6. citizenship/immigration status · 2020-06-25 · • foreign-born children, under age 18,...

Medi-CalMedi-Cal 6. Citizenship/Immigration Status

6. Citizenship/Immigration Status

If all other eligibility requirements are met, citizenship or immigration status determines the level of Medi-Cal (MC) benefits the client is eligible for; restricted-scope MC or full-scope MC.

Important:

Eligibility staff must under no circumstance offer legal advice on immigration. Clients should be referred to the appropriate entities for information.

6.0.1 Scope of Coverage

Full-scope MC Benefits

Individuals who declare and verify United States (U.S.) citizenship, Legal Permanent Resident status and/or individuals through age 25 who meet all other eligibility requirements are eligible for full-scope MC benefits.

Important:

If eligible for Full Scope benefits, applicants/recipients must not under any circumstance be approved restricted scope coverage. They may receive the entitled full scope coverage or withdraw or discontinue their MC.They may reapply at any time.

Restricted-scope MC Benefits

Individuals who do not provide proof of U.S. Citizenship, who have legal temporary resident status or who are undocumented who meet all other eligibility requirements are eligible for restricted-scope MC benefits.

6.1 Status/Medi-Cal Entitlement Chart

For Employment Authorization Document Codes and Medi-Cal scope, refer to the Employment Authorization Document Codes and MC Scope reference material.

6.2 U.S. Citizens

U.S. citizenship is granted to:

Update #20-02Page 6-1

https://ssaconnect.sccgov.org/ssa_departments/debs_program/Documents/reference_materials/EAD-RestrictedorFullScope.pdf

https://ssaconnect.sccgov.org/ssa_departments/debs_program/Documents/reference_materials/EAD-RestrictedorFullScope.pdf

2Medi-Cal 6. Citizenship/Immigration Status

• U.S Born Citizens and Nationals, including individuals born in:

• Any of the 50 states in the United States, • District of Columbia, • Puerto Rico, • Guam, • Virgin Islands of the U.S. (St. John, St. Croix and St. Thomas)• American Samoa• Swain's Island• Commonwealth of the Northern Mariana Islands

• Naturalized Citizens, including individuals born in another country who have met the U.S. residency requirements and have filed for an application to be naturalized U.S. citizens. Naturalized U.S. citizens typically obtained a legal permanent immigration status prior to naturalization.

• Foreign-born children, under age 18, residing in the U.S. with their birth or adoptive parents, at least one of whom is a U.S. citizen by birth or naturalization;

• Derived Citizens, certain individuals may have derived their U.S. citizenship as children prior to their 18th birthday because one or both of their parents became citizens through naturalization.

• Acquired Citizens, individuals born in another country to U.S. citizen parent(s) may ACQUIRE U.S. citizenship by filing an application at USCIS.

Individuals with derived or acquired citizenship should present originals of one of the following documents:

• A Certificate of United States Citizenship (USCIS Form N-560).

• A United States Citizen Identification Card (USCIS Form I-197). (Not issued since February, l981.)

• An Identification Card for the Use of Resident Citizen in the United States (USCIS Form I-179). (Last issued in February, 1974.)

• A Northern Mariana Identification Card issued by USCIS to individuals born in the Northern Mariana Islands before November 3, 1986 who are now U.S. citizens.

• A letter, on USCIS stationery, written by an USCIS official, which states that a foreign-born woman who married a U.S. citizen before September 22, 1922 thereby automatically became a U.S. citizen herself.

• A valid U.S. Passport issued by the Department of State.

• A Report of Birth: Child Born Abroad of American Parent or Parents (Dept. of State Form FS-240) issued by U.S. embassies and consulates to United States citizens born abroad.


http://www.dhcs.ca.gov/Pages/default.aspx

http://www.dhcs.ca.gov/individuals/Pages/MHPContactList.aspx

http://www.coveredca.com/

http://www.coveredca.com/

http://www.vitalrec.com/

http://www.vitalrec.com/


• A Certification of Birth Abroad (Dept. of State Form FS-545) issued by U.S. embassies and consulates to United States citizens born abroad.

• A Certification of Birth Abroad (Dept. of State Form DS-1350) issued to United States citizens born abroad.

No Documentation

Individuals who believe that they qualify for derived or acquired citizenship should contact either the passport office or their District USCIS office:

Passport Office of the U.S. Department of State525 Market St.San Francisco, CA 94105

Immigration and Naturalization Service630 Sansome St.San Francisco, CA 94111

Reminder:

Foreign born children of U.S. citizens must apply to USCIS or to the Department of State for approval and documents. U.S. citizenship is not automatic. Individuals who lack documentation may not have applied for or may not have been granted citizenship. Adoptive parents must also apply to USCIS for naturalization of their adopted child.

Citizenship Verification for Aged Individuals

Citizenship records for aged individuals may no longer be available (especially if they entered the U.S. before USCIS was established in 1924).These individuals must be referred to USCIS for documentation.

Verification that USCIS conducted a search of its records and the outcome of the search must be scanned in the case record when other documentation is not available. Scan a copy in IDM. No further action is required from the Eligibility Worker (EW).

6.3 Verification Requirements for U.S. Citizens

The federal Deficit Reduction Act of 2005 (DRA) requires U.S. Citizens and U.S. Nationals to provide proof of citizenship and identity as a condition of eligibility for states to receive federal funding. The DRA requirements do not apply to individuals receiving State-only MC benefits.



6.3.1 Verification of U.S. Citizenship and Identity

Acceptable verification of citizenship status and identity must be obtained for all non-exempt U.S. citizens/U.S. national applicants and clients. If verification from the Federal Data Services Hub (Federal Hub) or MEDS can be obtained, no other verification is required from the client. [Refer to “Federal Data Services Hub,” page 16-3]

Note:

Children born in the U.S. to foreign sovereigns or diplomatic officers are not U.S. citizens.

Reminder:

The U.S. citizenship and identity verification requirements do NOT apply to non-citizens including undocumented immigrants or individuals receiving State only MC benefits.

Proof Already Provided

If the applicant or client’s proof of citizenship/identity is on file (i.e. applicant provided acceptable proof at initial intake interview), but it was not previously entered, it must be entered into CalWIN and sent to MEDS. If the DRA requirement was previously provided on a different case, that information must be entered into the current case without the need for the client to provide the documents again. This will satisfy the DRA requirements.

A birth record match for California-born individuals can be requested at any time. A successful birth record match will not be overwritten by a verified or an unverified SSA Citizenship/Identity result.

6.3.2 Electronic Verification

The EW must grant full-scope benefits, without delay to clients who claim to be U.S. citizens/nationals, or to have satisfactory immigration status if all other eligibility criteria are met (i.e. income, residency, etc.)

Verified by Federal Hub

Citizenship and Identification information are now verified through the Federal Hub. When an application is submitted or a critical data element is changed the information is checked against the Federal Hub. The verifications status will display Pass, Fail, Pending or, Not Verified, depending on whether the citizenship and identification can be verified electronically through the Federal Hub.



Not Verified by Federal Hub

The following process must be followed if the client’s citizenship/identification cannot be initially verified via CalHEERS through the federal data hub:

Table 23: Citizenship and Identification Electronic Verification

Step If Citizenship/Identification Status... Then the EW Must...

1. Cannot be initially verified via CalHEERS through the federal data hub (i.e. because the hub is down) or the application information is not “reasonably compatible” with information from the Federal Hub,

• First use the information provided on the application to attempt verification of citizenship or satisfactory immigration status.

• Initiate SAVE.

• Submit a copy of the SAVE results and documents to be scanned into the case’s IDM file.

2. Cannot be verified through SAVE, • Provide the applicant a 90-day ROP to resolve the inconsistency.

• Grant full-scope MC benefits while verification of citizenship or immigration status is being obtained to otherwise eligible applicants.

• If citizenship or identification cannot be verified within the 90-day ROP, then the scope of benefits must be reduced (to restricted-scope) until the verification is provided.

This does not apply to children through age 25. [Refer to “SB75 & SB104,” section 6.10]

6.3.3 Electronic Birth Record Match

The Department of Health Care Services (DHCS) has implemented a process to perform an automated birth record match with the California Department of Vital Records database for individuals born in California. Information from Medi-Cal Eligibility Data System (MEDS), Statewide Client Index (SCI) and CalWIN is used to obtain an electronic record of U.S. citizenship.

The “Request for California Birth Record” (DHCS 0004) is used to obtain the necessary information from the client to initiate an electronic birth record match. It may be completed by the client or by the EW over the phone.

Note:



Note:

The DHCS 0004 must be scanned into IDM.

[Refer to UGSS Chapter 2.8.1 “Batch AP19 Process,” ]

6.3.4 Social Security Number Data Match

DHCS implemented a Social Security Number (SSN) matching process to verify the citizenship and identity of MC applicants and clients who are subject to the citizenship/identity requirements.

A successful SSN data match fulfills the citizenship AND identity requirements. No further verification is needed from the applicant or client.

The EW does not have to complete the “Proof of Acceptable Citizenship or Identity Documents” (DHCS 0011) when there is a successful SSA Citizenship/Identity verification match.

Note:

After approving full-scope MC for an eligible non-exempt applicant, review SSN data match results available on MEDS two business days later before requesting acceptable citizenship/identity documentations from the individual.

6.3.5 Frequency of Verification

Verification of citizenship and identity is only required once for MC. Once verification is provided or verified electronically, it does not need to be requested again, even if the client moves from one county to another, has a break in aid, or can show that he or she has already verified citizenship and identity in another state’s Medicaid program (the equivalent to Medi-Cal in California).

Reminder:

PRUCOL is not an immigration status and must be verified at intake, annual redetermination and if the client reports a change in citizenship/immigration.

6.3.6 Acceptable Citizenship/Identity Documents

To establish U.S. citizenship, an acceptable document must show a U.S. place of birth or that the person is a U.S. citizen or national.

Acceptable verification for citizenship and identity are grouped as follows:

• Tier one (or Level 1) evidence is the most reliable and establishes both citizenship and identity.

Update #20-02-6


• Tiers two through four are less reliable groups of documentation of citizenship only. Evidence of identity must also be provided.

• Tier five includes identity documents.

[Refer to “Identity Proofing and Verification Examples,” page 5-44]]

Note:

Expired documents are acceptable proof of citizenship/identity.

