Medical Assistance

2.1.2.2.1 Citizenship

To receive Medical Assistance (MA), applicants must be U.S. citizens, U.S. nationals or certain lawfully present noncitizens. See the MA Immigration Status policy for more information.

U.S. Citizen

A U.S. citizen is someone who is born in the U.S. (including U.S. territories, except for American Samoa) or who was born outside the U.S. and who either:

Was naturalized as a U.S. citizen
Derived citizenship through the naturalization of their parent(s)
Derived citizenship through adoption by U.S. citizen parents, provided certain conditions are met
Acquired citizenship at birth because he or she was born to U.S. citizen parent(s)
Became a U.S. citizen by operation of law

U.S. National

A U.S. national is someone who is a U.S. citizen or owes permanent allegiance to the U.S. With extremely limited exceptions, all noncitizen U.S. nationals are people born in American Samoa or people born abroad with one or more American Samoan parents under certain conditions.

Verification

Citizenship may be verified electronically at the time of application through a data match with the Federal Data Services Hub( FDSH) or the Social Security Administration (SSA). This is the preferred method of verifying citizenship for applicants and enrollees. The county , tribal, or state agency must attempt and exhaust all trusted electronic sources prior to requiring paper documentation from the enrollee. Only applicants and enrollees whose U.S. citizenship or U.S. national status cannot be verified electronically must provide proofs.

Eligibility must be approved for applicants who meet all other eligibility criteria and attest to meeting the citizenship eligibility requirement. A person approved for MA without verification of their citizenship status has a reasonable opportunity to work with the agency to resolve clerical discrepancies preventing electronic verification or to provide proof. The county, tribal , or state servicing agency must help applicants and enrollees obtain required proofs. A notice is sent to the enrollee to indicate they have 90 days, plus 5 days for mailing, from the date of the notice to satisfy the request. The 90 days plus 5 days for mailing cannot be extended for citizenship verification for MA enrollees. Eligibility and coverage must end with a 10-day advance notice if the enrollee fails to provide proof of citizenship by the end of the reasonable opportunity period.

During the reasonable opportunity period, the county, tribal or state servicing agency must continue efforts to complete verification of an applicant's citizenship. This includes correcting errant demographic data, re-running electronic sources and checking case records and files for prior instances of successful electronic verification or citizenship documentation received previously. The agency must document efforts to verify an applicant's citizenship during the reasonable opportunity period in the case record. The agency must also help applicants and enrollees obtain required paper proofs .

People who were previously enrolled in MA in another state were required to verify citizenship as a condition of eligibility for MA. As such, verification of citizenship obtained from another state's MA program is an acceptable form of verification. Proof of citizenship may be requested from the state where the client was previously enrolled in MA, if it is not available through other sources. A signed release, such as the Minnesota Department of Human Services General Authorization for Release of Information (DHS-2243A) must be obtained from the client to contact another state's MA program agency.

Once citizenship is verified, county, tribal and state servicing agencies cannot request proof again, unless an agency possesses inconsistent information regarding a person’s citizenship.

A person who reapplies for health care coverage, whose citizenship was not previously verified, must be given a new reasonable opportunity period to provide proof of citizenship.

Paper Proof of Citizenship

Applicants and enrollees who must provide proof when citizenship cannot be electronically verified can submit a copy of one of the following to verify U.S. citizenship:

U.S. passport, including a U.S. Passport Card issued by the Department of State, without regard to any expiration date as long as such passport or card was issued without limitation
Certificate of Naturalization
Certificate of Citizenship
Valid Minnesota Enhanced Driver's License or Enhance Identification Card
Documentary evidence issued by a federally recognized Native American Tribe which identifies the tribe that issued the document, identifies the individual by name, and confirms the individual's membership, enrollment or affiliation with the tribe. These documents include a tribal enrollment card, a Certificate of Degree of Indian Blood, a tribal census document, or documents on tribal letterhead, issued under the appropriate tribal official.

