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State of Wisconsin |
Release 24-02 |
U.S. citizenship must be verified for persons applying for or receiving Medicaid (MA), BadgerCare Plus, or FPOS benefits and who have declared that they are a U.S. citizen, unless they are exempt from this requirement (See Section 7.2.1.2 Exempt Populations). Citizenship verification for health care must first be attempted using the real-time data exchange with the Social Security Administration before requesting documentation of citizenship from applicants. (See Section 7.2.3 Citizenship Verification through Data Exchange). Only those who are not exempt and for whom verification was not available through a data exchange may be required to submit documentation of their citizenship (See Section 7.2.4 Citizenship Verification through Documentation). Once citizenship has been verified for a person, verification may never again be required to receive health care benefits unless previously verified information becomes questionable.
The U.S. citizenship verification requirement applies to all non-exempt applicants and members of the following programs:
If U.S. citizenship has been verified for any of these programs, U.S. citizenship is considered verified for all programs.
The following populations are exempt from the U.S. citizenship verification requirement:
The citizenship verification requirement does not apply to persons who are not applying for or receiving any health care benefits. This requirement also does not apply to persons who are not claiming to be a U.S. citizen.
Identity verification is only required in certain situations as part of citizenship verification. Persons not applying for or receiving any health care benefits and persons who are not claiming to be a U.S. citizen are not required to verify identity (see Section 7.2.4.3 Evidence of Identity).
Former Supplemental Security Income and Medicare Recipients
Medicare, SSDI, and SSI recipients lose their exemption from the citizenship verification requirement when their enrollment in these programs ends.
| Note: | IM workers must use data exchanges to verify receipt of SSI, SSDI, and Medicare prior to requesting verification from the applicant or member. |
For persons who meet the selection criteria below, a request will be sent electronically 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 verify U.S. citizenship, no additional verification of U.S. citizenship is required.
To be selected for this data exchange, a person must:
Non-exempt Medicaid applicants who do not provide an SSN, or whose SSN cannot be verified, cannot have their U.S. citizenship verified through the data exchange. They must meet the U.S. citizenship verification requirement by providing documentation as defined in Section 7.2.4 Citizenship Verification Through Documentation.
For individuals who are not exempt from the U.S. citizenship verification requirement and have not had their U.S. citizenship verified by the Social Security Administration, agencies must first attempt to verify U.S. citizenship as follows:
If verification cannot be obtained through the SSA, birth record query, or SAVE, the individual must provide verification of U.S. citizenship through either stand-alone documentation of citizenship (see Section 7.2.4.1 Stand-Alone Documentation of Citizenship) or both documentation of citizenship (see section 7.2.4.2 evidence of citizenship) and identity (see section 7.2.4.3 evidence of identity). Whether benefits may be granted while waiting for documentation to be provided and for how long are discussed under the Reasonable Opportunity Period for Verification of Citizenship (see section 7.2.4.4 reasonable opportunity period for verification of citizenship).
If an individual has provided proof of U.S. 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.
If an applicant/member contacts the agency for help with verifying citizenship, work with him or her to determine if anything on the document list in Process Help, Section 68.3 Acceptable Citizenship and Identity Documentation is readily available to the applicant/member. In certain circumstances the agency can authorize payment of documentation for an applicant/member. See section 7.2.5 agencies paying for documentation.
Agencies may accept citizenship and identity documents from an individual 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 the different last names are found questionable, 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.
An electronic copy of documentation submitted by the applicant or member to satisfy the citizenship verification requirement must be maintained in the case record.
See Process Help, Section 68.1 Citizenship and Identity Verification, for tools that IM workers can use to assist members and applicants in meeting the citizenship verification requirement.
Once citizenship has been verified by a State or IM agency, verification may never be requested again, even after periods of ineligibility for health care benefits, unless other information is received causing past previously verified information to be questionable. This includes verification of citizenship or identity documented by a written affidavit.