If a client originally provided a less reliable document (Tier 3 or 4) but later provides a document of higher reliability (Tier 1 or 2), the case information must be updated to reflect the higher level of verification



Table 24: DRA Citizenship Document Tiers 1‐4

Hierarchy of Reliability of Citizenship Documents

Evidence of Highest Reliability<<<<<<<<<<<<<<>>>>>>>>>>>>>>Evidence of Lowest Reliability

Primary Documents (Tier 1)

Establishes both Citizenship & Identity

Secondary Documents(Tier 2)

Must be Provided with Identity Document

Third Level Documents (Tier 3)

Must be provided with Identity Document

Fourth Level Documents(Tier 4)

Must be Provided with Identity Document

• U.S. passport issued without limitation

• Certificate of Naturalization (DHS Forms N-550 or N-570)

• Certificate of Citizenship (DHS Form N-560 or N-561)

• U.S. Public Birth Record issued before age 5 (1)

• Certification of Report of Birth (DS-1350)

• Certification of Birth issued by the Department of State (Form FS-545 or DS-1350)

• Report of Birth Abroad of a U.S. Citizen(FS-240)

• U.S.Citizen ID Card (Form I-197 or I-179)

• American Indian Card (I-872)

• Northern Mariana Identification Card (I-873)

• Final Adoption Decree (2)• Evidence of Civil Service

employment by U.S. Government showing employment before 6/1/76

• U.S. Military Record (2)

• Extract of a Hospital Record on Hospital Letterhead Established at the time of Birth (2,3)

• Life or health or other insurance record (2,3)

• Federal or State Census Record showing U.S. Citizenship or a U.S. place of birth (Generally for individuals born 1900-1950) (4)

• Seneca Indian tribal census record (2,3)

• Bureau of Indian Affairs tribal census record of the Navaho Indians (2,3)

• U.S. State Vital Statistics official notification of birth registration (2,3)

• Amended U.S. public birth record amended more than 5 years after the person’s birth (2,3)

• Statement signed by the physician or midwife who was in attendance at the time of birth (2,3)

• Institutional admission papers from a nursing facility, skilled care facility or other institution

• Medical (clinic, doctor or hospital) record (excludes immunization records)(2,3)

• Written Affidavit (5)

(1) Must show birth in: one of the 50 U.S. States; District of Columbia, America Samoa, Swain’s Island; Puerto Rico (DOB on or after 1/13/41); Vir-gin Islands of the U.S. (DOB on or after 1/17/17), Northern Mariana Islands (DOB after 11/4/86, NMI local time); or, Guam (DOB on or after 4/10/1899).

(2) Must show U.S. Place of Birth(3) Must have been created at least 5 years before the Medi-Cal application, unless applicant is a child under the age of 5(4) Must show applicant’s age(5) Affidavits should only be used in rare circumstances. An Affidavit by at least two individuals of whom one is not related to the applicant/benefi-

ciary and who have personal knowledge of the event(s) establishing the applicant’s/beneficiary’s claim of citizenship. The person(s) making the affidavit must be able to prove his/her own citizenship and identity for the affidavit to be accepted. A second affidavit from the applicant/benefi-ciary or other knowledgeable individual explaining why documentary evidence does not exist or cannot be readily provided must also be obtained.



Table 25: DRA Identity Document Tier 5

Acceptable Verification of Identity for Citizens and Nationals who do not Provide a Tier 1 Citizenship Document

(Tier 5)

• Certificate of Degree of Indian Blood, or other U.S. American Indian/Alaska Native Tribal document. (Acceptable if the document carries a photograph of the applicant or beneficiary, or has other per-sonal identifying information relating to the individual.)

• Driver’s license issued by State or Territory either with a photograph of the individual or other identifying information of the individual such as name, age, sex, race, height, weight or eye color.

• School identification card with a photograph of the individual• U.S. military identification card or draft record • Identification card issued by the Federal, State, or local government with the same identifying information

included on driver’s licenses • U.S. military dependent’s identification card • Native American Tribal document • U.S. Coast Guard Merchant Mariner card • For children under 16, school records may include nursery or day-care records• An affidavit to establish identity of children under 18 is only acceptable if signed under penalty of perjury by

a parent or guardian stating the date an place of birth of the child, and cannot be used if an affidavit for citi-zenship was provided (The affidavit of identity is permanently valid)

• A U.S. Passport, current or expired, even if issued with limitation.

NOTE: Expired identity documents are acceptable for proof of identity.

6.3.7 Original Documents

All documents provided as verification of citizenship and identity must either be originals or copies certified by the issuing agency. Uncertified copies or notarized copies do not meet the DRA requirements. Clients may provide original documents in person, by mail or by an authorized representative.

Use of Affidavits for Citizenship

Affidavits may be used in situations where no other acceptable proof of citizenship is available. Affidavits may not be used for both citizenship and identity. In order for an affidavit to be acceptable to establish citizenship, the following requirements must be met:

• No other evidence of citizenship can be obtained by the applicant/client.

• The affidavit(s) must be signed under penalty of perjury by at least two individuals who have personal knowledge of the event(s) establishing the applicant’s or client’s claim of citizenship


http://www.dhcs.ca.gov/services/medi-cal/eligibility/Documents/SB75/SB75_FAQ_042916.pdf

http://www.dhcs.ca.gov/services/medi-cal/eligibility/Documents/SB75/SB75_FAQ_042916.pdf


• At least one of the individuals providing an affidavit must not be related to the applicant/client.

• The applicant/client and the individuals completing the affidavit must provide proof of their own citizenship and identity.Copies of the witnesses original documents and forms must be scanned into IDM.

• If the affidavits do not explain why other evidence is unavailable, an additional affidavit (which provides the reason for unavailability), signed by the applicant or client or other knowledgeable individual, must be obtained.

The following forms are used as affidavits:

• “Affidavit of Reasonable Effort to Get Proof of Citizenship” (DHCS 0003)

• “Affidavit of Identity for U.S. Citizen Children Under 18” (DHCS 0009)

• “Affidavit of Citizenship” (SCD 101 CZ).

Note:

Most children born in California should meet the documentation requirements based on a birth record match and a signature on the application form.

Use of Affidavits for Identity

An affidavit to establish the identity of children under 18 is only acceptable if it is signed under penalty of perjury by a parent or guardian stating the date and place of birth of the child. An affidavit for identity cannot be used if an affidavit for citizenship was provided. If the child is 18 or older, an affidavit is not acceptable to document the identity of the child.

The “Affidavit of Identity for U.S. Citizen Children Under 18” (DHCS 0009) may be used as verification of identity for children under age 18.

6.3.8 Original Document Certification Forms

The “Proof of Citizenship or Identity Received” (DHCS 0005) is completed for each individual and signed by clerical staff to certify that a document submitted for verification of citizenship or identity is an “original” document or certified copy from the issuing agency.

• A copy of the DHCS 0005 receipt must be given to the client as a receipt that an original or certified copy was provided.



• If an original document is received by mail, staff must immediately make a copy and date stamp the COPY. The DHCS 0005 must be completed. The original document along with a copy of the DHCS 0005 must be returned to the client via CERTIFIED mail with a return receipt. The copy of the documents and the DHCS 0005 are given to the EW and also scanned into IDM

• The original signed DHCS 0005 must be scanned into IDM - Permanent Verifications and given to the EW along with a copy of the document(s) submitted.

• The EW will determine if the document submitted is acceptable or not acceptable and notify the client of the determination.

• The “Proof of Acceptable Citizenship or Identity Documentation” (DHCS 0011) must be completed by the EW to notify the client that they have submitted an acceptable citizenship and/or identity document.

• The DHCS 0011 must be given to the client in person or mailed to the client after the document(s) are reviewed by the EW.

• If the document submitted is not acceptable, the EW will inform the client that another form of verification is necessary.

• A copy of the DHCS 0011 must be scanned into IDM under Permanent Verifications.

Note:

If a client provides documents directly to the EW either in person or by mail, ONLY the DHCS 0011 needs to be completed and given/mailed to the client.

Document Certification by CAAs

Employees of Disproportionate Share Hospitals (DSH) and Federally Qualified Health Centers (FQHC) are qualified to view and certify original documents and complete the DHCS 0005. This includes Certified Application Assistors (CAAs) employed by Santa Clara Valley Health and Hospital Systems (HHS). ADHCS 0005 signed by a CAA employed by HHS is valid and is acceptable proof that the original document was viewed.

6.3.9 Reasonable Opportunity Period

All applicants and clients must be given a “reasonable opportunity” period to provide citizenship and identity documents. This period is defined as the time needed for the client to obtain acceptable verification of citizenship/identity based on:

• the individual’s circumstances,

• ability to obtain the verification, and



• a good faith effort

EWs must initially allow for 90 days for the individual to provide the necessary documentation, case comment that documentation is pending, and follow up at the end of th 90 day period. If the individual has not provided documentation at the end of the 90 day period, the EW must explore what actions the individual has taken to obtain the documentation. The EW must extend the ROP date if the individual is making a good faith effort to obtain the proper documentation. The EW must record all actions taken by the individual and the EW to obtain the appropriate documentation.

The “Proof of Citizenship or Identity Needed for MC Applicants and Clients Who Are U.S. Citizens or Nationals” (DHCS 0006) is used to request verification of citizenship and/or identity from the client. The DHCS 0001 for applicants or the DHCS 0002 for clients or the “Medi-Cal Rules Have Changed” (SCD 265) in the appropriate language must also be included, as the DHCS 0006 does not include a list of acceptable citizenship/identity documents.

6.3.10 Clients with Mismatching SSN Results

Applicants and clients who fail the SSN data match must be sent the Information Notice “Unable to Verify U.S. Citizenship/Identity Through the Social Security Administration” (MC 239 DRA-6). They have 90 days from the date they receive the notice to resolve the mismatch. The 90-day period starts seven (7) calendar days after the date of the Information Notice.

If acceptable proof of citizenship/identity is not provided or the inconsistency is not resolved with SSA, the applicant or client’s MC must be reduced from full-scope MC to restricted-scope MC benefits with a timely ten-day NOA.

Acceptable verifications include:

• Social Security Card, or

• An Award letter, Medicare card or a check from SSA showing applicant's name and SSN, with the letters A, HA, J, T, or M following SSN, or

• MC 194 (requires follow-up in 60 days)

• A parent may request an SSN at the time that the hospital obtains information for birth registration. The SSA-285-OP3 “Message from Social Security” can be used as evidence of SSN application when signed by a hospital official.

Resolving Mismatches

If the non-exempt individual’s SSN data match is unsuccessful make a reasonable effort to address the mismatch by checking for correctable errors (i.e. confirm SSN with client, is the date of birth correct, is the gender correct, is the name correct, etc.) and update CalWIN with the correct information.



If mismatch cannot be resolved as described above, request the client to provide acceptable citizenship/identity documentation OR refer the client via form MC 194 to SSA to have the inconsistency resolved.

