Medi-Cal Handbook Citizenship/Immigration Status 6 ...Presumptive eligibility provisions allow a noncitizen who is otherwise eligible for full-scope benefits and who is claiming under

Medi-Cal Handbook page 6-1Citizenship/Immigration Status

6. Citizenship/Immigration Status

Citizenship or immigration status determines the level of Medi-Cal benefits. All other eligibility requirements must be met in order to be eligible.

A declaration of citizenship/immigration status and place of birth on any form used as an application for Medi-Cal is required for every eligible Medi-Cal applicant or recipient, except when a “Joint Application for Children and Pregnant Women” (MC 321 HFP) is used. In addition, completion of “Statement of Citizenship, Alienage and Immigration Status” (MC 13) is required for non-citizens, for adult citizens who did not sign a Statement of Facts and for persons (adult and/or child) who are not listed on the current “Application for Medi-Cal” (MC 210) when adding them to Medi-Cal.

The forms listed below do not contain a declaration of citizenship/immigration status and place of birth. Therefore, completion of an MC 13 is still required if one of the following forms is used as an application for Medi-Cal, even if the applicant is a U.S. citizen.

• “Access for Infants and Mothers” (AIM) Application• “Annual Eligibility Review” (AER) form• “Application for Food Stamp Benefits” (DFA 285 A1) if used to approve Medi-Cal.

MC 13

An MC 13 is required for all noncitizens and any adult citizen who did not sign a Statement of Facts. The MC 13 is also required when adding a person (adult and/or child) who is not listed on the current “Application for Medi-Cal” (MC 210). The MC 13 must be completed by each adult applicant, or adult acting on behalf of a child. In cases where the applicant is a child, or is incapable, incompetent, or deceased, the same person who signs the Statement of Facts form must complete the MC 13. Applicants for restricted benefits (or persons acting on their behalf) are only required to complete Section A and B including: the applicant's name, the authorized representative's name, his or her relationship to the applicant, and the current date and to indicate the scope of benefits the applicant is requesting. Applicants requesting restricted services only do not have to disclose their citizen/noncitizen status or have it verified.

The MC 13 shall be completed at the following times:

• Application• Reapplication• Redetermination.

Update # XX-XX Revised: 06/28/13

page 6-2 Medi-Cal HandbookCitizenship/Immigration Status

Note:A new MC 13 is not required at each redetermination unless there is a change in level of benefits requested, or a change in noncitizen status.

• Restoration, or whenever there is a break in aid.• Whenever a change in noncitizen status is reported, whether or not it affects

eligibility.• Whenever a client is requesting an upgrade in benefit level, e.g., restricted to full

scope.

Applicants/recipients who fail to complete the MC 13 must be denied/discontinued for non-cooperation, failure to comply with requirements.

Application Consequences

Noncitizens who have questions regarding 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 Program 2625 Zanker Rd., Suite 201 San Jose, CA 95134 Phone:(408) 944-0691

6.1 Noncitizens Eligible for Full-Scope Benefits [50301]

6.1.1 Persons Eligible [50301]

The following noncitizens are potentially eligible for full-scope benefits:

• A noncitizen who has been lawfully admitted to the United States for permanent residence.

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

Revised: 06/28/13 Update # XX-XX


6.1.2 Acceptable Documentation

To receive full-scope benefits, a noncitizen lawfully admitted for permanent residence 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 has begun issuing USCIS Form I-551s with added antiforgery characteristics and ten-year expiration dates. The face of the new card is a rose color, the laminate containing an optical variable ink pattern which 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, with the bottom portion being white. The I-551 establishes both identity and employment eligibility for noncitizens 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 noncitizen status.

AR-3/AR-3a Resident Cards

These older versions of the Alien Registration Receipt Cards were issued to persons granted lawful permanent residence. They are acceptable proof of noncitizen 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



• Paroled or parolee

Note:Noncitizens are eligible for restricted benefits only if USCIS has not yet taken action on the application. [Refer to “Restricted Benefits,” page 6-11.] [Refer to Common-Place Handbook, “Immigration Forms,” page 13-1, for additional information regarding noncitizens and Medi-Cal eligibility.]

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.

6.1.3 Presumptive Eligibility

Noncitizen applicants must be given the opportunity to provide evidence of their satisfactory immigration status (SIS).

