individual receives documentation and provides it to the agency.
If an individual was born in Wisconsin and not found in the Wisconsin online birth query, agencies may authorize payment for a Wisconsin birth certificate to verify citizenship.
IM agencies should pay for a birth certificate or state ID card before using the "Special Populations" option (see Section 7.2.5 Policy for Special Populations). If there is an opportunity to obtain a document that meets federal guidelines, then that should be pursued.
However, when an applicant or member lacks any identity documentation needed to apply for a birth certificate or lacks any citizenship documentation to be able to apply for an ID card, it is appropriate to consider using the Written Affidavit for citizenship and/or "Special Populations" policy.
In order to obtain birth certificates or state ID cards for applicants or members, agencies need to follow the process outlined in Process Help Section 68.2.5 Agency Documentation Requests.
For tribes having an international border and whose membership includes non-U.S. citizens, tribal enrollment or membership documents may be used for purposes of proving both citizenship and identity.
It is expected that all non-exempt individuals requesting or receiving Medicaid provide acceptable documentation to verify citizenship and identity from the federally approved levels 1 through 5 at application or review. However, certain special populations may be particularly disadvantaged with regard to providing the required documentation. For some persons within a special population, it will be allowable to accept other documents besides those listed in levels 1-5, once it is determined that the person is unable to produce any level 1-5 documentation.
This policy only applies when it is determined that an individual within a special population is in a situation where he or she does not have the ability to obtain citizenship or identity documentation from level 1-5. This policy should be used with discretion and only when an individual has no other means of meeting the requirement.
Examples of individuals in special populations include, but are not limited to, persons who:
There are two ways for individuals in special populations to meet the citizenship and identity documentation requirement:
Present other documents besides those listed in levels 1-5 to meet the requirement as long as the document meets the general documentation requirement stated here:
"Any document used to establish U.S. citizenship must show either a birthplace in the U.S. or that the person is otherwise a U.S. citizen. Any document used to establish identity must show identifying information that relates to the person named on the document."
Some examples of documents that could be used to establish citizenship for special populations as long the document shows a birthplace in the U.S. or that the person is otherwise a U.S. citizen are:
Below are examples of documents that could be used to establish identity for special populations as long the document shows some identifying information (e.g., name, address, telephone number) that relates to the individual:
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Example 3: Due to their religious practices, an Amish family is not able to present a birth certificate for their child because the child was not born in a traditional hospital setting and no record of the child’s birth exists within the state system. In addition, the child is home schooled so there is no school identification card to present for identification verification. However, the family is able to produce a signed letter from their church leader that states the child’s birth place and birth date. This document can be used to satisfy the citizenship and identification requirement under the temporary policy for Special Populations. |
The Statement of Citizenship and/or Identity for Special Populations form (F-10161) can be used to meet the new requirement only when no other documentation is available from levels 1-5 or number one above.
This form can be completed by a related or unrelated individual who knows the applicant or member, an authorized representative , an IM agency worker, a worker for a housing agency who is aware of the individual’s living situation, a Medicaid provider for a minor , etc. Additional requirements concerning F-10161 are as follows:
Note: An F-10161 can be signed by the authorized representative of an individual who is not able to procure any other documents on his or her own.
While an IM worker is obligated to assist an applicant or member who asks for help in meeting the citizenship and identity requirement, this does not necessarily mean the IM worker must sign the F-10161. The signatory to the F-10161 must know and be able to truthfully attest to the applicant or member’s citizenship or identity. If an IM worker can do this for an applicant or member, then he or she may sign the form.
Maintain copies of any documents secured under this temporary policy in the case record. Enter Case Comments to document why this policy was used and note whether the F-10161 or another document was used to verify citizenship and identity.
Note: An individual who met the citizenship requirement by using documents obtained under the Special Populations policy or by using F-10161 has complied with the federal requirement and is not required to provide other documentation at his or her next review.
If you are aware of an individual who meets the special population category outlined above and whose Medicaid application has been denied or eligibility has ended because of his or her inability to provide acceptable documentation, contact the individual to see if the Special Populations policy may be applied. See Documentation Level 7 of the Acceptable Citizenship and Identity Documentation.
A person being added to a case is subject to the verification requirement at the time of his or her application. Inform the applicant of the documentation requirement and give him or her the “reasonable opportunity period” to comply. Do not grant eligibility for the individual until he or she has submitted valid documentation. If documentation is not received timely, deny Medicaid for that individual only. Do not require other non-exempt household members to submit citizenship or identification documentation until their next review.
IM workers should not delay an individual household member’s eligibility when awaiting another household members’ citizenship or identity verification. The individual pending for citizenship or identity should be counted as part of the group when determining eligibility for other group members. See Process Help Section 68.2 Documentation and Verification Codes for processing instructions.
Certain foreign-born individuals have derivative U.S. citizenship as a result of the Child Citizenship Act. Within the context of the Medicaid citizenship verification requirement, this means that for any applicant or member claiming citizenship through the Child Citizenship Act, IM workers should not request documentation for that person. In these cases, IM workers need to acquire documentation proving the citizenship and identity of at least one U.S. citizen parent. The parent’s U.S. citizenship is the basis for the child receiving derivative citizenship.
For persons who meet the citizenship verification requirement through the means allowed in the Child Citizenship Act, this is considered level 2 evidence. Therefore this counts for citizenship only and the individual needs to provide another document to verify identity. The code <CA> should be used in the Medicaid Citizenship Verification field.
See Section 7.1.2 Child Citizenship Act of 2000.
As a reminder, do not request or require citizenship and identity documentation from individuals who have not declared that they are citizens. Non-citizens who apply for IM programs are not subject to this policy. Legal non-citizens are subject to the verification process through SAVE and undocumented non-citizens do not have any status that can be verified. Undocumented non-citizens can apply for Emergency Medicaid or the BadgerCare Plus Prenatal Program and should not be subject to the citizenship verification policy.
When an individual who had legal non-citizen status subsequently gains U.S. citizenship, this is recorded in SAVE. Therefore, SAVE can be used to verify these individuals' citizenship. The verification result from SAVE will be used to verify these individuals' citizenship. The verification result from SAVE will be "individual is a US Citizen." See Process Help Chapter 82 SAVE for instructions on using SAVE. Use the <SV> code in the Medicaid Citizenship Verification field when using SAVE for this population. These individuals do still need proof of identity since the SAVE verification is considered to be Level 2 citizenship documentation.
Disabled individuals in institutional care facilities may have their identity attested to by the facility director or administrator when nothing else is available. Use the Statement of Identity for Persons In Institutional Care Facilities form (F-10175) for this purpose. A medical institution can be, but is not limited to, an SNF , ICF , IMD , and hospital.
This page last updated in Release Number: 15-03
Release Date: 11/24/2015
Effective Date: 11/24/2015
The information concerning the Medicaid program provided in this handbook release is published in accordance with: Titles XI and XIX of the Social Security Act; Parts 430 through 481 of Title 42 of the Code of Federal Regulations; Chapters 46 and 49 of the Wisconsin Statutes; and Chapters HA 3, DHS 2, 10 and 101 through 109 of the Wisconsin Administrative Code.
Notice: The content within this manual is the sole responsibility of the State of Wisconsin's Department of Health Services (DHS). This site will link to sites outside of DHS where appropriate. DHS is in no way responsible for the content of sites outside of DHS.
Publication Number: P-10030