6.3.11 Documents Received After Restricted-scope Benefits are Granted

For applicants or clients whose benefits are reduced from full-scope MC to restricted-scope MC for failure to provide evidence of citizenship/identity, their full-scope MC benefits may be restored back to the month restricted-scope MC benefits began, if they provide required verification within one year of the date of application or redetermination and any applicable retroactive months if good cause exists.

If documents are provided more than one year after the application or redetermination date, or if good cause does not exist, grant full-scope MC eligibility effective the first of the month in which the verification is provided.

6.3.12 Adding a Person to an Existing Case

When adding a person who is not currently receiving MC to an existing case, that person is considered a new applicant and full-scope MC benefits must be granted during the ROP while the individual obtains verification of citizenship and identity.

When adding a person who was already eligible for MC, he/she is considered a client and continues to receive ongoing MC during their ROP, if all other eligibility factors are met.

6.3.13 Good Faith Effort

An applicant/client is making a good faith effort if he/she dis trying to provide acceptable documents to meet the citizenship/identity requirements. If a client is making a good faith effort to provide documents, the allowable time for completing the necessary contacts and follow up to assist them must be extended. The EW must thoroughly explain good faith effort to the client so the client is aware that they will be granted additional time if necessary.

Examples of good faith effort include, but are not limited to:

• Providing a copy of a request for a document sent to the appropriate agency such as, a photocopy of a letter, a copy of an e-mail or a receipt for the requested document from the agency who will issue the document.

• Providing copies of documents along with verification that an original or certified copy of an acceptable document has been ordered (i.e. receipt).

Note:Note:If the client was born in California, initiate an AP 19 transaction for an electronic birth record match before requiring the client to provide an original document.



• Written or verbal statements of effort to obtain citizenship documents, such as an “Affidavit of Reasonable Efforts to Get Proof of Citizenship” (DHCS 0003).

• A written or verbal update of progress made in obtaining verification of citizenship or identity.

• A written or verbal explanation of attempts to locate two individuals who could attest to the applicant’s/client’s citizenship.

EWs must document all descriptions of a client’s good faith efforts, including dates and the expected time the client will need to obtain documents, and the reason for the determination that a client is no longer making a good faith effort in Maintain Case Comments.

6.3.14 Providing Client Assistance

Staff must assist applicants/clients in obtaining verification of citizenship and identity whenever necessary. This includes situations when a client is incapable of taking the steps necessary to obtain the required documents due to incapacity or disability or the client is unable to provide documents for any reason.

Examples of providing assistance include, but are not limited to:

• Reviewing and explaining acceptable verification of citizenship/identity

• Explaining how to provide proof of good faith effort to obtain documents

• Determining the possible acceptable documents that may be available to the client based on his or her individual circumstances

• Providing any resources available such as the name, address and telephone number of the vital statistics agency where the client can obtain the documents.

Requesting Birth Certificates

When a client is unable to provide an acceptable citizenship document and was born outside of California, or was born in California but an electronic birth record match is unsuccessful, EWs are to complete the “Clerical Check Sheet” (SCD 109) to request a certified copy of the client’s Birth Certificate.

Requesting Identity Documents

When a client is unable to provide acceptable identity document, EWs are to complete and issue the “Verification for Reduced Fee Identification Card” (DL 937) to the client to obtain a California ID from the Department of Motor Vehicles at a reduced cost. Allow the client 10 days to provide the ID.



Note:

The DL 937 and DL933 are shelf stock forms from the DMV, copies will not be accepted. The Office Management Coordinator (OMC) for each office maintains the supply of these forms.

There are two versions of these forms:

• DL 937 (Blue)- Reduced Fee

• DL 933 (Gold)- No Fee (only for homeless clients)

The following are guidelines on some of the ways staff can provide assistance:

Example 1 Client born outside of California (Tier 3)A mother is applying for herself and her child, both U.S. citizens born in another state. Only the child has an original birth certificate. The mother has a California Drivers License and she listed a life insurance policy on her MC application. The EW should determine if the life insurance policy was issued over five years ago and indicates a U.S. place of birth. If yes, the life insurance policy is acceptable proof of her citizenship if she does not have more reliable proof. The EW will need to view and copy the original life insurance policy.

Example 2 Lost Naturalization Papers in a Fire (Tier 2)A family applies for MC and both parents indicate they are naturalized U.S.citizens but have lost their naturalization certificate/papers. Prior MC case records show alien registration numbers/documents for both parents. Initiate SAVE, if unsuccessful, the EW will refer them to the closest U.S. Citizenship and Immigration Services office to obtain copies of their naturalization documents.

Example 3 Deemed Eligible Infants (Exempt)A mother applies for herself and her one child. Both were born in California but the mother does not have original birth certificates. The child was born in 2004 while on aid and was deemed eligible for MC at that time. The EW should initiate a request for a MEDS birth record match for the mother by obtaining information on the DHCS 0004. No evidence of citizenship or identity is required for the child since the child was previously deemed eligible for MC.

Example 4 No Record of Birth (Tier 4)A granddaughter is applying for her aged grandmother with Alzheimer’s, who was born in Kansas at home. The granddaughter states that there is no record of birth. After determining there is no other proof of citizenship available, the EW must



explain what is required to provide an affidavit as verification of citizenship. Requirements for the affidavit must be met in order to meet the citizenship verification requirement.

Example 5 Some Family Members Do Not Have Verification (Tier 4)A mother applies for MC for herself, her spouse and their three children. All family members were born in the U.S. The family has never been on aid prior to this application. The mother provides original birth certificates for herself and her three children. She does not have an original or certified birth certificate for her husband. Eligibility for all family members must be granted as soon as possible without waiting for the husband’s verification, if all other requirements are met.The father was born in Texas. The EW provides the client with the name, address and telephone number of the Vital Statistics agency in Texas. In addition, the EW completes the SC 109 to request a certified birth certificate from the state of Texas.

Note:Note:EWs can find the Vital Statistics office for each state at http://www.vitalrec.com

Example 6 Disabled IndividualA disabled adult man applies for MC at a mental health facility. The applicant states he is a U.S. born citizen but does not have any citizenship or identity verification because he is homeless. The applicant is not currently capable of providing proof of his citizenship. If the client was born in CA, the EW must explore the option of a birth record match by asking for the information needed on the DHCS 0004. If the data match is unsuccessful, the EW must complete the SCD 109 to request a certified birth certificate and the DL 937 for the client to obtain a California ID at reduced cost, or DL 933 for homeless clients for no cost.

Example 7 Client Has No Money to Obtain VerificationA hospitalized applicant applies for MC with the assistance of a patient advocate. The applicant is a mother with a 19-year-old son living in the home who attends a continuation high school. The applicant states she and her son are U.S. born citizens but she has no birth certificates. The EW explains acceptable documents including affidavits. The applicant states they have no funds to secure the original document and is unable to find anyone to complete the affidavit. The EW must complete SC 109’s to request certified birth certificates for both.

Example 8 Pregnant WomanAn applicant who is two months pregnant applies for MC. She declares U.S. citizenship, but citizenship cannot be e-verified immediately. The client will be granted the pregnancy aid code she is eligible for (depending on income) during the 90-day Reasonable Opportunity Period (ROP). The EW initiates a MEDS AP 19 birth



record match which is unsuccessful. The EW explains acceptable documents including affidavits. If the client is unable to provide verification, the EW completes the SCD 109 to request a certified birth certificate.

6.3.15 Exempt Individuals

Individuals in the following groups are exempt from citizenship and identity requirements:

• Current Supplemental Security Income (SSI) clients

Note:Note:When a person loses SSI (Craig v. Bontá client) and eligibility is determined for MC-only, verification of citizenship/identity is required. [Refer to “Craig v Bontá - Loss of SSI/SSP,” page 40-1]

• Social Security Disability Insurance (SSDI – Title II) clients

• Social Security Retirement and Survivors Insurance (RSDI – Title II) clients who receive those benefits based on their own disability

• Current Medicare clients

• Minor Consent applicants and clients

• MC Dialysis Only Program (Aid Code 71) applicants/clients

• Total Parenteral Nutrition (aid Code 73) applicants/clients

• Medically Indigent Long Term Care (Aid Code 53) applicants/clients

• Children receiving foster care or adoption assistance, including Kinship Guardianship Assistance Payment (Kin-GAP) recipients

• Former Foster Youth in Aid Code 4M

• Deemed eligible infants who are born in the U.S. and are citizens (including children born to non-citizen mothers whose delivery was covered by MC)

• Infants eligible under the Abandoned Baby Program who are born in the U.S. and have no documentation.

Presumptive Eligibility (PE) Programs

Individuals receiving MC benefits in the following programs are exempt from the citizenship/identity requirements when PE is established:



• Presumptive Eligibility for Pregnant Women

• Presumptive MC Eligibility under the Breast and Cervical Cancer Treatment Program (BCCTP)

• Child Health and Disability Prevention (CHDP) Gateway program

• MC Accelerated Enrollment at the Single Point of Entry National School Lunch Program.

Note:

Clients must be placed in the appropriate aid code for ongoing MC eligibility as soon as they are found to be otherwise eligible, if they are making a good faith effort to obtain DRA citizenship/identity documents.

6.3.16 Citizenship Verification Process

For more information refer to Applications Chapter 5, table 5-1.

IF... AND... THEN...

Client Declares U.S. Citizenship,

Client is not exempt from DRA requirement, proof of citizenship is not on file, and no data is on [INQE] screen in MEDS,

The citizenship must be verified.

Note:

Once Citizenship verification is provided or verified electronically, it does not need to be requested again, even if the client moves from another county in CA.

EW attempts to verify citizenship via the Federal Hub,

The results from the Federal Hub are reasonably compatible,

The citizenship documentation requirement is met.

Citizenship is not verified via the Federal Hub,

A successful SSN data match is found (INQE after 2 business days),OR A successful Electronic Birth Match (California born individuals) is updated INQE

The citizenship documentation requirement is met.

Note:

A successful SSN data match fulfills the citizenship AND identity requirements.

Citizenship is not verified via Federal Hub,

Cannot be verified via an Electronic Birth Match or SSN Data Match,

The client is eligible for full-scope MC benefits, if all other eligibility requirements are met, while making a good faith effort to provide citizenship verification.

SSN Data Match is unsuccessful,

The EW checked for correctable errors (i.e. typographical errors, confirms SSN, etc) and the mismatch cannot be resolved,

The EW refers the client to the Social Security Administration via MC 194 to have the inconsistency resolved.