General

Presumptive eligibility provisions allow a noncitizen who is otherwise eligible for full-scope benefits and who is claiming under penalty of perjury, satisfactory immigration status for 30 days or the period of time it actually takes to clear eligibility, whichever is longer, to provide proof of noncitizen status. Full-scope benefits can be approved while documentation is pending. The 30 day period begins when the applicant submits a completed MC 13.

Satisfactory Immigration Status (SIS), for Medi-Cal purposes, means a noncitizen:

• Lawfully admitted for permanent status, or• A noncitizen permanently residing in the U.S. under color of law (PRUCOL); or• An amnesty noncitizen.

Process

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

1. Obtain a completed and signed MC 13 from each adult applicant or beneficiary, or from an adult acting on behalf of a child. The noncitizen must check the boxes indicating he/she is applying for full-scope benefits and that he/she has satisfactory immigration status.



2. Inform the client to submit within 30 days, from the date the MC 13 is completed, documentation of SIS.

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

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

Declares SIS, has completed the MC 13 requesting full-scope benefits, and is otherwise eligible, but HAS NOT provided evidence of SIS,

Grants full scope benefits pending submission of the documents within the 30 day period, or the period of time it takes to clear eligibility, whichever is longer.

Submits within 30 days, or by the time eligibility is cleared, whichever is longer, documentation of permanent residence status as outlined in the section,

Continues to grant client full-scope benefits; noncitizen verification requirements “acceptable documentation” met. Initiate primary SAVE.

Submits within 30 days, or by the time eligibility is cleared, whichever is longer, documentation showing that:

He/she is living in the U.S. with USCIS knowledge and permission, and

USCIS does not plan to deport him/her. Noncitizen has declared SIS under PRUCOL, checks either of 1 - 15,.

Forwards the documents, with completed form G-845S to USCIS for verification of SIS. Follow PRUCOL procedures discussed on the following pages.

Does not submit the documents within the 30- day period, or by the time eligibility is cleared, whichever is longer,.

Sends a Notice of Action discontinuing full-scope benefits and reduce to restricted benefits. (A 10-day NOA is required.)

6.2 Restricted Benefits

6.2.1 Who Receives [50302]

Noncitizens eligible to receive restricted benefits include the following persons:

• A noncitizen who lacks a USCIS document or an order issued by a USCIS District Director, the Executive Office of Immigration Review, or a federal court that serves as reasonable evidence of SIS.

• A nonimmigrant noncitizen legally admitted to the U.S. for a limited period.



• A U.S. citizen applicant/beneficiary who has not provided acceptable proof of citizenship/identity at the end of the reasonable opportunity period (ROP).

• Applicants applying for restricted benefits who lack documentation of SIS, or who are nonimmigrants.

Persons who request restricted benefits and who choose not to give any information about their citizenship/immigration status shall be identified as “undocumented,” Aid Codes 58 or 5F (if pregnant).

If the noncitizen chooses to give this information, the EW must use the information which is provided.

Important:

If the client's SSN is made known by other means, for example, SSN is already in case record, on MEDS, on earnings statements, etc., it must be used to initiate IEVS.

6.2.2 General Requirements

Citizens and noncitizens entitled only to restricted benefits shall receive Medi-Cal benefits limited to emergency care and pregnancy-related services.

• Anyone applying for or eligible to receive only restricted benefits must be a California Resident.

• SAVE shall not be initiated on clients applying for or receiving restricted benefits.

Exception:SAVE shall be initiated on those persons indicating they are amnesty noncitizens.

• They shall meet all other requirements for program eligibility.

• The application shall be approved, if otherwise eligible, although there may be no current need for emergency or pregnancy-related care.

• Applicants cannot choose restricted benefits as a way to avoid IEVS and SAVE, if they are otherwise entitled for full-scope benefits.

• Eligibility shall continue as long as the beneficiary continues to meet all eligibility requirements.



• Restricted benefit approval NOAs must be issued to clients who are granted restricted benefits only.

6.2.3 SSN Requirement [50302]

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, e.g., already on file, on MEDS, on earnings statements, etc., it must be used for IEVS and for any other Medi-Cal related purpose.

• Follow current pseudo number procedures if the SSN in unknown.

Important:

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

• The SSN requirement for U-parent deprivation is waived for persons applying for restricted benefits.

6.2.4 Emergency Care

The provider, not the EW, shall determine if the medical service is an “emergency”. 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 in serious jeopardy, or• Serious impairment to bodily functions, or• Serious dysfunction to any bodily organ or part.