Stand-alone documentation is a single document that verifies U.S. citizenship, such as a United States Passport. Stand-alone documentation of U.S. citizenship is the most reliable way to establish that the person is a U.S. citizen. If a person presents a stand-alone document, no other U.S. citizenship verification is required. See the chart below or Process Help, Section 68.3.2 Stand-Alone Documentation of Citizenship for a list of acceptable documents.
An applicant or member who does not provide a stand-alone document must provide documentation of both U.S. citizenship and identity (see Section 7.2.4.2 Evidence of Citizenship and Section 7.2.4.3 Evidence of Identity).
| Stand-Alone Document | Description/Explanation |
| Certificate of Naturalization | Form N-550 or N-570. Issued by the Department of Homeland Security for naturalization. |
| Certificate of Citizenship | Form N-560 or N-561. The Department of Homeland Security issues certificates of citizenship to individuals who derive citizenship through a parent. |
| A State-issued Enhanced Driver’s License | A special type of driver’s license identified specifically as an “Enhanced Driver’s License”. It requires proof of U.S. citizenship to obtain. Five states currently issue enhanced driver’s licenses (Minnesota, Michigan, New York, Vermont, and Washington), but more states are expected to issue these licenses in the future. Accept an Enhanced Driver’s License issued by any U.S. state. REAL IDs are not Enhanced Driver’s Licenses. REAL IDs only provide documentation of identity, not citizenship. |
| U.S. Passport | The Department of State issues this. A U.S. passport does not have to be currently valid to be accepted as evidence of U.S. citizenship, as long as it was originally issued without limitation. Do not accept any passport as evidence of U.S. citizenship when it was issued with a limitation. Passports issued with a limitation may only be used as proof of identity. |
| Tribal Identification Documents | Documentary evidence issued by a federally recognized Indian tribe, which meets all the following criteria:
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| SAVE Database | Using the SAVE system to verify citizenship status for non-citizens who gained U.S. citizenship. |
| Birth Query | A birth record query confirms a person's birth in Wisconsin. |
If an applicant whose U.S. citizenship has not been verified by SSA, birth query, or SAVE database is unable to provide stand-alone documentation of U.S. citizenship (see Section 7.2.4.1 Stand-alone Documentation of U.S. Citizenship), they must provide other documentation proving U.S. citizenship.
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 (see the chart below or Process Help, Section 68.3 Acceptable Citizenship and Identity Documentation). If an applicant is unable to provide any of the acceptable documents of U.S. citizenship, they may submit an affidavit signed by another person under penalty of perjury, who can reasonably attest to the applicant’s U.S. citizenship. The affidavit must contain the applicant’s name, date of birth, and place of U.S. birth. The affidavit does not have to be notarized.
The applicant may submit a Statement of Citizenship and/or Identity (F-10161) or another affidavit.
Applicants whose U.S. citizenship cannot be verified by SSA or through stand-alone documentation of U.S. citizenship must also provide documentation of identity (see Section 7.2.4.3 Evidence of Identity).