(Chart page 1 of 2)



6.3.17 Single Point of Entry Applications

When an application is received from Single Point of Entry (SPE), children may have presumptive eligibility under Accelerated Enrollment or CHDP Gateway; however, citizenship/identity requirements must be met during the application process when the EW determines ongoing eligibility for MC. (Deemed Eligible Infants are exempt from DRA requirements.) Although SB75 grants full-scope MC to all children, the DRA requirements still apply and verifications requested, however, the MC benefit will not be affected if the client cannot provide verification up to age 26. If an individual turns 26 years old and does not have appropriate DRA documentation the benefits will reduce from full-scope MC to restricted-scope MC benefits.

Note:

The EW must send the “Proof of Citizenship and Identity” (DHCS 0002) to the client to inform them of the citizenship/identity requirements along with the other required Intake informing notices when processing an SPE application.

• If the application includes a copy of the child’s birth certificate, along with a completed DHCS 0005 that was signed by a CAA from Health and Hospital Systems certifying the original birth certificate was viewed, no further documentation is required. The application, signed under penalty of perjury is sufficient to meet the identity requirement for the child.

The client is unable to provide one of the acceptable documents,

The client was born outside of California, or was born in California but an Electronic Birth Match was unsuccessful,

The EW must request a certified copy of the client’s birth certificate from the agency in the state where the client was born using the “Verification of Birth, Death, Marriage, Divorce” (SCD 109).

The Reasonable Opportunity Period Ends,

The client is otherwise eligible and has not provided DRA citizenship/identity documentation,

Medi-Cal benefits must be reduced to restricted-scope benefits (emergency, pregnancy-related, state-only Long Term Care benefits) with a timely 10-day NOA.

Note:

The EW must clearly document the reason for the determination that the individual is not making a good faith effort to obtain verification.

Documents are provided within one year of the application date,

The client has good cause for not providing documentation sooner,

Full-scope MC benefits must be restored starting from the month that the limited benefits began.

Documents are provided within one year of the application date,

The client does not have good cause for not providing documentation sooner,

The EW must grant full-scope MC benefits

IF... AND... THEN...

(Chart page 2 of 2)



• If a birth certificate is not included with the application, and MEDS [INQE] does not contain citizenship information, the EW must explain acceptable verification of citizenship and identity and give an ROP to provide it.

• If the child is under 18 and there was a MEDS birth record match or citizenship information is on the MEDS [INQE], no further documentation is required because the application, signed under penalty of perjury is sufficient to meet the identity requirement for the child.

• If the child is 18 or older and there was a MEDS birth record match or citizenship information is on the MEDS [INQE] screen, the parent or guardian must still provide proof of identity for the child.

• If the client is unable to provide acceptable documents and the birth record match is unsuccessful, the EW must complete the SCD 109 to request a certified copy of the birth certificate.

Reminder:

An affidavit is not acceptable to document the identity of a child 18 or older.

6.3.18 CalWORKs Cases

The CalWORKs citizenship and identity verification requirements fulfill the MC requirements while clients are receiving CalWORKs. Once a client transitions to an MC only program, citizenship and identity verification must be reported to MEDS via AP19 or a birth record match must be requested if the MEDS [INQE] screen fields are blank. Therefore, it is recommended to report citizenship and identity verification to MEDS for all CalWORKs clients whenever possible, as once verified, it will not need to be requested again if CalWORKs benefits end.

6.3.19 Medi-Cal Performance Standards

The 45-day (for regular applications) or 90-day (for applications based on disability) requirement is considered to be met if the EW has completed the eligibility determination, except for citizenship/identity verification within 45 or 90 days.

Annual redeterminations (RD) are considered complete for purposes of performance standards if the RD has been completed, except for the citizenship/identity verification.

6.3.20 Processing Intake Applications

The following outlines procedures when clients have not already provided acceptable citizenship/identity documents.



Face-to-face Interview

For non-exempt applicants who apply in person, follow the steps below

Table 26: Citizenship/Identity Verification at Intake Application Face‐to‐Face

Step Who Action

1. Intake EW • Reviews the intake application and updates CalWIN appropriately.• Searches IDM and prior case records for Citizenship/Identity verification• Reviews for exemptions to Citizenship/Identity requirements• Reviews MEDS [INQE] for Citizenship/Identity coding

NOTE: If MEDS shows the client was active in another county and no data is present on [INQE], contact the other county to request Citizenship/Identity document(s).

If verification... Then

Is E-Verified • Confirms that DRA information is sent to MEDS.• Enters appropriate citizenship/immigration information into CalWIN


Provided • Completes DHCS 0011 and send to IDM to confirm that the EW reviewed the documentation.

• Confirms that DRA information/coding is sent to MEDS

Not E-Verified andNot Provided

• Checks [INQE] after 2 business days to see if the client has a successful SSN data match result (DOC TYPE = 2Z).

[Refer to “SSN Data Match for Citizenship/Identity,” section 4.9]• If the client claims to have an acceptable document, allows an

additional 10 days if verifications are not provided within the original 10-day due date.

• If verifications are still not provided or client is unable to obtain documents, completes the SCD109 to request a certified copy of the client's birth certificate and/or DL 937 to request a CA ID. A copy of the SCD 109 must be scanned into IDM under Permanent Verifications.

• Ensures all contacts are documented in Maintain Case Comments window.

Cases must not be transferred out of Intake without either an SSN Data Match, a California Birth Record Match, acceptable citizenship/identity documents or an SCD 109/DL 937 on file.

2. Intake EW • Approves full-scope MC benefits, if otherwise eligible.

Note:



Mail-In Applications

For non-exempt applicants using the mail-in process follow the steps below:

Table 27: Citizenship/Identity Verification At Intake Mail In Application

Step Who Action

1. Applicant Request MC in person or by phone.

2. CST • Completes SAWS 1/SC 41 process.• Gives/mails complete intake packet with SCD 1481/DHCS 0001 to client.• Informs client of Mail-In option or scheduling an appointment.• Complete CalWIN/MEDS File Clearance process.• Prints MEDS INQE screen and other necessary screens for each person.• Completes application registration process.

3. Applicant • Chooses to mail in the application.• Receives intake packet with 10 day due date.• Returns application.

(Chart page 1 of 2)



4. Intake EW • Reviews application to determine which household members are citizens• Searches IDM/case record for Citizenship/Identity verification• Reviews for citizenship/identity exemptions• Reviews [INQE] for Citizenship/Identity coding• Processes Mail-In application, updates CalWIN queue as needed• Approves full-scope MC benefits if otherwise eligible.

Note:

If there is no data on [INQE] and MEDS shows client was active in another county, contact the other county to request Citizenship/Identity documents.


Is E-Verified • Confirms that DRA information is sent to MEDS.• Enters appropriate citizenship/immigration information into

CalWIN [Refer to UGSS Chapter 2.8.1 “Batch AP19 Process,” ]




• Checks [INQE] after 2 business days to see if the client has a successful SSN data match result (DOC TYPE = 2Z). [Refer to “SSN Data Match for Citizenship/Identity,” section 4.9]

• If the client claims to have an acceptable document, allows an additional 10 days if verifications are not provided within the original 10-day due date.



Important:Cases must not be transferred out of Intake without either an SSN Data Match, a California Birth Record Match, acceptable citizenship/identity documents or an SCD 109/DL 937 on file.

Table 27: Citizenship/Identity Verification At Intake Mail In Application

Step Who Action

(Chart page 2 of 2)



6.3.21 ProcessingAnnualRedeterminations

Face-to-Face Annual RD; CalWORKs/CalFresh/MC

Table 28: Citizenship/Identity at Redetermination Face‐To‐Face

Step Who Action

1. EW Prior to Face-to-Face Interview:• Searches IDM and prior case files for citizenship/identity verification on file• Reviews for Citizenship/Identity exemptions• Reviews MEDS INQE for Citizenship/Identity coding

If verification is not found and MEDS shows the client previously active in another county, the EW must contact the other county to request documents.

• Reviews and updates RRR Appointment Letter (CSC 35) indicating which case members need to provide Citizenship/Identity documents

Mails RD packet with DHCS 0002 included.

2. Client Requests a Face-to-Face appointment.

3. EW Updates the CalWIN queue as needed.












Cases must not be transferred out of Intake without either an SSN Data Match, a California Birth Record Match, acceptable citizenship/identity documents or an SCD 109/DL 937 on file.

Note:

Important:



Note:

If the client does not keep the scheduled appointment for the CalWORKs/Food Stamps face-to-face interview, the EW must mail the MC Application packet to the client with a 10-day due date

Mail in Redeterminations - Non-BSC

If the client does not keep the scheduled appointment for the CalWORKs/Food Stamps face-to-face interview, the EW must mail the MC Application packet to the client with a 10-day due date.

If the client brings in original documents to the district office, follow the steps below:

Table 29: Citizenship/Identity Verification at Redetermination (not BSC)

Step Who Action

1. Clerical Follows standard procedure to notify the EW.

2. CST • Complete the DHCS 0005 to verify that original documents were received. • Makes a copy of each document and date stamps the copy.

Do not date stamp the original Citizenship/Identity documents. • Returns originals to the client immediately along with the DHCS 0005.

3. EW • Follows the Report Citizenship/Identity Data CalWIN process to send confirmation to MEDS that the original documents were verified and recorded by the county.

• Completes the DHCS 0011 to verify that the documents were reviewed and accepted.

Important:



Mail In Originals

If the client mails in original documents, follow the steps below:

Table 30: Mail in Citizenship/Identity Documents

Step Who Action

1. Clerical • Receives the RD packet and/or original documents in the mail room.

• Immediately makes a copy and date stamps the copy.

Do not date stamp the original Citizenship/Identity documents.

• Complete the DHCS 0005 to verify that original documents were received.

• Scans the DHCS 0005 and copies of the documents into IDM.

• Provides the original DHCS 0005 and the original documents to the EW.

2. EW • Completes the DHCS 0011 to verify that the documents were reviewed and accepted.

• Returns original(s) and DHCS 0011 to the client via Certified Mail with a return receipt.

• Follows the Report Citizenship/Identity Data CalWIN process to send confirmation to MEDS that the original documents were verified and recorded by the county.

The document(s) and a copy of the DHCS 0011 must be scanned into IDM under Permanent Verifications.

Adding a Person

When adding a person to the MC case, follow the steps below:

Important:

Note:

Table 31: Citizenship/Identity Verification when Adding a Person

Step Who Action

1. Clerical Calls the EW to add a person (excluding DE newborns)



Client at Outstation Office

If the client is scheduled for a face-to-face interview with an Outstation EW to bring in proof of citizenship/identity follow the steps below:

2. • Searches IDM and prior case files for citizenship/identity verification on file• Reviews for Citizenship/Identity exemptions• Reviews MEDS INQE for Citizenship/Identity coding• Approves full-scope MC benefits if otherwise eligible.

