Documentation of Citizenship
Provisions of the 2005 Deficit
Reduction Act (DRA) Affecting
Medicaid Applicants and Recipients
Overview of new provision
• All Medicaid (MA) applicants & recipients who
declare they are US citizens or nationals must
present documentary evidence of both:
• The DRA and Centers for Medicare and
Medicaid (CMS) guidance provide examples of
acceptable documents to meet requirement.
• Documentation must be done at application or
review and only needs to be done once.
Who is affected?
• The citizenship documentation requirement
applies to anyone applying for MA, BadgerCare
(BC), Family Planning Waiver (FPW) and
declaring U.S. citizenship.
• Includes MA subprograms where eligibility may
be determined by persons outside of the Income
Maintenance agency and outside of the CARES
system. This includes Foster Care MA, Adoption
Assistance, TB-MA, Katie Beckett MA, and Well
Who is affected?
• Exempt populations include:
Anyone receiving Supplemental Security Income (SSI) MA
Anyone enrolled in Medicare
Anyone applying for or receiving BC Prenatal Program
• The requirement does not apply during the Presumptive Eligibility
(PE) process. When the individual applies for benefits at the local
agency at the end of the PE period, she will be subject to the
requirements at that time.
• For Continuously Eligible Newborns (CENs) documentation is not
needed until first eligibility re-determination after birth. (This usually
occurs in the month in which the child turns age one, however, if the
child no longer lives with his/her birth mother, it would need to
happen when the household composition changes).
• Photocopies of documentation are allowed.
• Hierarchy concept-Federal regulations divide the list of citizenship
documents into 4 levels. Applicants and recipients need to
provide documentation from the highest level available to them
within the reasonable opportunity period.
• One item from list below will satisfy both the citizenship and
Certificate of Naturalization
Certificate of U.S. Citizenship
• One item from each of the lists below is needed to satisfy the
citizenship and identification requirements.
Note: These are examples not a comprehensive list
Proof of Citizenship
U.S. citizen ID card
Report of birth abroad
U.S. Military record of service
Proof of Identity
State driver’s license
Federal, State, or local govt issued ID card
Native American Tribal document
U.S. Military card or draft record
School ID card with photo
Reasonable Opportunity Period
• The period of time that an applicant or recipient has to provide the required
citizenship and/or identity documentation.
• For recipients, the reasonable opportunity period is about 45 days:
– Begins when the review notice and "smart letter" are sent (1st Friday of month
prior to review month)
– Ends on the last day of the review month
– Can be extended (with eligibility) for as long as the person is making a good faith
effort to comply
• For applicants, the reasonable opportunity period is about 30 days:
– Begins when the person files an application
– Ends on the last day of the 30 day application processing period
– Can be extended (without eligibility) for as long as the person is making a good
faith effort to comply
Good Faith Effort
• Any communication with the IM worker suggesting that
the applicant or recipient is trying to comply with the
requirement will be an indication that "good faith effort"
is being made.
• Examples of "good faith effort" include contacts made
with the IM worker:
– To request assistance in securing the required documentation
– To explain any delays in securing the required documentation
– To inquire whether certain documentation would meet the
Temporary Policies--State Defined ID List
• To assist applicants and recipients to comply with the federal requirement to
verify identity, WI has expanded the list of acceptable documentation to
include the documents listed below.
• If an individual is unable to provide an acceptable identity document from
Level 5, one of the following state-defined identity documents may be used
to meet the identity verification portion of the requirement.
– Military discharge papers, including the Federal DD-214
– Certified copy of a marriage certificate or judgment of divorce
– International driver license
– Employee photo ID card issued by the current employer and containing the
employer’s name. The card must also contain either the employer’s address or
NOTE: This expansion is in effect on a temporary basis pending the
release of final federal regulations regarding the citizenship and identity
Temporary Policies--Special Populations
• 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.
• This policy should be used with discretion and only when an individual has
no other means of meeting the requirement.
NOTE: The following policy is in effect on a temporary basis
pending the release of final federal regulations regarding the
citizenship and identity requirement.
• Examples of individuals in special populations include, but are not
limited to, persons who:
• Are physically or mentally incapacitated and whose condition renders
them unable to provide necessary documentation.
• Are chronically homeless and whose living arrangement makes it
extremely difficult to provide the necessary documentation.
• Are minors.
• Have religious beliefs that prevent them from securing the documentation.
• There are two alternative ways for individuals in special populations to
meet the citizenship and identity documentation requirement:
– Present other documents besides those listed in Levels 1-6
– OR –
– Submit the Statement of Citizenship and/or Identity for Special Populations form
Documentation outside of Levels 1-6
If an applicant or recipient presents other documents besides those listed in
Levels 1-6 to meet the requirement the documents must meet the following
– 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 citizenship documentation:
» Hospital “souvenir” birth certificate
» Baptismal certificate
» Native American documentation
• Some examples of identity documentation:
» Social Security Card
» School record or transcript
» Credit card with signature
» Voter registration materials
» Permanent Resident card
Statement of Citizenship and/or Identity
• The Statement of Citizenship and/or Identity for Special Populations
form (HCF10161) can be used to meet the new requirement only
when no other documentation is available.
– This form can be completed by a related or unrelated individual who
knows the applicant/recipient.
– Additional requirements concerning the HCF10161 are as follows:
» The person completing the form attesting to another
person’s citizenship must be a US citizen.
» IM agencies are not required to verify the citizenship of the
person signing the form.
NOTE: Individuals who have met the new citizenship requirement by
using documents obtained under the new Level 6 or Special
Populations policy have complied with the federal requirement; do not
require other documentation at his/her next review.
Electronic Matching Options
• The identity requirement may be satisfied through a
match with another agency or program that has already
verified the identity of the individual. In WI we are able
to document ID for all FoodShare primary persons.
• WI is looking at other ways to take advantage of this
option. (DOT, SSA)
• A data exchange match with Vital Records to confirm
birth in WI fulfills the citizenship requirement. Workers
have access to this DX.
Utilizing electronic matches
• DHFS identified MA recipients who have already
satisfied either the Citizenship or ID requirement through
currently available system resources and data matches.
• Updated SSI MA and Medicare recipients files to reflect
their exempt status.
• Through these efforts:
85% of current MA recipients have met Citizenship
25% of current MA recipients have met Identity
• Wisconsin is conducting outreach to educate people on the new
• Items in Outreach Plan:
Notice to current MA/BC Recipients
Describes the new requirement, what they may bring or send to satisfy the
requirement, and additionally the notice is tailored according to the specific
requirements for each household member. If a person has already fulfilled
the requirement, based on our system efforts described earlier, s/he won’t
need to do anything.
Operations Memos to agencies
Poster and Brochure
Revisions to current brochures and fact sheets
Update ACCESS tools
Department Secretary Letter to Community Groups
MA Provider Update
Communication to other divisions and departments.
Resources and Web Links
• DHFS Operations Memos
#06-32: Introduce citizenship/identity provision & outline DX efforts to update recipient’s
citizenship & identity.
#06-36: Policy detail including who’s affected, documentation hierarchy, good faith concept, &
reasonable opportunity period.
#06-38: CARES processing detail outlining new verification fields & how to confirm or deny
eligibility based on new policy.
#06-42: New temporary policies for identity documentation and special populations.
• DHFS Fact Sheet
• Federal DHHS Proof of Citizenship site