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State of Wisconsin |
HISTORY |
The policy on this page is from a previous version of the handbook.
Persons applying for or receiving Medicaid, BadgerCare Plus, or FPOS benefits, who have declared that they are a U.S. citizen, must provide documentation of their U.S. citizenship unless they are exempt from this requirement (See 7.2.1.2) or their citizenship is verified by the Social Security Administration through a data exchange.
Certain documents, such as a passport, are considered verification of citizenship by themselves. These are called “stand-alone documents”. Those who are not exempt from the requirement, have not had their citizenship verified by the Social Security Administration and do not provide a stand-alone document, must provide documentation of citizenship and of identity. 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.
Applicants who are otherwise eligible and are only pending for verification of citizenship (and identity when needed) must be certified for health care benefits within the normal application processing time frame (30 days from the filing date). Applicants are not eligible for backdated health care benefits while pending for citizenship and/or identity. Once verification is provided, the applicant’s eligibility must then be determined for backdated health care benefits if they have been requested.
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 when needed) requirement is met, it need not be applied again, even if the person loses Medicaid at some point and later reapplies. A person should ordinarily be required to submit evidence of citizenship (and identity when needed) only once, unless other information is received causing the evidence to be questionable.
Note: Do not reverify 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.
An electric copy of documentation submitted by the applicant or member to satisfy the requirement must be maintained in the case record.
See Process Help Section 68.1 General Citizenship and Identity Verification 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 Beckett (Note: Since eligibility for Katie Beckett is determined by staff in the Bureau of Children's Long-Term Support Services, they will ensure 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
Anyone who has been eligible for Wisconsin Medicaid or BadgerCare Plus as a Continuously Eligible Newborn (CEN) born on or after July 1, 2005
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
For individuals who meet the selection criteria below, the state will submit a file to the Social Security Administration (SSA) with the person’s name, verified Social Security Number (SSN), and date of birth for comparison to SSA’s data. If SSA is able to match the individual to its files and verify the declaration of citizenship, no additional verification of citizenship is required.
Only persons meeting all of the following criteria will be selected for the SSA Citizenship Data Exchange/Auto-Update:
Non-exempt BCP applicants/members who do not provide an SSN or whose SSN cannot be verified, must meet the citizenship/identity verification requirement by providing verification as defined in 7.2.4.
If an individual applying for Medicaid is not exempt from documenting citizenship and the Social Security Administration is unable to verify his or her citizenship through the data exchange, he or she needs to provide documents that verify citizenship (and identity when needed). If an applicant or member contacts the agency, work with him or her to determine if anything on the document list in Process Help is readily available to the applicant or member.
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.
Stand-Alone Documentation of Citizenship
Stand-alone documentation is a single document that verifies citizenship, such as a U.S. Passport. Stand-alone documentation of citizenship is the most reliable way to establish that the person is a U.S. citizen. If an individual presents a stand-alone document, no other information is required; however, relatively few Medicaid applicants and members may be able to provide a stand-alone document. See Process Help Section 68.3 for a list of stand-alone documents.
An applicant or member who does not provide a stand-alone document must provide documentation of citizenship and identity.
Evidence of Citizenship
If an applicant is unable to provide stand-alone documentation of citizenship, the first thing he or she must provide is evidence or other documentation proving citizenship. (See Process Help, Section 68.3.3 Acceptable Documentation of Citizenship Only for a list.) If an applicant is unable to provide any of the acceptable documents of citizenship found in Process Help, he or she may submit an affidavit signed by another individual under penalty of perjury who can reasonably attest to the applicant’s citizenship, and that contains the applicant’s name, date of birth, and place of U.S. birth. The affidavit does not have to be notarized. Provide the applicant with the Statement of Citizenship and/or Identity form, F-10161. Note that a citizenship document is evidence of only U.S. citizenship and must be accompanied by evidence of identity.
Note: Completing an online birth query can be done for all persons born in Wisconsin.
Evidence of Identity
If an applicant is unable to provide stand-alone documentation of citizenship, in addition to providing evidence of citizenship, they must also provide evidence of identity. (See Process Help, Section 68.3.4 Acceptable Documentation of Identity Only for a list.) The applicant may provide any documentation of identity listed in Process Help, to prove identity, provided such document has a photograph or other identifying information sufficient to establish identity, including, but not limited to, name, age, sex, race, height, weight, eye color, or address.
In addition, you may accept as proof of identity a finding of identity from a Federal agency or another State agency, including but not limited to a law enforcement, revenue, or corrections agency, if the agency has verified and certified the identity of the individual. If the applicant does not have any documentation of identity and identity is not verified by another Federal or State agency, he or she may submit an affidavit signed, under penalty of perjury, by a person other than the applicant who can reasonably attest to the applicant’s identity. Such affidavit must contain the applicant’s name and other identifying information establishing identity, as described above. The affidavit does not have to be notarized. Provide the applicant with the Statement of Citizenship and/or Identity form, F-10161.
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 of citizenship or identity,
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 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 relying on a written affidavit. If there is an opportunity to obtain a document that meets the 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 a written affidavit for citizenship and/or identity.
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.
A person being added to a case is subject to the verification requirement at the time of his or her request for benefits. If not exempt and citizenship is not verified by the SSA, inform the applicant of the documentation requirement and give him or her the 95-day reasonable opportunity period to comply. Grant eligibility for the person, if otherwise eligible. If documentation is not received timely, terminate Medicaid for that person only.
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.
People who meet the citizenship verification requirement through the means allowed in the Child Citizenship Act, need 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. These individuals still need proof of identity.
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: 18-02
Release Date: 08/10/2018
Effective Date: 07/01/2018
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