Note:

If verification is not found and MEDS shows the client previously active in another county, the EW must contact the other county to request documents.












Important:Cases must not be transferred out of Intake without either an SSN Data Match, a California Birth Record Match, acceptable citizenship/identity documents or an SCD 109/DL 937 on file.

Table 32: Citizenship/Identity at Outstation Offices

Step Who Action

1. Client Provides Citizenship/Identity documents.

(Chart page 1 of 2)

Table 31: Citizenship/Identity Verification when Adding a Person

Step Who Action



Documents Received by Mail

If the client mails in proof of citizenship/identity, follow the steps below:

Table 33: Citizenship/Identity documents received by MAIL

Step Who Action

1. Clerical • Completes the DHCS 0005 and makes a copy.• Makes copies of original Citizenship/Identity documents.• Date stamps the COPIES.• Mails the original Citizenship/Identity documents and DHCS 0005 back to the client

via certified mail with a return receipt.

2. EW • Reviews copies of documents. • Follows Report Citizenship/Identity Data CalWIN process to record

Citizenship/Identity Documents to MEDS for all case members.

2. Outstation EW • Completes and signs the DHCS 0005 and gives a copy to the client. • Makes copies of the original Citizenship/Identity documents.• Date stamps the COPIES. • Returns the originals to the client immediately along with the DHCS 0005.• Places in basket to be returned to BSC for scanning. • Schedules another appointment with the client if there are still missing

Citizenship/Identity documents.

3. Clerical Assigns RD packet and/or Citizenship/Identity verifications to EW for document processing.

4. EW • Enters appropriate citizenship/immigration information into CalWIN [Refer to UGSS Chapter 2.8.1 “Batch AP19 Process,” ]

• Completes and updates the RRR in CalWIN.

5. Outstation EW or EW

• Completes the DHCS 0011 to certify client provided acceptable documents.• Completes SCD 109 and/or DL 937 if client is unable to provide acceptable

documents from Tiers 1-5.

Important:The DHCS 0011, SCD 109 and DL 937 must be scanned into IDM under Permanent Verifications.

Table 32: Citizenship/Identity at Outstation Offices

Step Who Action

(Chart page 2 of 2)



6.3.22 Follow Up Process for Pending Verifications

The following process applies to both Intake and Continuing when Citizenship/Identity verifications are pending:

Table 34: Citizenship/Identity documentation Follow up Process

Step Who Action

1. EW • Sends DHCS 0006 with list of acceptable documents with a 10-day due date if phone contact is not successful.

• Makes another attempt to contact the client by phone if documents are not provided and/or there is no contact from the client.

• Extends the Reasonable Opportunity Period (ROP) if the client is making a Good Faith Effort to obtain documents and/or the Certified copy of the Birth Certificate is not yet received.

• Documents all contacts made in Maintain Case Comments along with any reasonable information provided by the client which shows they are attempting to obtain the required Citizenship/Identity verifications.

6.4 Non-citizens Eligible for Full-Scope MC Benefits

6.4.1 IndividualsEligible

The following non-citizens are potentially eligible for full-scope MC benefits:

• A non-citizen who has been lawfully admitted to the United States for permanent residence.

• A non-citizen permanently residing in the United States under color of law (PRUCOL).

• Survivors of Human Trafficking or Serious Crime pursuing T Visa status (the client must at least have the intent to apply for the T visa)

• Survivors of Human Trafficking or Serious Crime and can verify that they have applied for or been approved U Visa status.

• Refugees & Asylees (granted Asylum)

• Deferred Action for Childhood Arrivals (DACA)

• Individuals aged 25 and under regardless of immigration status



Important:

Individuals through age 25 cannot opt out of full-scope MC.

6.4.2 Canadian Born American Indians

American-Indians born in Canada, provided that they are at least 1/2

American-Indian ancestry are considered to be lawfully admitted for permanent residence.

American-Indian ancestry must be verified by a birth or baptismal certificate issued on a Canadian Indian reservation, tribal, or school records which establish that an American-Indian born in Canada is of at least 1/2 American-Indian ancestry.

Note:

USCIS will issue Form I-551s to American-Indians born in Canada.

6.5 Inconsistent Birthdates & SAVE Process

Use this chart when there are birth date discrepancies between USCIS and the Social Security Administration:

If... Then...

Age is not an eligibility factor and the non-citizen presents both USCIS and SSA documents which show two different birth dates.

Use the date of birth recorded by SSA and inform the non-citizen to reconcile the birthdate discrepancies with USCIS and SSA.

Age is the non-citizens’ only linkage with MC. (i.e. the FPL is different for a 14 year old and a 24 year old.)

Individuals must be informed to clear up the birthdate inconsistency with the appropriate agency or the application will be denied or discontinued.

6.5.1 Acceptable Documentation

To receive full-scope MC benefits, a non-citizen’s lawful presence must be verified. If e-Verification and SAVE are unsuccessful the client must provide acceptable documentation of satisfactory immigration status consisting of one of the following:



I-551 Alien Registration Receipt Card

Since late August 1989, USCIS issues a USCIS Form I-551 with added antiforgery characteristics and ten-year expiration date. The face of the card is a rose color, the laminate containing an optical variable ink pattern reads “I-551” when the card is tilted at an angle. All codes are on the back of the I-551. The back of the I-551 has a pink-to-blue rainbow effect shading on the top portion, the bottom portion is white. The I-551 establishes both identity and employment eligibility for non-citizens lawfully admitted for permanent residence.

I-151 Alien Receipt Card

The I-151 was first introduced in 1946 and has gone through sixteen revisions. The latest revision of 7/1/72 shows a photograph of either black/white or color. Some editions of the I-151 do not contain class code information. The I-151 has been replaced by the I-551. However, the I-151 is still acceptable proof of non-citizen status.

AR-3/AR-3a Resident Cards

These older versions of the Alien Registration Receipt Cards were issued to individuals granted lawful permanent residence. They are acceptable proof of non-citizen status, but have since been replaced by the I-551.

I-137 Re-Entry Permit

A permit to reenter the United States.

I-94-Arrival/Departure Record

Annotated with one of the following:

• Conditional Entry

• Refugee

• Cuban/Haitian Entrant

• Political Asylum

Note:

Paroled or paroleeNon-citizens are eligible for restricted-scope MC benefits only if USCIS has not yet taken action on the application. [Refer to “Restricted-scope Benefits,” page 6-44].]



Foreign Passport Stamped

“Processed Form I-551, Temporary Evidence of Lawful Admission for

Permanent Residence valid until

Employment Authorized.” OR

“Temporary Form I-551, Admission for Permanent Residence at:

(Port)

(Date)

(Office of Issuance)

(Date)

SIGNATURE OF ISSUING OFFICIAL (TITLE)

I-181 B

Notification letter issued in connection with an USCIS Form I-181, Memorandum of Creation of Record of Lawful Permanent Residence, which shows that an Alien Registration Receipt Card (I-551) will be issued.

G-711 Individual Fee Receipt

An Individual Fee Receipt for replacement of a lost, stolen or unreadable I-551 or I-688.

Canadian Indian Affairs Letter

A letter from the Canadian Department of Indian Affairs; a birth or baptismal record issued on a Canadian Indian reservation; tribal or school records which establish that an American-Indian born in Canada is of at least one-half American-Indian ancestry.

Registry Alien Status

Any person who can prove that they have lived in the U.S. continuously since before January 1, 1972 may apply to USCIS for a “Registry Alien” adjustment from undocumented status to lawful admission for permanent residence. While the application is pending, the person has PRUCOL status.



6.5.2 Reasonable Opportunity Period

Non-citizen applicants must be given the opportunity to provide evidence of their satisfactory immigration status (SIS). If an applicant’s immigration status cannot be initially verified through the Federal Hub, MEDS, or SAVE process the applicant must be allowed a 90-day Reasonable Opportunity Period (ROP) to provide verification of their satisfactory immigration status. The EW must grant full-scope MC during the ROP. If Satisfactory immigration status cannot be verified within the 90-day ROP, the EW must reduce the benefit to restricted-scope MC.

ROP Process

Follow these steps to determine presumptive eligibility when a non-citizen applying for full-scope MC benefits declares SIS, but lacks documentation:

1. Obtain a completed and signed MC 13 from each adult applicant or client.The non-citizen must check the boxes indicating he/she is applying for full-scope MC benefits and that he/she has satisfactory immigration status.

2. Inform the client to submit within 90 days, from the date the application is completed.

3. Process the full-scope MC application according to the following time frames:

Table 35: ROP Process

If the client... Then the EW...

Submits documentation of permanent residence status or other status allowing full-scope MC within 90 days,

Initiates SAVE and continues to grant client full-scope MC. [Refer to “Electronic Verification Process”, section 14.11] of the Common Place Handbook (CP HB).

Is a non-citizen that declared SIS under PRUCOL, checked category 1 - 15 on the MC13, and then submits corresponding documentation within 90 days,

Initiates SAVE and continues to grant client full-scope MC (unless an unfavorable response is received from USCIS).

Submits the MC 13 with category 16 selected, Approve full-scope MC benefits, no further action required.

Does not submit the documents within the 90-day ROP, Sends a timely 10-day Notice of Action discontinuing full-scope MC benefits and reduce to restricted-scope MC benefits. [Refer to “Restricted-scope Benefits,” section 6.11]

Reminder:

Individuals through age 25 should NOT be placed onto restricted-scope MC aid codes.


https://ssaconnect.sccgov.org/ssa_departments/debs_program/Documents/handbooks/cp/cpchap14.pdf#page=10





6.6 MC13

The MC13 is a tool for clients who are requesting full-scope MC but do not have documentation indicating that they have a status which is eligible for full-scope MC AND the immigration status cannot be verified electronically. Applicants requesting only restricted-scope MC services do not have to disclose their citizen/non-citizen status or have it verified.

Reminder:

A non-citizen applying for restricted-scope MC benefits is not required to sign the MC 13.

If the immigration status cannot be e-verified the MC 13 must be completed at the following times:

• Application

• Reapplication

• Restoration, or whenever there is a break in aid.

• Whenever a change in non-citizen status is reported, whether or not it affects eligibility.

• A new MC 13 is not required at each redetermination unless there is a change in level of benefits requested, or a change in non-citizen status.

