Certificate Citizenship

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					Documentation of Citizenship
      and Identity
     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:
  – Citizenship
  – Identity
• 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
  Woman MA.
                   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).
    Acceptable Documentation
•   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
    identification requirements:

           U.S. passport
           Certificate of Naturalization
           Certificate of U.S. Citizenship


                                  -----------OR----------
       Acceptable Documentation
•   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
           Birth certificate
           U.S. citizen ID card
           Report of birth abroad
           U.S. Military record of service
           Hospital record

         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
     requirement
     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
         telephone number.
         NOTE: This expansion is in effect on a temporary basis pending the
         release of final federal regulations regarding the citizenship and identity
         requirement.
      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.
                         Special Populations
•   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
       (HCF10161)
          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
    requirements:

     – 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
    requirement
    25% of current MA recipients have met Identity
    requirement
                                  Outreach

•   Wisconsin is conducting outreach to educate people on the new
    requirements

•   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
       Fact Sheet
       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
    http://dhfs.wisconsin.gov/em/ops-memos/2006/default.htm
    #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
    http://dhfs.wisconsin.gov/medicaid1/recpubs/factsheets/
    phc10157.htm

•   Federal DHHS Proof of Citizenship site
    http://www.cms.hhs.gov/MedicaidEligibility/
    05_ProofofCitizenship.asp