Note:The emergency must be certified by a physician or other appropriate medical provider (Section 51056 of Title 22 of the California Code of Regulations). DHCS may review the provider's decision that an emergency existed and that certain follow-up treatment services were medically justified.”



6.2.5 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.

Note:A woman who is eligible for a restricted card with a share of cost or who loses her entitlement to Medi-Cal after a pregnancy ends may be entitled to 60-Day Postpartum Medi-Cal, under Aid Code 76.

6.2.6 Undocumented Noncitizens and Visas

Undocumented noncitizens and persons with unexpired temporary visas (students or visitors) may qualify for restricted benefits if:

• They are otherwise linked and eligible for Medi-Cal, and• They also meet California residency requirements.

Example:A single adult undocumented noncitizen, age 50, applies for Medi-Cal. He claims to be disabled and meets all other Medi-Cal eligibility requirements, including intent to remain in California. A DDSD packet shall be completed, and if DDSD is approved, he is entitled to a Restricted Card for emergency care and pregnancy-related services.

Reminder:Undocumented noncitizens are not entitled to Full-Scope Medi-Cal benefits unless they are eligible as PRUCOL and they are claiming to have satisfactory immigration status (SIS). [Refer to “Presumptive Eligibility,” page 6-5 for more information.]

6.2.7 Undeclared Status

Any person who does not wish to declare or verify citizenship, immigration status, social security number or birthplace may only receive restricted benefits, Aid Code 58.



6.2.8 Verification/Procedures

Each adult noncitizen and an adult citizen who did not sign the Statement of Facts must complete section A and B of the MC 13. When the applicant/beneficiary is a child, the adult acting on behalf of the child must complete the MC 13. A noncitizen applying for restricted benefits is not required to sign the MC 13.

NOTE: Undocumented noncitizens, those persons with temporary visas, and other persons who apply for restricted benefits must only complete Section A and B of the MC 13; however, they may volunteer to give additional noncitizen status information.

Initiate SAVE verification for individuals who voluntarily present their USCIS documents, although verification of immigration status is not required when a person is applying for restricted benefits.

6.2.9 Immigration Reform and Control Act (IRCA Amnesty) Noncitizens

Information regarding IRCA (Amnesty) noncitizens are kept in this chapter for historical purposes only.

General Information

Under the Federal Immigration Reform and Control Act of l986 (IRCA), certain noncitizens who were residing illegally in the U.S., were given the opportunity to apply for adjusted Temporary Resident Status (TRS) and then to apply for Lawful Permanent Resident (LPR) status.

• IRCA (amnesty) noncitizens are issued USCIS Forms I-688A, I-688 and/or I-551.

• USCIS Forms I-688A and I-688 have expiration dates, as they are temporary residence documents.

• The expiration date is 31 months from the legalization date on the front of the I-688.

• IRCA noncitizens must apply for permanent residence status before the expiration date on their I-688 cards.



Note:Receipts from USCIS are acceptable verification of noncitizen status if the noncitizen has not yet received the permanent document.

• Those who fail to apply for permanent status before their cards expire will lose their amnesty status.

• Noncitizens who lose their amnesty status revert to undocumented noncitizen status.

Full Benefits

IRCA (Amnesty) noncitizens who are entitled to full-scope benefits include:

• Those with an I-688, Temporary Resident Card, with Class 210, 210A, 245A, or I-551, Permanent Resident Card, with Class S16, S26, R16, R26, W16, W26, or W36 AND WHO ARE:

• Aged, blind, or disabled, or• Under l8 years of age, or• More than 5 years has elapsed since the date the noncitizen was granted

lawful temporary resident status.

Restricted Benefits

Effective October 1, 1988, IRCA (amnesty) noncitizens who are only entitled to restricted benefits include:

• Those with an I-688, Temporary Resident Card, with Class 210, 210A, 245A or I-551, Permanent Resident Card, with Class S16, S26, R16 R26, W16, W26, or W36, AND WHO ARE:

• AFDC-MN or MI persons, age 18 thru 20, or• AFDC-MN linked adults, age 21 thru 64, or• MIA persons in LTC, or• MIA pregnant women.

• Those with an I-688A, Employment Authorization Card, or I-689, Fee Receipt Form, and are otherwise linked and Medi-Cal eligible.