| Acceptable Documentation of Citizenship Only | Description/Explanation |
| Final Adoption Decree | The adoption decree must show the child’s name and U.S. place of birth. Where an adoption is not finalized and the state in which the child was born will not release a birth certificate prior to final adoption, a statement from a state-approved adoption agency that shows the child’s name and U.S. place of birth is acceptable. The adoption agency must state in the certification that the source of the place of birth information is an original birth certificate. |
| Birth Certificate |
A U.S. public birth certificate showing birth in one of the 50 States, the District of Columbia, Puerto Rico (if born on or after January 13, 1941), Guam (on or after April 10, 1899), the Virgin Islands of the U.S. (on or after January 17, 1917), American Samoa, Swain’s Island, or the Northern Mariana Islands (after November 4, 1986). The birth record document may be recorded (previously 'issued') by the state, commonwealth, territory, or local jurisdiction. Note: A Puerto Rican birth certificate used to verify U.S. citizenship of anyone applying for health care benefits must have been issued on or after July 1, 2010. Older birth certificates that were used to verify citizenship for persons when they previously applied for any IM program before October 1, 2010, are still considered valid. |
| U.S. birth record amended more than 5 years after person’s birth | An amended U.S. public birth certificate showing birth in one of the 50 States, the District of Columbia, Puerto Rico (if born on or after January 13, 1941), Guam (on or after April 10, 1899), the Virgin Islands of the U.S. (on or after January 17, 1917), American Samoa, Swain’s Island, or the Northern Mariana Islands (after November 4, 1986). Must show a U.S. birthplace. |
| Acquired citizenship through parent(s) as outlined in the Child Citizenship Act 2000 (CCA) | An individual demonstrates that s/he has gained his/her U.S. Citizenship through the Child Citizenship Act of 2000. |
| US Citizen ID Card or Northern Mariana Card | U.S. Citizen ID Card The Immigration and Naturalization Service (INS) issued the I-179 and the I-197 from 1960 until 1983 to naturalized U.S. citizens living near the Canadian or Mexican border who needed it for frequent border crossings. Northern Mariana Card Form I-873. Issued by INS for those born in the Northern Mariana Islands before November 4, 1986. |
| State or Federal census record | Must show birthplace and citizenship. Census records from 1900 through 1950 contain certain citizenship information. To secure this information, the applicant, member, or State should complete a Form BC-600, Application for Search of Census Records for Proof of Age. Add in the remarks portion “U.S. citizenship data requested.” Also add that the purpose is for Medicaid eligibility. This form requires a fee. |
| Education Document | The school record must show a U.S. birthplace and the name of the child. |
| Evidence of civil service employment by U.S. government | The document must show employment by the U.S. government before June 1, 1976. Persons employed with the U.S. Government prior to that date had to be U.S. citizens. |
| Hospital record | Extract of a hospital record on hospital letterhead established at the time of the person’s birth and that indicates a U.S. place of birth. This is not a souvenir “birth certificate” issued by the hospital. |
| Life, health, or other insurance record | Must show a U.S. place of birth. |
| Medicaid Birth Claim | When the Wisconsin Medicaid program pays the costs associated with the birth of an infant who either:
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| Medical record (doctor, clinic, hospital) | The document must show a U.S. birthplace. An immunization record is not considered a medical record for purposes of establishing U.S. citizenship. |
| Official Military record of service | The document must show a U.S. birthplace. |
| Admission papers from nursing home, skilled nursing care facility, or other institution | The document must show a U.S. birthplace. |
| Other MA Program Verified Citizenship | An individual has already provided proof of citizenship while they were receiving Wisconsin Medicaid outside of CARES. For example, use this for members previously enrolled through the Katie Beckett program. |
| Birth Certificate Paid by IM Agency | A U.S. public birth certificate (paid for by the Income Maintenance agency) showing birth in one of the 50 States, the District of Columbia, Puerto Rico (if born on or after January 13, 1941), Guam (on or after April 10, 1899), the Virgin Islands of the U.S. (on or after January 17, 1917), American Samoa, Swain’s Island, or the Northern Mariana Islands (after November 4, 1986). The birth record document may be recorded (previously 'issued') by the state, commonwealth, territory, or local jurisdiction. |
| Religious Record or Baptismal Certificate | An official religious record. The document must show a US birthplace and either the date of birth or the individual's age at time the record was made. |
| Certification of Report of Birth | The Department of State issues a DS-1350 to U.S. citizens in the U.S. who were born outside the U.S. and acquired U.S. citizenship at birth. |
| Certification of Birth Abroad | Form FS-545. Issued by the Department of State consulates prior to November 1, 1990. |
| Consular Report of Birth Abroad of a US Citizen | Form FS-240. The Department of State consular office prepares and issues this. Children born outside the U.S. to U.S. military personnel usually have one of these. |
| Written Affidavit (Form F-10161) |
If the applicant cannot produce the accepted documents verifying U.S. citizenship, a written affidavit may be used. The affidavit must:
The affidavit doesn't need to be notarized. The "Citizenship Statement" section of the Statement of Citizenship and/or Identity form (F-10161) may be used for the affidavit. |
If an applicant whose U.S. citizenship is not verified by SSA is unable to provide stand-alone documentation of citizenship (see Section 7.2.4.1 Stand-alone Documentation of Citizenship), they must provide evidence of both citizenship (see Section 7.2.4.2 Evidence of Citizenship) and identity.