• Whenever a client is requesting to change benefit level, e.g., restricted-scope MC to full-scope MC and e-Verification or SAVE are unsuccessful.

Exception:Exception:

Children will continue to receive full-scope MC under SB75 even without an MC 13.

The MC 13 form is not required if an applicant meets one of the two conditions below:

1. Attest to being a U.S. citizen/national or to having satisfactory immigration status on the MC application,

OR

2. Are secondary adults on a case who did not sign the application and the primary applicant attests the individual is a U.S. citizen/national,

AND



Whose citizenship/ immigration status is verified via electronic means including the federal data hub, California birth match, or the Social Security Administration citizenship verification process. Applicants/clients who fail to complete the MC 13 must be denied/discontinued for non-cooperation, failure to comply with requirements.

Automatic MC 13 Generation

CalWIN will generate an MC13 when the clients application originated in CalHEERS and the Immigration Status and document type are Not Listed or when the application originated in CalWIN and the field is blank or Not Listed.

Immigration Questions

Non-citizens who have questions regarding immigration and/or the consequences of an application should be advised to contact the individual or attorney who is helping them with the legalization process, or they can contact:

Catholic Charities Immigration Program2625 Zanker Rd., Suite 201San Jose, CA 95134Phone:(408) 944-0691

6.7 PRUCOL

PRUCOL is a public benefits eligibility category for clients requesting MC. PRUCOL is not an immigration status (such as Lawful Permanent Resident, Refugee, etc.) and does not imply a legal non-citizen status, no immigration status changes result from claiming PRUCOL status. PRUCOL is used only for benefit entitlement purposes (i.e., MC). Undocumented individuals 26 years old or older are not entitled to full-scope MC benefits, unless they are eligible under PRUCOL and claim to have SIS.

Reminder:

Individuals under age 25 receive full-scope MC, if otherwise eligible.

As a result of the court-ordered permanent injunction issued in the Ruiz v. Kizer lawsuit, PRUCOL procedures must be initiated by the EW for non-citizens who have declared and provided adequate documentation of SIS or who claim PRUCOL by completion of the MC 13. Full-scope MC benefits are granted to otherwise eligible non-citizens during the time PRUCOL status is being determined by USCIS.



Important:

Staff must never offer legal advice to individuals about PRUCOL and/or their MC case. Instead, refer individuals to legal aid or to a center for immigrants' rights. The EW should NEVER advise a client to claim PRUCOL. Just as an EW would not sign the MC13 for a client, the EW should not advise a client to claim or not to claim any particular status. That is a decision that the client must make on his or her own. EWs should be able to explain what PRUCOL and any other SIS category are when a client asks. PRUCOL can be claimed for a deceased person and for children.

Undocumented individuals are not entitled to full-scope MC benefits UNLESS they are eligible as PRUCOL AND they claim to have SIS. If a client provides documentation of SIS, follow the process for the status provided (i.e., USCIS documents with a non-citizen #, initiate SAVE, institute secondary verification., etc.). If the client does not have any documentation that supports SIS or does not have any documents but states that he/she has SIS through completion of the MC 13, then, the MC 13 is sufficient to initiate PRUCOL. If a client checked “Yes” on #4 of Section B, one of the options on #5 must also be checked “Yes” to indicate the PRUCOL status category, thus declaring USCIS knows that they are in the U.S. and does not intend to deport him/her, either because of the person’s status category or individual circumstance.

Important:

When clients claim PRUCOL through completion of the MC 13, they are doing this under rules and regulations. The EW must explain to the client that claiming SIS through completion of the MC 13 is a process of declaring their PRUCOL status under penalty of perjury. Further explain that for PRUCOL categories 1 - 15, the EW will seek PRUCOL determination from USCIS.

Benefit Level for PRUCOL Clients

PRUCOL is a claim of SIS and is treated like any other claim of SIS. The person claiming PRUCOL, who is otherwise eligible, receives full-scope MC benefits until:

• Unfavorable response is received from USCIS

• The client is discontinued from MC for any reason.

• There is a change in SIS reported.

Do not to reduce benefits from full-scope MC to restricted-scope MC while awaiting a PRUCOL response from the USCIS.

Reminder:

PRUCOL is not an immigration status and must be reviewed at every MC RD. The MC 13 is only required again at RD if there is a change in status or scope of MC requested.



PRUCOL Definition

PRUCOL status is not recognized by the USCIS as a real or implied legal non-citizen status. USCIS has agreed to determine PRUCOL status for full-scope MC eligibility purposes only.

6.7.1 Categories of PRUCOL

There are 16 PRUCOL categories (MC13).

(1) A conditional entrant admitted to the United States before April 1, 1980

(2) An alien paroled into the United States, including Cuban/Haitian entrants

(3) An alien subject to an Order of Supervision

(4) An alien granted an indefinite stay of deportation

(5) An alien granted an indefinite voluntary departure

(6) An alien on whose behalf an immediate relative petition (INS Form I-130) has been approved and who is entitled to voluntary departure

(7) An alien who has properly filed an application for lawful permanent resident status

(8) An alien granted a stay of deportation for a specific period

(9) An alien granted asylum

(10) A refugee admitted to the United States since April 1, 1980

(11) An alien granted voluntary departure who is waiting issuance of a visa

(12) An alien in deferred action status

(13) An alien who entered and has continuously resided in the United States since before January 1, 1972, who would be eligible for an adjustment of status to lawful permanent resident pursuant to INQ Section 249 (Eligible as a Registry Alien)

(14) An alien granted a suspension of deportation whose departure INS does not contemplate enforcing

(15) An alien granted withholding of deportation pursuant to INA Section 243(h)

(16) An alien, not in one of the above categories, who can show that: (1) INS knows he/she is in the United States; and (2) INS does not intend to deport him/her, either because of the person’s status category or individual circumstances



Category 1-15

All Category 1-15 PRUCOL granted determinations are provisional and must be initiated by the EW for non-citizens who have declared and provided adequate documentation of SIS.

Category 16

An individual may claim PRUCOL status by checking the box 16 on the MC 13, no further documentation/verification required.

Examples of PRUCOL individuals

• Abused aliens who have self-petitioned under VAWA but not yet received a “Notice of Prima Facie” eligibility.

• Abused aliens who are a relative of a U.S. citizen with an approved I-130 petition but not meeting the other requirements of battered immigrants.

• Applicants for adjustment of status.

• Applicants for cancellation of removal.

• Applicants for suspension of deportation.

• Applicants for withholding of deportation or removal.

• Cancellation of removal granted. (Note: If a person is granted cancellation of removal based on having been abused they are a “qualified alien,” not PRUCOL.)

• Deferred action granted. (Note: If a person is granted deferred action based on having an approved self-petition as an abused alien, they are a “qualified alien,” not PRUCOL.)

• Deferred enforced departure granted.

• Family Unity granted.

• “K” status granted. “K,” “S,” “U,” or “V” statuses, designated on a person's visa, allow holders to work and eventually to adjust to Lawful Permanent Resident (LPR) status.

• Lawful temporary residents under the amnesty program of the Immigration Reform and Control Act (IRCA), including those admitted under Sections 210 (“special agricultural workers”) and 245A of the INA.



• Citizens of the Marshall Islands. These individuals have special rights under Compacts of Free Association and are lawfully allowed to enter, reside, and work in the U.S. but are not U.S. Nationals.

• Order of suspension granted.

• Citizens of Palau. (See Citizens of the MC Islands, above.)

• Paroled (the procedure by which USCIS allows a non-citizen to enter the U.S. without granting him or her “admission.” It is different from the use of term in the criminal justice system) into the U.S. for a period of one year or less.

• Residing in the U.S. since prior to January 1, 1972.

• Eligible to petition as special immigrant juveniles. These are juveniles who have been declared a “dependent of the state” and eligible for long-term foster care due to abuse, neglect, or abandonment.

• Stay of deportation granted.

• Stay of removal granted.

• Suspension of deportation granted. (Note: If a person is granted suspension of deportation based on having been abused they are a “qualified alien,” not PRUCOL.)

• Voluntary departure granted - definite time.

• Voluntary departure granted - indefinite time.

6.7.2 Change in PRUCOL Status

Individuals who initially declared undocumented or temporary status who later seek PRUCOL status, must be allowed to complete a new MC 13 declaring PRUCOL status by checking Yes” on #4 of Section B and one of the options on #5 must also be checked.

Table 36: Other Presumptive PRUCOL

Step Who Action

1. Client • Requests full-scope MC benefits• Completes the MC 13 or Submits documentation of SIS:

• The documentation does not need to be a USCIS document, it can be a statement from an attorney or someone who is helping the applicant adjust/obtain their documentation.

• The documents must indicate that the applicant is in the U.S. with USCIS knowledge and permission, and that USCIS does not plan on initiate deportation action.

• Checks the “yes” in section B #4 and checks one of the options on #5 category 1-16.

(Chart page 1 of 2)



6.7.3 PRUCOL CalWIN Entries

For individuals Permanently Residing Under Color of Law (PRUCOL) CalHEERS has added 14 categories. CalWIN will add a new drop-down field titled PRUCOL Category. The PRUCOL drop-down will become mandatory when the CalWIN Immigration Status is Claiming PRUCOL or CalWORKS PRUCOL Elig (for MC only). The PRUCOL drop-down will include:

1. Non-citizen, Approved Visa Petition, Pending Adjstmt to LPR

2. Non-citizen, No Visa Petition, Pend Adjstmt to LPR, Emp Auth

3. Non-citizen, Pend Adjstmt to LPR, without Emp Auth

4. Granted a stay of deportation

5. Granted suspension of deportation, depart USCIS not enforced

6. Paroled into the United States for less than one year

7. Granted Deferred Action but not under DACA

8. Granted Deferred Action for Childhood Arrivals - (DACA)

9. Granted Order of Supervision, Employment Authorization

10. Granted Order of Supervision, no Employment Authorization

11. Immigrant prior to Jan 1st 1972, eligible Registry immigrant

12. Granted voluntary departure and awaiting issuance of a visa

2. EW • Receives document showing SIS• Initiates SAVE

IMPORTANT: For individuals who select category 16 on the MC 13, no further verification is needed.

3. Client Continues to receive full-scope MC benefits until there is a negative determination or a change in status.

Table 36: Other Presumptive PRUCOL

Step Who Action

(Chart page 2 of 2)



13. Non-citizen, I-130 approved, entitled to voluntary departure

14. Last Category

6.8 Expiration of Documents

Expired USCIS documents of any kind are acceptable verification of non-citizen status.


DACA status cannot be verified using expired documentation.