Stuffer

Some IRCA noncitizens previously entitled to restricted benefits only are now eligible to apply for full-scope benefits.

EWs are not required to search out or identify existing cases of IRCA noncitizens who are currently receiving restricted benefits and for whom the five-year moratorium period has expired. The Department of Health Services (DHS) mailed Medi-Cal card stuffers at six-month intervals informing IRCA noncitizens (i.e., Aid Codes 51, 52, 56, and 57) that:

• Their individual five-year moratorium periods may be expiring,• Once they have changed their status to that of lawful permanent resident,• They may be eligible to apply for full-scope benefits.

Filing Dates

The initial date on which noncitizens could file for adjusted Temporary Resident Status was May 5, 1987; therefore the first five-year moratorium period expired on May 5, 1992.

• The filing periods for noncitizens who applied for TRS under IRCA were May 1, 1987 through May 4, 1988.

• The filing period for SAW noncitizens only (Section 210 of the Immigration and Naturalization Act) was extended to November 30, 1988.

• For other individual IRCA noncitizens the expiration of the five-year moratorium period depends on individual temporary resident adjustment dates.

Exceptions

Under the Zambrano v USCIS ruling the deadline to file for amnesty under IRCA was extended to December 29, 1989 for the following noncitizens who did not meet the May 4, 1988 deadline (November 30, 1988, for SAW noncitizens) for one of the following reasons:

• The applicant, or a family member, received public cash assistance and USCIS told him or her that they were not eligible for amnesty; or

• The applicant applied for amnesty and the USCIS rejected his or her application because they, or a family member, received public cash assistance.



Noncitizen applicants for full scope Medi-Cal benefits who fall within this class will present documentation with temporary resident adjustment dates between December 6-29, 1989. If otherwise eligible, these noncitizens will be eligible to receive full-scope Medi-Cal benefits as of December 6-29, 1994.

Additional IRCAs

Certain noncitizens from Poland, Afghanistan, Ethiopia and Uganda were allowed to apply for amnesty until December 22, 1989. If otherwise eligible, these noncitizens who are not aged, blind, disabled or under 18, will be eligible to receive full-scope Medi-Cal benefits as of December 22, 1994.

LPR Documents

Evidence of lawful permanent resident (LPR) status for the IRCA noncitizen will be USCIS Form I-551, Alien Registration Receipt card. Codes appearing on the I-551 and other USCIS documents that identify IRCA noncitizens are:

• W16, W26, and W36 for Section 245A noncitizens,• S16 and S26 for SAWS noncitizens, and• R16 and R26 for RAWS noncitizens.

Adjustment Date

In determining eligibility for full-scope benefits for IRCA noncitizens, EWs must determine the correct “date of adjustment to temporary status”. The date of adjustment is the date payment of the amnesty application fee is made (USCIS Form I-689, Fee Receipt). Eligibility for full-scope benefits for most IRCA noncitizens begins five years from the adjustment date.

Note:If an IRCA noncitizen presents any USCIS document having an expired date, the EW should consider this evidence to be invalid and request that the IRCA noncitizen obtain an USCIS document with a valid date, or an USCIS receipt indicating that the noncitizen has requested a new document.

[Refer to Common-Place Handbook, “USCIS Codes,” page 12-1, for additional information in determining acceptable IRCA documents showing LPR status and correct dates of adjustment.]



Redetermination Review

At redetermination EWs must check the USCIS documents for the date of adjustment to TRS for every beneficiary who is not receiving a full-scope Medi-Cal card.

Prior to issuing full-scope benefits the EW must verify that:

• It has been five years since the IRCA noncitizen acquired TRS AND• The noncitizen has obtained lawful permanent resident (LPR) status from

USCIS. Evidence of LPR status is a Form I-551, Alien Registration Receipt Card.

A new MC 13 is necessary at redetermination when the level of benefits to full-scope or immigration status changes.

Note:Regular full-scope aid codes (AFDC-MN/MI, ABD, etc.) apply to IRCA noncitizens who now have LPR status and whose five-year moratorium period has expired. Do not use the 50* series aid codes for these individuals.

Important:

If the five-year moratorium has expired and the IRCA noncitizen has failed to acquire lawful permanent resident (LPR) status as evidenced by the I-551 and verified by SAVE, the noncitizen reverts automatically to the status of undocumented noncitizen; restricted benefits may continue.