As a reminder, for health care, verification of identity must not be requested or required for:
The applicant may provide any documentation of identity listed in the chart below or Process Help, Section 68.3 Acceptable Citizenship and Identity Documentation to verify identity, provided such document has a photograph or other identifying information sufficient to establish identity such as name, age, sex, race, height, weight, eye color, or address.
In addition, the IM agency may accept proof 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 person. If the applicant does not have any documentation of identity and identity is not verified by another Federal or State agency, they 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. The applicant may submit a Statement of Citizenship and/or Identity (F-10161) or another affidavit.
| Acceptable Documentation of Identity Only | Description/Explanation |
| State or Territory Driver’s license | Driver’s license issued by a U.S. State or Territory either with a photograph of the individual or other identifying information of the individual such as name, age, sex, race, height, weight, or eye color. REAL IDs only provide documentation of identity, not citizenship. Note: Real IDs only provide documentation or identity, not citizenship. |
| Education Document | For children under age 19, school records providing the name and other identifying information. School records would include, but not be limited to report cards, daycare, or nursery school records. |
| FoodShare Identification Requirement met | Verifying the identity of the primary person is a requirement for a FoodShare application. Once this requirement is met for FoodShare, it is also met for the identity verification requirement for health care. |
| Identification card issued by Federal, State, or local government | Must have the same information as is included on driver license. |
| Institutional Care Affidavit (Form F-10175) |
If the applicant cannot produce the accepted documents verifying identity, a signed Statement of Identity for Persons in Institutional Care Facilities (F-10175) may be used. A residential care facility administrator signs this form under penalty of perjury attesting to the identity of a disabled individual in the facility. |
| U.S. Military card or draft record, Military dependent’s identification card, or US Coast Guard Merchant Mariner card | Must show identifying information that relates to the person named on the document. |
| Medical record | Doctor, clinic, or hospital records for children under age 19 only. |
| Motor Vehicle Data Exchange | This is a data exchange update with the Division of Motor Vehicles or when verifying an individual’s identity through the DOT Driver License Status Check website. |
| Multiple Identity documents | An individual may provide 2 or more corroborating ID documents to verify his/her identity. Examples include marriage license, divorce decree, high school or college diploma, or an employer ID card. |
| Other MA Program Verified Identity | An individual has already provided proof of identity while they were receiving Wisconsin Medicaid outside of CARES. For example, use this for members previously enrolled through the Katie Beckett program. |
| State ID Paid by Agency | Must have the same information as is included on driver license. |
| School Identification card | School identification card with a photograph of the individual or other identifying information. |
| Written Affidavit for Children (Form F-10154) |
If the applicant cannot produce the accepted documents verifying identity for children under 18 years of age, a Statement
of Identity for Children Under 18 Years of Age (F-10154) is acceptable. The affidavit must be signed under penalty of perjury by a parent, guardian or caretaker relative stating the date and place of birth of the child. The affidavit does not have to be notarized. |
| Written Affidavit (Form F-10161) |
If the applicant cannot produce the accepted documents verifying identity, a written affidavit may be used. The affidavit must:
The affidavit doesn't need to be notarized. The "Identity Statement" section of the Statement of Citizenship and/or Identity form (F-10161) may be used for the affidavit. |
Applicants who are otherwise eligible for Medicaid or other health care benefits and are only waiting for verification of U.S. citizenship must be certified for health care benefits within the normal application processing timeframe (see Section 2.7 Application Processing Period). They can continue receiving health care benefits for which they are eligible while the IM agency waits for U.S. citizenship verification. Applicants have 90 days after receiving a request for U.S. citizenship verification to provide the requested documentation. This 90-day period is called the reasonable opportunity period (ROP). The 90-day ROP starts on the date after the member receives the notice informing them of the need to provide U.S. citizenship verification by the end of the reasonable opportunity period. Federal regulations require that states assume a minimum five-day time frame for applicants to receive notices. For this reason, the end of the ROP must be no less than 95 days after the date on the notice, even when the member receives the notice in less than five days. If a member shows that a notice was received more than five days after the date on the notice, the deadline must be extended to 90 days after the date the member received the notice.