Applicants and enrollees can also verify citizenship by submitting a copy of one document from each of the following two lists:

List 1
- U.S. public birth certificate or other birth document
  - The birth record document may be issued by a state, commonwealth, territory, or local jurisdiction.
  - For people born in Minnesota, birth records can only be obtained by sending the Minnesota Department of Health ( MDH) the Minnesota Birth Records Application form . For people that were born in another state , birth records can be obtained directly from the state of birth.
- U.S. citizen ID card
- An electronic data match with a state vital statistics agency can substitute for a List 1 document.
- A Certificate of Report of Birth, issued to U.S. citizens born outside of the U.S., or Report of Birth Abroad of a U. S citizen
- Certification of birth in the U.S.
- Northern Marianas Identification Card issued by the U.S Department of Homeland Security
- American Indian card (I-872) from the U.S. Department of Homeland Security
- Final U.S. adoption papers that show the child's name and a U.S. place of birth, or if an adoption is not final, a statement from the state approved adoption agency that shows the child's name and the U.S. place of birth
- Papers showing U.S. government employment before June 1,1976
- U.S. Military Record of Service showing U.S. place of birth
- Documentation that a child meets the requirements of section 101 of the Child Citizenship Act of 2000
- Medical records showing a U. S. place of birth
- Life, health or other insurance company record showing a U. S. place of birth
- Official religious record recorded in the U.S. showing that the birth occurred in the U.S.
- School records including preschool records, Head Start and daycare showing the child's name and U.S. place of birth
- Federal or state census record showing U.S. citizenship or U.S. place of birth
- An affidavit can be used in lieu of a List 1 proof, if citizenship cannot be verified electronically and the person does not have any List 1 documents.
  
  The affidavit must be signed under penalty of perjury by a person other than the applicant who can attest to the applicant's citizenship. The affidavit must include the applicant's name, date of birth, and place of birth. The affidavit does not need to be notarized.
List 2

The following are accepted as proof of identity, as long as the document has a photograph or other identifying information sufficient to establish identity, including (but not limited to) name, age, sex, race, height, weight, eye color, or address:
- State driver’s license or state ID card
- Real ID driver's license or ID card
- School ID card
- U.S. military ID card or draft record
- Military dependent's ID Card
- U.S. Coast Guard Merchant Mariner Card
- For a child under age 16:
  - School records including pre-school or daycare records
  - Clinic, doctor or hospital records
  - Two other documents containing consistent information that corroborates a person's identity.
- Finding of identity from a federal or state government agency
- An affidavit can be used in lieu of List 2 proof, if citizenship cannot be verified electronically and the person does not have any List 2 documents.

Exemptions from the Citizenship Verification Requirement

The following people are exempt from the U.S. citizenship verification requirement:

People enrolled in or entitled to enroll in Medicare. The SSA has already verified citizenship and identity for these people.
People who receive or previously received Supplemental Security Income (SSI)
People who receive or previously received Retirement, Survivors or Disability Insurance (RSDI) benefits due to disability (also known as SSDI). This does not include people who receive RSDI retirement or survivor’s insurance benefits. They are not exempt from this requirement unless they meet another condition for exemption (such as enrollment in Medicare).
Auto newborns and children previously enrolled as auto newborns

Legal Citations

Code of Federal Regulations, title 42, section 435.406

Code of Federal Regulations, title 42, section 435.407

Code of Federal Regulations, title 42, section 435.911

Code of Federal Regulations, title 42, section 435.945

Code of Federal Regulations, title 42, section 435.949

Code of Federal Regulations, title 42, section 435.952

Code of Federal Regulations, title 42, section 435.956

Code of Federal Regulations , title 42. section 435.1008

Code of Federal Regulations, title 42, section 457.320

Code of Federal Regulations, title 42, section 457.380

Patient Protection and Affordable Care Act, Public Law 111-148, section 1413

Patient Protection and Affordable Care Act, Public Law 111-148, section 14141