6.9 DACA

On June 15, 2012, Deferred Action for Childhood Arrivals (DACA) was approved. Individuals who qualify under DACA may refer to themselves as “part of the Dream Act”, “Dreamers”, or “Immigrant Youth”.

Participants must:

• Have arrived in the U.S. before the age of 16

• Have lived in the U.S., continuously, since June 15, 2007

• Be under the age of 31 as of June 15, 2012

• Not have lawful immigration status as of June 15, 2012



• Be pursuing education or military service

• Not have any prior convictions (felony or significant misdemeanor)

• Be Physically present in the U.S. on June 15, 2012 and at the time of requesting DACA

DACA individuals, if otherwise eligible for MC, are eligible to receive full-scope MC benefits. However, DACA individuals are not eligible for Advanced Premium Tax Credit (APTC), Cost Sharing Reduction (CSR) or a Qualified Health Plan (QHP). DACA individuals are considered Category 12 PRUCOL individuals on the MC13, “an alien in deferred action status”.

If the individual claims DACA status but is unable to provide verification of that immigration status the EW must allow a 90-day ROP for verification. Full-scope MC benefits must be granted to the individual while the DACA immigration status is verified, if the individual is otherwise eligible for MC.

6.10 SB75 & SB104

State of California Senate Bill 75 (SB75) grants full-scope MC for all children under age 19, who do not have satisfactory immigration status (SIS) or who are unable to verify satisfactory immigration status or citizenship. On January 1, 2020 full scope MC eligibility was expanded to include the new young adult group aged 19-25 through SB104 Young Adult Expansion.


Although CCHIP is listed under MAGI MC in the MC Hierarchy, CCHIP is limited to U.S. citizen and LPR children. [Refer to Chapter 1, "CCHIP,” page-7].

Individuals aged 25 and under cannot opt-out of full-scope MC benefits under SB75 & SB104.

DRA and SIS verification requirements are federal regulations that still apply. If an individual aged 25 and under is unable to provide DRA or SIS verifications he or she will be eligible for full-scope MC under state funded SB75 & SB104. DHCS will track clients who have failed to provide DRA/SIS documents with the citizenship indicator on the Medi-Cal Eligibility Data System (MEDS).

Reminder:

If a child is potentially an Unaccompanied Refugee Minor (URM) who has not yet received the certification letter from the Office of Refugee Resettlement (ORR) the child should be evaluated for regular MC. Once granted the URM status the client should be forwarded to Foster Care (FC).

Note:

Restricted-scope MC aid codes are not available to individuals aged 25 and under.



6.10.1 SB104 Age Policy

SB75 and SB 104 grants full-scope MC to all individuals regardless of their immigration status under the aged 25 and under. Individuals who turn 26 years old are no longer eligible for full-scope MC under SB104. If a client continues to meet all eligibility requirements for MC, the first full month that he/she is 26 years old the client will return to restricted-scope MC.

6.10.2 Aging Out of SB104 Process

After January 1, 2020, DHCS will implement a new MEDS renewal alert that will be sent to counties for review when a Young Adult Expansion individual turns age 25 and 9 months (MEDS Renewal Alert #9581 Message: POTENTIAL ELIG CHG- AGE 25 YRS, 9 MOS). These individuals will require their Medi-Cal eligibility reviewed by the county eligibility worker. During this review period, the individual will remain in their full scope aid code until a complete determination of ongoing eligibility can be made. When a complete eligibility determination is made resulting in continued eligibility for Medi-Cal, the annual renewal date must be reset for a new 12- month period as a Change in Circumstance.

6.10.3 Income changes

If household income goes above the income the MC limit for all individuals aged 25 and under, the individuals will lose full-scope MC eligibility. Initially the individual may be placed onto Soft Pause at which point they will be evaluated for other programs they may be eligible for including CEC, TMC and Non-MAGI.

Note:

Undocumented clients are not eligible for Covered California health plans (APTC/QHP).

Example:

Jessica is 13 and she is undocumented. The household income increases to 300% FPL. The EW updates CalWIN with the increased income and the clients are placed onto Soft Pause. The EW completes an ex-parte review and/or sends the Non-MAGI MC Screening Packet to the clients; however, the parents decline a Non-MAGI MC evaluation or do not provide the information. The EW terminates the case following the 10 day NOA requirements.


https://ssaconnect.sccgov.org/ssa_departments/debs_program/Documents/handbooks/medical/mcchap10.pdf#page=46


6.10.4 Managed Care/Fee-For-Service

Children receiving full-scope MC under SB75 and SB104 clients are subject to Managed Care requirements and will receive the Health Care Options Choice Packet; new enrollees can select the Managed Care plan by calling or returning the packet. If no plan is chosen, DHCS will assign a plan.

Note:

Fee-for-Service (FFS) refers to the way providers are paid by the state. Clients with FFS MC are responsible for asking the provider if they will accept payment from MC before services are received. Not all providers accept MC.

6.11 Restricted-scope Benefits

Restricted-scope MC benefits are limited to emergency care and pregnancy-related services. Individuals can apply for and maintain restricted-scope MC year round, even if a current emergency or pregnancy does not exist.

Non-citizens eligible to receive restricted-scope benefits include the following individuals:

• A non-citizen 26 years of age or older with no documentation to prove SIS.

• A non-citizen 26 years of age or older legally admitted to the U.S. for a limited period (i.e. temporary visa).

• A U.S. citizen applicant/client 26 years of age or older who has not provided acceptable proof of citizenship/identity at the end of the reasonable opportunity period (ROP).

6.11.1 Eligibility

Individuals applying for restricted-scope MC must:

• Be a California Resident. or have intent to reside in CA.

• Meet all other requirements for program eligibility.

6.11.2 SSN Requirement

Social Security numbers are not required for anyone who is only applying or eligible for restricted benefits.



• If the client's SSN is known from other means, i.e., already on file, on MEDS, on earnings statements, etc., it must be used for IEVS and for any other MC related purpose.

• Follow current pseudo number procedures if the SSN in unknown. [Refer to “Allowable Changes,” section 3.3.2]

Reminder:

If an individual has an SSN and chooses to give this information or it is known from other means, the EW must record the SSN in Display Individual Demographics Detail window. An IEVS applicant transaction is then generated.

Note:

An SSN is not required for Victims of Human Trafficking and Serious Crimes to receive MC benefits. [Refer to “TCVAP (T Visa/U Visa),” page 34-23]

6.11.3 Emergency Care

The medical provider, not the EW, determines if the medical service is an “emergency”. The emergency must be certified by a physician or other appropriate medical provider. DHCS may review the provider's decision that an emergency existed and that certain follow-up treatment services were medically justified.

A medical emergency is generally defined as “a medical condition manifesting itself by acute symptoms of sufficient severity, including severe pain, which in the absence of immediate medical attention could reasonably be expected to result in any of the following:

• Placing the patient's health at risk,

• Serious damage to bodily functions, or

• Serious harm to any bodily organ or part.”

6.11.4 Pregnancy Services

Pregnancy related services include prenatal care, labor and delivery, 60-day postpartum services and family planning services which may continue after the sixty-day postpartum period.

6.11.5 Undocumented Non-citizens and Visas

Undocumented non-citizens and non-citizens with unexpired temporary visas (students or visitors) may qualify for restricted benefits if they:



• Are otherwise linked and eligible for MC, and

• Also meet California residency requirements.

Example:

A single adult undocumented non-citizen, age 50, applies for MC. He claims to be disabled, has income less than 138% FPL and meets all other MC eligibility requirements, including intent to remain in California. A DDSD packet is completed; and he is approved on a restricted-scope MAGI MC aid code.

Reminder:

Undocumented non-citizens age 26 years of age or older are not entitled to full scope MC unless they are eligible under PRUCOL and they are claiming to have SIS.

6.11.6 Undeclared Status

Any person who does not wish to declare or verify citizenship, immigration status, social security number or birthplace may only receive restricted-scope benefits.

6.12 Questions and Answers

The following are commonly asked questions related to citizenship/identity verification:

Automated Birth Record Matches

Question 1: Does an application signed under penalty of perjury need to indicate a child’s date and place of birth to be acceptable proof of identity for a child under 18?

Answer 1: Yes, a signed application must include the date and place of birth, to be accepted as an affidavit of identity for children under 18.

Question 2: If a person provides a Passport or other Tier 1/Tier 2 citizenship verification and has not yet posted to MEDS, is there a need to request a birth record match?

Answer 2: No. If a person provides a Passport or other acceptable verification, MEDS must be updated with the information. A birth record match is not required if an applicant or client provides other acceptable evidence of citizenship. MEDS has been modified to automatically check for a birth record match when a transaction contains



information indicating a client was born in California and includes the client’s birth name. This automatic check will occur even if a birth record match has not been specifically requested.

Exempt Individuals

Question 3: Are Former Foster Care Children exempt from the DRA requirement?

Answer 3: Yes, they are exempt while in Aid Code 4M.

Question 4: Which exempt categories are exempt indefinitely and which are not?

Answer 4: An individual is exempt from the DRA citizenship and identity requirement only if they are currently in an exempt status, with the exception of the following:

a. Deemed eligible infants who are born in the U.S. (includes children born to non-citizen mothers and whose delivery was covered by MC); and

b. Infants eligible under the Abandoned Baby Program who are also born in the U.S. and have no documentation.

Question 5: What is Retirement and Survivors Disability Insurance (RSDI) that is received based on a person's own disability?

Answer 5: Recipients receiving RSDI based on their own disability are those who have not worked the required quarters themselves but are entitled to receive retirement or survivor’s benefits based on a spouse’s or parent’s work quarters and are determined disabled by SSA. This group includes Disabled Adult Children and Disabled Widows/Widowers. These recipients are between the ages of 18 and 65. This group may be hard to identify with their Award letter as their eligibility can shift over time (for instance they may start receiving retirement based Social Security after age 60 or 62 if they have accrued work quarters of their own). If it is not clear whether a recipient is receiving Social Security benefits because of their own disability after viewing the Award letter, the EW must contact SSA. This is necessary because there is no reliable information in MEDS to identify individuals receiving RSI based on their own disability.

Question 6: Are recipients of Railroad Retirement benefits exempt?

Answer 6: No. However, individuals who are receiving or eligible to receive railroad retirement benefits can be eligible for Medicare. Individuals receiving Medicare are exempt.

Question 7: If an applicant is not exempt from citizenship/identity requirements at the time of application, but meets one of the exemption criteria while they are making a good faith effort, do we grant full-scope MC back to the date of application?



Answer 7: Yes.