Beginning Date

Eligibility for full-scope benefits for IRCA noncitizens begins with the month of client request, provided required USCIS documentation of LPR status, MC 13s and all other Medi-Cal eligibility criteria are met.

SAVE

Due to the large number of forged documents in circulation, EWs must verify all IRCA noncitizen documentation through SAVE.

SSN Requirements [50302]

• IRCA (amnesty) noncitizens applying for a full-scope or restricted benefits must have a SSN or apply for one.



• When applying for amnesty, IRCA noncitizens who report no SSN to USCIS must complete form SS-5, Request for Social Security Number.

• The USCIS sends the SS-5 to the Social Security Administration (SSA), who assigns a SSN, then issues it to the noncitizen on a letter rather than issuing a Social Security card.

• The heading of the letter indicates an USCIS address; however, the letter and SSN are issued by SSA.

• The SSA letter can be accepted as verification of an SSN when presented with a valid USCIS form I-688A, Employment Authorization Card.

Note:When lawful temporary resident status is granted, the noncitizen should receive an I-688, Temporary Resident Card, and a SSN card.

6.3 PRUCOL (Permanently Residing Under Color of Law)

Most noncitizens who apply for full-scope benefits have documentation of their legal status. However, for those noncitizens who declare they have satisfactory immigration status (SIS), but who do not have formal USCIS documents, PRUCOL status can be sought. 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 those noncitizens who have declared and provided adequate documentation of SIS or who claim PRUCOL by completion of the MC 13. Full-scope benefits are granted to otherwise eligible noncitizens during the time PRUCOL status is being determined by USCIS.

A person does not have to be in long-term care (LTC) or on Renal Dialysis (RD) to claim PRUCOL. The California Department of Health Care Services (DHCS) has clarified that we do not have to ask for any kind of documentation from people claiming PRUCOL status under category 16. An individual may claim PRUCOL 16 status by simply checking the box. DHCS understands that many people claiming PRUCOL by checking the last box on Section B, #5 of the MC 13 (i.e., “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.”) are undocumented and do not have any proof for us to send to USCIS. We still collect and submit documentation from the other kinds of PRUCOL per Section B #5.



Staff must never offer legal advice to persons about PRUCOL and/or their Medi-Cal case. Instead, refer people 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 worker 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. Workers should be able to explain what PRUCOL and any other satisfactory immigration status (SIS)category is when a client asks. PRUCOL is not an immigration status (such as Lawful Permanent Resident, Refugee, etc.) and does not imply a legal non-citizen status, so no immigration benefits result from claiming PRUCOL status. PRUCOL is used only for benefit entitlement purposes (e.g., Medi-Cal).

For PRUCOL statuses 1 - 15, a manual Systematic Alien Verification of Entitlement (SAVE) is completed for persons who will be approved for full-scope MC based on PRUCOL.

For the last PRUCOL status (16th) that says, “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” the EW is no longer required to verify PRUCOL with an MC 845, G 845 or SAVE.

The non-citizen client claiming PRUCOL will not be deported on the basis that they claim PRUCOL and/or receive Medi-Cal. PRUCOL non-citizens are subject to deportation, when their cases warrant it, for reasons unrelated to the Medi-Cal case. An example is when a non-citizen has an open warrant for his or her arrest.

PRUCOL Definition

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

USCIS will use SAVE secondary verification to process PRUCOL requests with three variations:

• Agents, rather than status verifiers, review and act on PRUCOL requests.• USCIS does not discuss the reasons for particular PRUCOL determinations.• Additional information is required with USCIS form G-845, Document Verification

Request.

USCIS will not deport noncitizens who claim PRUCOL or who apply for or receive Medi-Cal. USCIS, however, reserves the right to seek deportation action on a case for reasons unrelated to Medi-Cal, such as:



• Noncitizens submits false information to USCIS, or• When there is an open warrant for the noncitizen's arrest.

PRUCOL can be requested for a deceased person.

A PRUCOL response from USCIS is for full-scope Medi-Cal entitlement purposes only. USCIS does not recognize PRUCOL as a real or implied legal noncitizen status, so no immigration benefits result from it.

Except for the last category of Section B, 5, all PRUCOL granted determinations are provisional and must be redetermined by USCIS within one year from the day that USCIS annotates the G-845S.

Examples of PRUCOL aliens

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

2.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.

