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Wisconsin Department of Health and Family Services Obsolete Medicaid Eligibility Handbook For the current MEH, see http://www.emhandbooks.wi.gov/meh-ebd/ For the current BC Plus Handbook, see http://www.emhandbooks.wi.gov/bcplus/ |
The Federal Deficit Reduction Act of 2005 requires persons applying for or receiving Medicaid (MA), BadgerCare (BC), or Family Planning Waiver (FPW) 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 new MA requirement to document citizenship and identity in order for the State to obtain Federal matching funds. As part of on-going DHFS 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. The Department will work with non-compliant agencies to achieve compliance.
The citizenship and identity documentation requirement covers all non-exempt applicants and recipients of:
Medicaid
BadgerCare
Family Planning Waiver Program
Katie Becket
Tuberculosis-related Medicaid
Wisconsin Well Woman Medicaid
The following populations are exempt from the new citizenship and identity documentation requirement:
Anyone receiving Social Security Disability Insurance (SSDI).
Anyone who is receiving or has received Supplemental Security Income (SSI) benefits.
Anyone receiving Medicare.
Anyone applying for or receiving BadgerCare Prenatal Program benefits.
Anyone applying for or receiving Emergency MA.
Anyone receiving Title IV-E Foster Care.
Anyone receiving Adoption Assistance.
Note: Qualified providers who conduct MA presumptive eligibility determinations must not apply the new citizenship and identification documentation requirement to persons seeking presumptive eligibility. Persons determined presumptively eligible for MA are not subject to the documentation requirement until they file a formal application with the local Income Maintenance agency.
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.
See 3.0.2 Documentation section for additional information.
See 3.0.4 for Situations Which Require Special Documentation Processing.
All applicants and recipients must be given a reasonable period of time to present documents establishing that they are a U.S. citizen or national, and their identity. This newly designated time frame for purposes of citizenship documentation is called the “reasonable opportunity period.” See 3.06 reasonable opportunity period section for additional information.
The "Good faith effort" policy for the citizenship and identity documentation requirements provides more time during which the applicant/recipient can provide the necessary verification to meet this new requirement. This policy allows for the extension of the reasonable opportunity period without jeopardizing the original filing date or review date. See Good Faith Effort section 3.0.7 for specific requirements of this policy.
The list of valid documents used to verify citizenship and identity is divided into six levels. Applicants and recipients must provide documentation from the highest level available that can be obtained during the reasonable opportunity period. See the Hierarchy of Documentation 3.0.5 for additional information.
It is expected that all non-exempt individuals requesting or receiving MA provide acceptable documentation to verify citizenship and identity from the federally approved Levels 1 through 5 or the state-defined Level 6 identity documentation, 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 1-6, once it is determined that the person is unable to produce any Level 1-6 documentation. See 3.0.8 for Temporary Policy for Special Populations.
In an effort to minimize the burden on existing MA/BadgerCare recipients and to ease local agency workload, the Department has used existing CARES data, MA Birth Claims data, and data exchanges to auto-update as many current participant records as possible with valid citizenship or identification verification codes. See 3.0.9 Data Matches and Auto Updates for more information.
New fields were added to the (CWW) “Permanent Demographics” page and “Current Demographics” page to record an individual's compliance with the Citizenship and Identity Documentation Requirements. The fields are called the “US Citizenship MA verification” field and the “Identification MA verification” field. When the documentation requirement policy went into effect August 2006, the new fields on some cases were auto-populated with valid codes in the conversion process. Individuals who had existing citizenship or identity codes that are considered valid under the new policy had those codes copied and populated into the new fields.
Valid Documentation presented to verify citizenship and identity must be recorded in the (CWW) Permanent Demographics page and/or Current Demographics page. CARES Verification Codes for Acceptable Documentation is provided on the Citizenship Documentation Requirement Updated List.
See Process Help Chapter 68 for Agency Processing of Citizenship and Identity Documentation Requirements.
This page last updated in Release Number: 07-07
Release Date: 08/30/07
Effective Date: 08/30/07