Revised August 20, 2008

Purpose: Procedures for adults unable to verify citizenship or identity at application or review.

SSI Related/LTC Adult Citizenship Requirements

Clients 19 or older must provide approved citizenship and identity documentation prior to approval for Medicaid (see approved documents list).
Adults unable to provide citizenship and identity documentation at application or review can no longer use the Citizenship Documentation and Identity Declaration Form (DSHS 13-789) to receive Medicaid.
Adults who declare they are citizens who are unable to verify citizenship and identity and have an emergent medical need are not eligible for AEM.
Adults unable to verify citizenship will need to complete the Citizenship Documentation and Identity Declaration Form (DSHS 13-789) for the CCU to request an out of state birth certificate (see attached check list).
Due to delays to receive out of state birth certificates FSS should review with client the possibility of T3 or T4 verification (see citizenship check list) before requesting an out of state birth certificate. If client thinks they have T3/T4 verification send a request to the CCU following T3/T4 instructions below.

NOTE:

If the adult has proof of citizenship or identity at home do not send to CCU for T3/T4, identity or out of state birth certificate. FSS must give client a pend letter for the verification.

At application the medical AU will remain pending until citizenship or identity is verified. FSS will need to code the MISC screen with “OS” good cause code. When the citizenship or identity verification is received, the CCU staff will send DMS tickler to the FSS to process the pending AU.
At review medical will be terminated if adult is unable to provide citizenship or identity verification.

ACES DEM2 Coding If Unable to Verify Citizenship or Identity

	Citizenship	Identity
19 or older unable to verify	FR	R

All adults unable to verify citizenship/identity must be coded with FR or R above. This coding will deny or terminate any SSI related or LTC Medicaid program.

Disability Approval Received

If citizenship is coded T1, T2, T3, T4 or EW and identity is coded V or E then SSI related medical can be authorized.
If any other coding exists for citizenship and identity then SSI related medical cannot be approved. The AU will remain pending and FSS will code good cause “OS” on ACES MISC screen.
When citizenship verification is received CCU will send DMS tickler to FFS for approval.

EXAMPLE

SSI Related:

Married 50 year old woman with no income claiming disability and is over GAU standards with husband’s income. She has picture ID but does not have any acceptable proof of citizenship and was born in Idaho. Client must complete, sign and date the Citizenship Documentation and Identity Declaration Form (DSHS 13-789 and FSS will send this to the CCU to request a birth certificate from Idaho at the same time she is referred for disability decision. Even if the disability decision is approved, the client will not be eligible for SSI related medical until the citizenship is verified.

LTC

Application for SSI-related medical and LTC services – eligible for GAU

Single man age 35 is hospitalized on 5-5-08 after a motor vehicle accident. He has paraplegia, meets functional criteria for LTC services and is ready for discharge to a less restrictive setting. He needs a couple of weeks of physical therapy in a nursing facility. After that, he would prefer to receive services in his own home. He received his last paycheck 2 weeks after the admission. His earned income exceeds the GAU standard for May. No income is anticipated for June. He does not have his Virginia birth certificate and his wallet with his driver’s license disappeared in the accident.

Client’s citizenship is not questionable and collateral contacts confirm his identity. GAU can be approved starting in June. Under GAU scope of care, the LTC options available are nursing facility care and state-funded residential services in an adult family home or ARC.

Client must complete, sign and date the Citizenship Documentation and Identity Declaration Form (DSHS 13-789) and FSS will send this to the CCU to request a birth certificate from Virginia at the same time he is referred for a disability decision. He will apply for a replacement of his driver’s license.

Coverage for May hospital bills and other options for LTC services such as COPES or MPC in his own home cannot be approved until his citizenship and identity are verified.

ACES DEM2 Citizenship and Identity coding if citizenship and identity is not verified at approval of disability decision:

Citizenship FR (has no proof of citizenship)

Identity V (WA ID

T3 or T4 Requests

FSS must get a completed Citizenship Documentation and Identity Declaration Form (DSHS 13-789) even if referring for T3/T4 process and send to DMS for imaging (this will be used if client ends up not being able to provide this level).
DMS tickler to CCU with subject line T3/T4 request is sent to CCU pool (site 127 @CCU).
Details in tickler need to tell CCU which requirement the client says they can get.
CCU will send letter requesting documents or affidavits.
CCU will request out of state birth certificate if unable to provide acceptable T3/T4.
When verification is received CCU will send a DMS tickler to FSS for processing.

Identity and Birth Certificate Request Requirements

For a birth certificate request:
Citizenship Documentation and Identity Declaration Form (DSHS 13-789) must be signed, dated and have all sections completed.
DMS tickler with subject “Out of State BC request” is sent to CCU Pool (site 127 @CCU).
Declaration is faxed to CCU (800- 374-5313).
For identity verification FSS will send a DMS tickler with subject “ID verification request” to CCU Pool (site 127@CCU ).
When verification is received CCU will send a DMS tickler to FSS for processing.
CCU will follow up on birth certificate requests pending longer than 3 months.

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Disability Approval Received

SSI Related:

Coverage for May hospital bills and other options for LTC services such as COPES or MPC in his own home cannot be approved until his citizenship and identity are verified.

T3 or T4 Requests