3.Applicants for adjustment of status.

4.Applicants for asylum.

5.Applicants for cancellation of removal.

6.Applicants for suspension of deportation.

7.Applicants for withholding of deportation or removal.

8.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.)

9.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.)

10.Deferred enforced departure granted.

11.Family Unity granted.

12.“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.



13.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.

14.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.

15.Citizens of Micronesia. (See Citizens of the Marshall Islands, above.)

16.Order of suspension granted.

17.Citizens of Palau. (See Citizens of the Marshall Islands, above.)

18.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.

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

20."S" status granted. (See "K" status granted, above.)

21.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.

22.Stay of deportation granted.

23.Stay of removal granted.

24.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.)

25.Temporary protected status granted.

26.Voluntary departure granted - definite time.

27.Voluntary departure granted - indefinite time.

28."U" status granted. (See "K" status granted, above.)

29."V" status granted. (See "K" status granted, above.)



General Provisions

• Undocumented individuals are not entitled to full-scope benefits UNLESS they are eligible as PRUCOL AND they are claiming to have Satisfactory Immigration Status (SIS).

• If a client provides documentation of SIS, we need to proceed according to the documents provided (i.e., USCIS documents with an noncitizen #, do SAVE, institute secondary verification., etc.).

• If the client does not have any documentation that supports SIS or does not have any documents whatsoever 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 signed 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, and who complies with, PRUCOL procedures and is otherwise eligible receives full-scope benefits until:

• Unfavorable response is received from USCIS (this may never arrive)

• The client is discontinued from Medi-Cal for any reason.

DHCS has emphasized that we are not to reduce benefits from full-scope to restricted while we are waiting for a PRUCOL response from the USCIS.

6.3.1 Categories of PRUCOL

There are three categories of PRUCOL:

• Undocumented individuals in long-term care (LTC)• Undocumented individuals receiving renal dialysis• Other presumptive PRUCOL.



There are specific and different procedures for EWs to follow regarding undocumented noncitizens in LTC/Renal Dialysis compared to other presumptive PRUCOL category.

For the “Other presumptive PRUCOL” group, just claiming SIS under PRUCOL is not sufficient to receive full Medi-Cal benefits, these individuals must meet other Medi-Cal eligibility criteria (i.e., a claim of disability that must be established through a DDSD referral, has linkage or deprivation, etc.). For this category, there is no 30-day time frame as the client is not required to produce a document. That means, if the client fails to provide documents, full scope benefits continue.

6.3.2 PRUCOL for Undocumented Individuals in LTC or Receiving Renal Dialysis

Senate Bill 175 mandated the Department of Health Services (DHS) and counties to continue to provide full scope benefits to undocumented noncitizens receiving Medi-Cal who were in long term care (LTC) or who were receiving renal dialysis services on October 1, 1988.

The Ruiz v. Kizer and Crespin v. Kizer court injunctions expanded the application of PRUCOL to noncitizens in LTC and to those receiving renal dialysis who applied for Medi-Cal after October 1, 1988.

The following PRUCOL procedures shall be followed only for undocumented noncitizens who apply for or receive full or restricted benefits because they are in LTC or are receiving renal dialysis.

Do NOT request these special PRUCOL procedures for:

• Undocumented noncitizens who are not currently in LTC or receiving renal dialysis services.

• Undocumented noncitizens who check the last PRUCOL category, Section B #5 of the MC 13.

Note:This includes any patient currently on a waiting list for dialysis. They are not entitled to full-scope benefits. The client must already be in an LTC facility, not waiting to get in. The client’s situation must be considered whether the client has already met the LTC status and is already in LTC facility. LTC status is defined as inpatient medical care which lasts for more than the month of admission and is expected to last for at least one full calendar month after the month of



admission. An LTC facility is defined as a medical institution or nursing facility, including: acute care hospitals (like VMC), psychiatric hospitals, intermediate care facilities and skilled nursing facilities. Important: Transfers from one nursing home or medical institution to another do not affect long-term care status, as long as the patient does not go home or to board and care. (e.g. patient admitted to VMC 0n 2/17 and discharged to nursing home on 3/4 and is expected to remain through 3/31 or longer.) That means, PRUCOL can be granted as soon as the client has met the LTC status and is in LTC facility (like VMC hospitals) per above definitions. Again, transfers from one nursing home or medical institution to another do not affect long-term care status, as long as the patient does not go home or to board and care.