The 90-day ROP applies when citizenship verification is needed from a person at any time: applications, reviews, and when a person is newly requesting benefits on an existing case.
Applicants are not eligible for backdated health care benefits while pending for citizenship verification. Once citizenship verification is provided, the applicant’s eligibility must then be determined for backdated health care benefits if they have been requested.
The ROP ends on the earlier of the date the agency verifies the person’s citizenship or identity or on the 95th day following the date the reasonable opportunity period notice was sent (unless receipt of the notice was delayed). If the requested verification is not provided by the end of the 95 days, the worker must take action within 30 days to terminate eligibility. Extensions of the reasonable opportunity period are not allowed for verification of U.S. citizenship.
When a person is terminated from health care benefits for failure to provide verification of citizenship or identity by the end of the reasonable opportunity period, they are not eligible to have their benefits continued if they request a fair hearing. If a person later reapplies for health care benefits, they may receive another reasonable opportunity period to provide verification of citizenship or identity.
Benefits issued during a reasonable opportunity period (including benefits issued due to timely notice requirements) to a person otherwise eligible for Medicaid or BadgerCare Plus are not subject to recovery, even if the person never provides citizenship verification.
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:
| 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.
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 SSA, inform the applicant of the documentation requirement and give him or her the 95-day reasonable opportunity period to comply. Grant eligibility if the person is 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 persons have derivative U.S. citizenship as a result of the Child Citizenship Act (CCA) (see SECTION 7.1.2 CHILD CITIZENSHIP ACT OF 2000).
IM workers should not request citizenship documentation for persons claiming U.S. citizenship through the CCA. In these cases, IM workers must instead verify the U.S. citizenship of one parent. The parent’s U.S. citizenship is the basis for the child receiving derivative citizenship.
The parent’s U.S. citizenship is considered evidence of the child’s citizenship only. The child must provide another document to verify their identity (see SECTION 7.2.4.3 EVIDENCE OF IDENTITY).
IM agencies must not request or require citizenship verification from persons who have not declared that they are U.S. citizens. Non-U.S. citizens who apply for IM programs are not subject to citizenship verification policy. Documented non-U.S. citizens are subject to the verification process through Federal Data Services Hub (FDSH) and Systematic Alien Verification for Entitlements (SAVE), and undocumented non-U.S. citizens do not have any status that can be verified (see Process Help, Section 44.2.1.12 Immigrant/Refugee Verification for instructions on using FDSH and Process Help, Chapter 82 SAVE for instructions on using SAVE). Undocumented non-U.S. citizens can apply for Emergency Medicaid or BadgerCare Plus Prenatal Program and are not subject to the citizenship verification policy. They also do not have to verify their identity.
A person who had documented non-U.S.-citizen status and subsequently gained U.S. citizenship, should be verified through SAVE. The verification result from SAVE will be "individual is a US Citizen."
Applicants with a disability in institutional care facilities may have their identity (if required) attested to by the facility director or administrator when nothing else is available. Use the Statement of Identity for Persons in Institutional Care Facilities (F-10175) for this purpose. A medical institution can be, but is not limited to, skilled nursing facilities, intermediate care facilities, institutes for mental disease, and hospitals.
This page last updated in Release Number: 24-02
Release Date: 08/22/2024
Effective Date: 06/03/2024
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