Question 8: When a foreign-born applicant or client claims to be a U.S. citizen and is exempt from citizenship/identity requirements based on current receipt of Supplemental Security Income (SSI) or Medicare, is it necessary to obtain verification of citizenship?

Answer 8: No. The EW must not require citizenship or identity verification for any individual who claims to be a U. S. citizen and is exempt from the requirement.

Question 9: If a MC applicant without a birth certificate is in pending status for three months, and then starts receiving Social Security Disability Insurance, should the EW approve the case with full-scope benefits from the date of application and obtain proof of their status as verification for those few months?

Answer 9: Approve full-scope MC from the date of application including eligible retroactive months. If SSDI is approved while the application is pending, no additional verification of citizenship identify is required for the months before SSDI benefits are approved. Proof of citizenship/identity is not needed if an applicant has met SSA requirements for SSDI.

Question 10: Are children in Foster Care (aided under Aid Code 45) exempt from the DRA citizenship/identity requirements?

Answer 10: Yes.

Question 11: Are former SSI/Medicare recipients exempt?

Answer 11: No. Former SSI or Medicare recipients are not exempt from citizenship/identity requirements. Individuals who are no longer receiving those benefits are not exempt. If a MC client's DRA exemption status changes to non-exempt, they must be treated as a client for purposes of DRA citizenship/identity requirements and must continue to receive full-scope MC during the reasonable opportunity period.

Question 12: When a person is terminated from SSI for citizenship reasons, will SSA update MEDS data to indicate the person has not provided required information?

Answer 12: Yes. The “N13” value in the Payment Status field of the INQX screen in MEDS indicates that the client is “Not a citizen or is an ineligible alien.”

Question 13: For a former SSI client who is no longer exempt, but has filed a timely appeal with Social Security, when does this individual have to comply with citizenship/identity requirements?



Answer 13: The client must comply once an outcome of the appeal is determined. If they remain on SSI, there would be no need to provide DRA verification. If they lose their SSI appeal, and are not exempt on some other basis, they are treated as a client and proof of citizenship/identity must be requested immediately. The client must continue to receive full-scope MC during the reasonable opportunity period.

Presumptive Eligibility: Accelerated Enrollment

Question 14: When is proof of citizenship/identity required for children who are on Accelerated Enrollment (AE) and Child Health and Disability Prevention (CHDP)?

Answer 14: The EW must ask for proof of citizenship/identity when evaluating ongoing MC eligibility. However, children on AE and CHDP Gateway must stay in an AE or CHDP Gateway Aid Code until the EW makes a determination of MC eligibility. The AE/CHDP benefits continue until the end of the reasonable opportunity period or until the determination of ongoing MC eligibility.

Question 15: Is a person who is presumptively disabled exempt from citizenship/identity requirements?

Answer 15: No. Presumptive disability is not a basis for an exemption from citizenship/identity requirements. Presumptive disability is not the same as Presumptive Eligibility.

Acceptable Documents

Question 16: Is a hospital Birth Confirmation Report acceptable as a Birth Record for DRA citizenship purposes?

Answer 16: No, it is not acceptable as a Birth Record for DRA purposes; however it is acceptable as a Tier 3 “extract of a hospital record.”

Question 17: Is a passport card an acceptable document for citizenship/identity purposes under the DRA rules?

Answer 17: Yes, a passport card is acceptable as a Tier 1 document under DRA rules. It must be treated the same as a passport without limitations and coded as a “1A” document type in MEDS.

Question 18: Children approved for free school lunches can apply for MC using the National School Lunch Program (NSLP) application [Refer to “Express Enrollment for Children in the National School Lunch Program,” section 5.26]. Since the application is completed under penalty of perjury, is the signature on the NSLP application the equivalent of a signature on the SSApp for verification of identity for children under 18?



Answer 18: No, the NSLP application is not acceptable proof of identity for DRA purposes. An identity document must show the date and place of birth of the child and signed under penalty of perjury. The NSLP application does not meet these requirements. The NSLP application is used to establish presumptive eligibility for MC.

Question 19: Are birth registration cards from the office of vital statistics, with an official seal that indicates a place of birth acceptable for citizenship verification?

Answer 19: Yes. Birth registration cards from the office of vital statistics, with an official seal that indicates a place of U.S. birth are acceptable.

Question 20: Is an Abstract of Birth from a County acceptable proof of citizenship?

Answer 20: Yes. An abstract of birth showing a U.S. place of birth is acceptable verification of citizenship if it is an original or certified copy.

Question 21: If an individual provides a document that is not listed in any of the tiers of acceptable proof, the EW must forward a copy to the MC Coordinator for a state decision. If the state confirms it is acceptable, how do we code this on MEDS?

Answer 21: Only the state can enter the Document Type code in MEDS.

Question 22: If citizenship is verified through SAVE for an immigrant who is now a naturalized citizen, can we can grant full-scope benefits back to the month of application and cover any retro months for which the applicant is eligible?

Answer 22: Yes

Question 23: Is a marriage certificate that indicates a U.S. place of birth and date of birth an acceptable document for citizenship?

Answer 23: No. A marriage certificate cannot be used as an acceptable document for citizenship. However an original or certified copy of a marriage certificate along with two other corroborating identity documents may be used to establish identity.

Question 24: Does a parent, guardian or caretaker relative signature on the SAWS 2 Statement of Facts serve as proof of identity for a child under 16?

Answer 24: Yes.

Reasonable Opportunity Period (ROP)

Question 25: Are individuals receiving MC under Craig v. Bonta treated as applicants or clients for purposes of citizenship identity requirements?



Answer 25: Individuals receiving MC under Craig v. Bontá are considered clients for purposes of meeting the DRA requirements. Their MC benefits must continue during the reasonable opportunity period.

Use of Affidavits

Question 26: Can a relative other than a parent who is not a MC recipient verify identity for a child under 16?

Answer 26: Yes, but only a parent, guardian or caretaker relative can sign the affidavit of identity for children under 16. For children under 16, the application is considered acceptable documentation of identity, so the need to sign a separate affidavit for this purpose should be rare.

Question 27: Is the affidavit of identity valid indefinitely?

Answer 27: Yes, the affidavit of identity is valid indefinitely. That is even if the child becomes an adult applying for himself.

Question 28: Can we use an affidavit of identity for a 16 or 17 year old who is not in school and who does not have a driver’s license?

Answer 28: Yes. An affidavit or signed application may be used to document the identity of a child under 18 if all of the following conditions are met: (1) an affidavit was not used to document citizenship for the child, and (2) the child cannot obtain a school ID card and (3) the child does not have a driver’s license.

CalWORKs Cases

Question 29: CalWORKs does not require children age 16-18 to provide proof of identity. Is proof of identity required for these children to be eligible for MC in the CalWORKs case?

Answer 29: No. Individuals, including children, who are determined eligible for federal CalWORKs benefits are automatically eligible for no-cost MC effective the date of their Cal-WORKS eligibility. Citizenship/identity requirements do not affect MC eligibility that is established based on ongoing CalWORKs eligibility.

Question 30: Do individuals who were CalWORKs eligible in the past need to provide verification to establish MC eligibility?

Answer 30: Individuals who have met the citizenship and identity requirements for ongoing CalWORKs eligibility do not have to provide that information again to establish MC eligibility in the future. However, EWs must update MEDS to indicate how the MC citizenship and identity requirements were met if that information is not already in MEDS.



Question 31: Would a CalWORKs client who gets CalWORKs during the 90 days have to provide documents and then loses eligibility because eligibility wasn’t met need to provide evidence of citizenship right away or at redetermination?

Answer 31: They are treated as clients and should provide proof of citizenship right away since they since CalWORKs eligibility was not established. Do not wait until the next RD to request proof of citizenship in this situation. Other than that, they are treated the same as clients. If they stop making a good faith effort to obtain documents, they are not eligible for full-scope MC and must be reduced to restricted scope benefits if the reasonable opportunity period ends.

Question 32: Do we need to complete the DHCS 0011 “Proof of Acceptable Citizenship or Identity Documentation” to validate the individual has met the Citizenship/Identity requirements when CalWORKs is discontinued and ongoing MC is established?

Answer 32: No. MEDS will be populated by the state for those who are CalWORKs eligible that they have met the citizenship/identity requirements.

Question 33: Are clients being discontinued from CalWORKs required to verify citizenship at the next MC redetermination?

Answer 33: No. The only exception would be if a CalWORKs client claiming to be a U.S. citizen loses CalWORKs because they did not verify their citizenship.

6.13 Citizen/Alien Indicator

Citizen/Alien Indicators sent to MEDS indicate the following:

Table 37: Citizen/Alien Indicator for MEDS per MEDS quick Reference Guide

Citizen/Alien Indicator Description

A Proven U.S. Citizen

B Alleged U.S. Citizen

C Conditional entrant admitted under INA Section 203(a)(7)

D Deportation withheld admitted under INA section 243(h) or 241(b)(3)

E Amerasian refugee admitted under INA Section 207

F Refugee admitted under INA Section 207 or 203(a)(7)

G Parolee admitted under INA Section 212(d)(5)

(Chart page 1 of 3)



H Silva vs. Levi alien

K Lawful Permanent Resident (LPR)

L Asylee admitted under INA Section 208 but not Kurdish or Iraqi Asylee

M Residents of the Northern Mariana Islands

N identity and citizenship of the individual verified by the Numident interface (Code was previously A or B)

O Victim of Severe Forms of Trafficking who has been certified by ORR or who has been granted a T Visa

P Pre-January 1, 1972 alien (presumed lawfully admitted for permanent residence)

Q Alleged born in U.S., supported by a U.S. birthplace shown on online Numident

R Other refugee admitted under INA Section 207 but not Amerasian or Indochinese refugee

S Other documented immigrants eligible for full scope benefits (includes DACA)

T Last PRUCOL Category (Category 16)

U Undocumented Individuals eligible for State Only Funded Long Term Care (Denied PRUCOL) restricted-scope MC eligibility

V Visitor/Student/etc. individuals with temporary documentation

W Parolee admitted under INA Section 212(d)(5) with a period of parole over one year

X Indochinese refugee admitted under INA Section 207

Y Parolee admitted under INA Section 212(d)(5) with a period of parole less than one year

Z Kurdish or Iraqi Asylee admitted under INA Section 208

0 Other alien (not 1, 5, 7, 8 or 9)

1 Indochinese refugee admitted under INA Section 207

2 Lawfully present not a qualified immigrant

5 Citizen child born to refugee parent(s)

7 Other refugee



(Chart page 2 of 3)



8 Cuban/Haitian entrant

9 Aged alien (Medicare ineligible alien and not 1, 7 or 8)



(Chart page 3 of 3)