• Non-linked noncitizens eligible for State-Only LTC Aid Code 53 benefits.

• Noncitizens who claim to have citizenship or lawful resident status, but who do not have documentation. They shall be treated according to PRUCOL procedures [Refer to “Presumptive Eligibility,” page 6-5].

PRUCOL Procedures for Undocumented Individuals in LTC or Renal Dialysis

Note:The following procedures apply to undocumented individuals who check any box from 1 - 15 in Section B5 of the MC 13.

New Applicants

Step Action

1 Have the applicant read the “Applicant PRUCOL Notification Letter” SC 1627, prior to completion of the MC 13.

2 The applicant must complete the MC 13 as follows:

• Request full benefits. • Claim PRUCOL status by checking any box from 1 - 15 in Section B 5.

3 The applicant (or representative) must complete the “G-845 Supplement - PRUCOL” (MC 845).



Continuing Cases

Persons who are receiving restricted benefits and who are in LTC or are receiving renal dialysis shall be changed to full benefits:

• Effective the first of the month that SIS status based on PRUCOL is claimed. The noncitizen must:

• Complete an MC 13 requesting full benefits, and• Check the last PRUCOL box Section B, #5 on the MC 13.

• Follow procedural requirements for completion and referral of the MC 845 and G-845S to USCIS as discussed in “New Applicants Procedures.” if one of the boxes 1-15 is checked on Section B 5 of the MC 13.

4 Allow the applicant 30 days, or the period of time it takes to clear eligibility, whichever is longer, for the return of the MC 845.

• Review MC 845 to ensure the beneficiary/representative supplied requested information and documents (if any). No sections can be let blank. “Information unknown not available

• If the MC 845 is completed and returned within 30 days, and Medi-Cal is subsequently approved, establish full benefits once eligibility is cleared.

• If the MC 845 is not returned within 30 days, nor by the time eligibility is cleared after 30 days, establish restricted benefits.

• Notify the applicant that the MC 845 must be completed and returned so that full benefits can be granted.

• If the MC 845 is completed and returned after the 30 days, or after eligibility is cleared after 30 days, change to full scope benefits effective the first of the month that the MC 845 is received.

• Spltr 484 is available for used when the MC 845 must be returned to the client for more information.

5 Submit the completed MC 845 to USCIS with the Document Verification Request, (G-845).

• Check “other” in Box 8 of the G-845S and write PRUCOL REQUEST” in the open space.

• Do not check any other square within Box #8. • Send the original forms to USCIS, following the standard secondary SAVE

procedures.

6 Scan a copy of the MC 845 and G-845S in IDM. Set a case alert for a 30-day follow up.

Step Action



6.3.3 Other Presumptive PRUCOL

Individuals who claim SIS based on PRUCOL, with or without documentation, fall in the category of “other presumptive PRUCOL.” For this category, there is no 30-day time frame as the client is not required to produce a document. However, there are instances where the individual claims that he/she is able to produce or have documentation of SIS and must be given time to submit such within 30 days. If later, he/she fails to provide, then his/her claim for PRUCOL via completion of MC 13 is sufficient to grant full scope if other eligibility requirements are met.

Individuals who initially declared undocumented 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.

Stage Who Action

1 Applicant Completes the MC 13 as follows:

• Request full benefits. • Check the “Yes” in Section B #4 and checks one of the options on #5.

For those who have no documentation at all, the last category in Section B #5 would apply, thus declaring USCIS knows that they are in the U.S. and does not intend to deport them, either because of their status category or individual circumstances.

2 Applicant Submits documentation of SIS within 30 days of MC 13 completion, or when eligibility is cleared by EW, whichever is longer and as applicable.

• The documentation does not have to be USCIS documents. 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 initiating deportation proceedings.

Individuals who are unable to provide documentation, “other presumptive PRUCOL” can still be pursued as long as the last box in Section B #5 of the MC 13 is checked.

3 EW Completes a G-845S, Document Verification Request, check “Other” in Box #8 and write “PRUCOL Request” in the open space. (Do not check any other square within Box #8.) Attach a copy of the document provided. For individuals who check the last box (16th) on Section B #5, do not complete a G-845S or MC 845

4 EW Files copies of the G-845S and SIS documents (if any) in the case record.



5 EW Sends the original form and documentation to USCIS, following standard secondary SAVE procedures. For individuals who check the last box (16th) on Section B #5, do not obtain a G-845S.

