Purpose: States are required to verify citizenship and identity for all applicants and recipients of Medicaid as required by WAC 388-490-0005
WAC 388-490-0005
Effective February 5, 2009
WAC 388-490-0005 The department requires proof before authorizing benefits for cash, medical, and Basic Food.
This rule applies to cash, medical, and Basic Food.
When you first apply for benefits, the department may require you to provide proof of things that help us decide if you are eligible for benefits. This is also called "verification". The types of things that need to be proven are different for each program.
After that, we will ask you to give us proof when:
You report a change;
We find out that your circumstances have changed; or
The information we have is questionable, confusing or outdated.
Whenever we ask for proof, we will give you a notice as described in WAC 388-458-0020.
You must give us the proof within the time limits described in:
We will accept any proof that you can easily get when it reasonably supports your statement or circumstances. The proof you give to us must:
Clearly relate to what you are trying to prove;
Be from a reliable source; and
Be accurate, complete, and consistent.
We cannot make you give us a specific type or form of proof.
If the only type of proof that you can get costs money, we will pay for it.
If the proof that you give to us is questionable or confusing, we may:
Ask you to give us more proof, which may include providing a collateral statement. A "collateral statement" is from someone outside of your residence who knows your situation;
Schedule a visit to come to your home and verify your circumstances; or
Send an investigator from the Division of Fraud Investigations (DFI) to make an unannounced visit to your home to verify your circumstances.
By signing the application, eligibility review, or change of circumstances form, you give us permission to contact other people, agencies, or institutions.
If you do not give us all of the proof that we have asked for, we will determine if you are eligible based on the information that we already have. If we cannot determine that you are eligible based on this information, we will deny or stop your benefits.
For all Medicaid programs, you must provide proof of citizenship and identity as specified at Section 6036 of the Deficit Reduction Act of 2005 (PL 109-171 amending USC 1396b).Exempt from this requirement are recipients of :
Title IV-B child welfare services, or Title IV-E adoption assistance or foster care payments;
SSI benefits;
Social Security benefits (based on their own disability); or
The department requires proof before authorizing benefits for cash, medical, and Basic Food.
Citizenship and identity are two separate requirements and acceptable forms of verification are listed in the citizenship and identity documents section. This section describes:
Who must verify citizenship and identity?
Who is exempt?
Requirements for applicants/recipients.
CSO application/review procedures
Citizenship Central Unit (CCU)
Who must verify citizenship and identity?
Medicaid (Title XIX) applicants and recipients that declare they are U.S citizens or U.S Nationals are required to verify their citizenship and identity.
Applicant and recipients for the following programs are required to verify citizenship and identity, if they do not meet one of the exemptions:
Cash programs: TANF (F01) and General Assistance (G02).
The following Medicaid applicants /recipients are exempt from the citizenship and identity requirements:
People who receive Supplemental Security Income (SSI) or who have received SSI in the past.
People who receive Social Security Disability based on their own disability.
People who are entitled to or enrolled in Medicare.
People who are not U.S. citizens or U.S. Nationals, regardless of immigration status.
Newborn children, born to a mother on Medicaid, and automatically eligible for one year.
Children in Foster Care (ACES coverage group D01 and D02).
Children receiving SCHIP (ACES coverage group F07).
Requirements for Applicants/Recipients
Applicants
Applicants who meet all other eligibility factors but are unable to provide citizenship and identity documentation should be approved for Medicaid using a completed Citizenship Documentation and Identity Declaration form (DSHS 13-789) and given a reasonable opportunity to verify citizenship/identity.
EXAMPLE
Family medical application is received for mom, dad and one child ages 10. Mom and dad provide their ID and birth certificates. Child is born in Idaho and city/state of birth field on the application is completed. Application is pended for citizenship verification for child or a completed declaration (DSHS 13-789). Client does not return completed declaration, Medicaid is denied for the household.
EXAMPLE
Same examples as above except the clients have provided citizenship and identity verification for Dad and child. Application is pended for citizenship or a completed declaration for mom only. Client does not return citizenship verification or the completed declaration; Medicaid is approved for Dad and child only. Mom is denied Medicaid.
NOTE:
You must get a completed and signed Citizenship Documentation and Identity Declaration form (DSHS 13-789) for any applicant, without citizenship or identity before approving Medicaid, unless pregnant.
Recipients
Recipient adults 19 or older, who are not pregnant, must during a reasonable opportunity time frame provide approved citizenship and identity documentation. If they fail to cooperate with the department by providing the documentation or the needed information for the department to get the verification within a reasonable opportunity period Medicaid will terminate given advanced and adequate notice.
Recipients 18 or younger who do not provide approved citizenship and identity documentation or information required to request an out of state birth certificate will continue to receive medical but will be removed from managed care until they provide the required verification. These clients are worked by reports at the CCU and sent for removal from managed care if they do not cooperate.
Pregnant Clients
Pregnant applicants and recipients are not pended, denied or terminated when the only missing verification is for citizenship and/or identity. The CCU will follow up with the pregnant client to provide needed verification or a completed citizenship and identity Declaration form.
EXAMPLE
A pregnant woman mails in her application for medical. The ECR has no citizenship or identity documentation. The CSO sends a letter for both income and citizenship and identity verification. She returns the income verification and her photo ID but fails to include citizenship verification. As long as the client is otherwise eligible, the application is approved and the CCU will request the missing verification.
NOTE:
Applications for pregnant women are not denied or pended when the only missing verification is for citizenship and/or identity. The CCU will follow up with the pregnant client to provide needed verification.
For each non-exempt client who does not have citizenship and/or identity verification available in the ECR, do the following:
For in-office interview:
If the client is born in Washington State and they do not have a birth certificate at home look up birth in DOH, print out and send copy to DMS. Update citizenship/identity codes (See citizenship and identity flowchart ).
If all other verification except citizenship and/or identity is available to approve Medicaid, have client complete the "Citizenship Documentation and Identity Declaration" (CIF) in the interview.
If client has citizenship or identity verification at home, give 10 day request letter for required citizenship and identity verification and document in ACES that client will provide verification and approve using CIF.
If the client is born in Washington State and they do not have a birth certificate at home look up birth in DOH, print out and send copy to DMS. Update citizenship/identity codes (See citizenship and identity flowchart ).
Send 10 day pend letter for required citizenship and/or identity verification or a completed “Citizenship Documentation and Identity Declaration”.
CCU will follow ut with clients approved with the declaration still needing verification.
If verification or declaration is not received deny or terminate Medicaid.
NOTE:
Recipient children under age 18 or age 18 on children's medical are not terminated for failure to provide verification or declaration. These children will continue on state-funded medical. ONLY applicant children are denied if verification or declaration is not received.
NOTE:
See adult checklist for T3/T4 verification and what is considered a completed declaration.
Citizenship Central Unit (CCU)
Health & Recovery Services Administration (HRSA) Citizenship Central Unit (CCU) will obtain citizenship and/or identity documentation for applicants and recipients unable to provide proof.
CCU will work all active applicants and recipients that need an out of state birth certificate or ID from reports.
CCU will track the reasonable opportunity for applicants/recipients and if the client fails to cooperate in getting acceptable verification or the CCU is unable to get the verification within a reasonable opportunity timeframe they will send a DMS tickler to the CSO worker of record to terminate Medicaid with advanced and adequate notice.
Staff with questions regarding specific cases can contact the CCU by calling the Medical Assistance Customer Service Center:
By phone at 1-800-562-3022 and choosing option 5.
By mail at Mail Stop 45534, attention Citizenship Central Unit.