6 Client Continues to receive full-scope benefits.

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

Declares SIS, completes the MC 13, Section B, # 5, and checks the last category (#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.”

Grants full scope benefits. Do NOT complete the Secondary SAVE verification or send form (G-845) to USCIS.

Stage Who Action



6.3.4 PRUCOL Redeterminations

Step Action

1 For persons who checked PRUCOL status 1 - 15 on Section B 5, At each annual redetermination, send the beneficiary (or representative):

• The “PRUCOL Notification Letter” (spltr 483)• MC 845 (for PRUCOL clients in LTC, renal dialysis or Foster Care only)

A NEW MC 845 AND G-845S MUST BE SUBMITTED TO USCIS EACH YEAR.

1. A copy of the previous MC 845 can be sent to the beneficiary and submitted for redetermination instead of completing a new form, as long as the beneficiary (or representative) indicates on the form that the information has not changed.

2. A new medical statement (attached to the MC 845 form) must be completed at each annual redetermination.

3. When the beneficiary is not capable of acting on his/her own behalf, and no guardian, relative, or friend is acting as the representative, a nursing home administrator can appoint a representative.

This process does not apply for individuals who check the last PRUCOL status (16th) on Section B 5.

2 Allow 30 days for the completion and return of the MC 845.

• If the MC 845 is not completed and returned within 30 days, reduce to restricted benefits with a proper 10-day NOA.

• If the EW has changed the case to restricted benefits and the MC 845 is received sometime later, establish full scope benefits effective the first of the month that the MC 845 is received.

• Spltr 484 is available for use when the MC 845 must be returned to the client for more information.

3 Submit the completed MC 845 with the G-845S to USCIS.

• Check “other” in Box 8 of the G-845S and write “PRUCOL REQUEST” in the open space. Do not check any other square within Box #8.

4 Scan a copy of the MC 845 and G-845S in IDM under Permanent Verifications.

• Send the original forms to USCIS, following the standard secondary SAVE procedures.

5 Continue full scope benefits while the USCIS decision is pending.

Note:



6.3.5 USCIS Responses on the G 845

A COPY OF EVERY G-845S APPROVING OR DENYING PRUCOL MUST BE FORWARDED TO THE MEDI-CAL PROGRAM COORDINATOR UPON RECEIPT.

Note:Medi-Cal Program liaisons are asked to ensure that this information is being forwarded from their district offices. DHCS must submit a report to the legislature each year.

• USCIS will list in Box 8 the USCIS case number (e.g., LOS-89-0123). The middle digits indicate the current year.

• USCIS will check Box #14 if they cannot respond with the information submitted. (USCIS will ask the Eligibility Worker to provide additional information, and to resubmit the G-845S.)

• Upon a PRUCOL determination, USCIS will check Box 17 or 18.

• The “Stamp” box at the bottom of page 1 will have the date, location and signature of the USCIS verifier.

• USCIS should respond to the PRUCOL request within 30 days. Set up a case alert for a 30-day response follow up.

• If USCIS determines that they did not receive the PRUCOL request, complete a new G-845S, attach a copy of the MC 845 and resubmit to USCIS. (Set another 30-day tickler for follow-up.)

PRUCOL Approved

When box #18 of the G845S is checked by USCIS, the statement “USCIS is not actively pursuing the expulsion of an noncitizen in this class/category at this time” means that the beneficiary is PRUCOL.

• The beneficiary is entitled to receive full scope benefits, if he/she remains otherwise eligible.

• Scan the returned G-845S into IDM (Permanent Verification) as proof of PRUCOL based on SIS.



PRUCOL Denied Aid Code 55

When box #17 of the G-845S is checked by USCIS, the statement “USCIS actively pursues the expulsion of a noncitizen in this class/category” means that the beneficiary is NOT PRUCOL.

General

When an undocumented person applies for PRUCOL status, he/she is established on full-scope benefits pending the USCIS decision.When USCIS denies PRUCOL status to the undocumented noncitizen in LTC, the level of Medi-Cal benefits must be reduced, changing the client to Aid Code 55. Aid Code 55 entitles the recipient:

• To receive all LTC services (at state-only expense), and • Restricted benefits, which are emergency and pregnancy-related services.

Undocumented noncitizens in LTC who:

• Have gone through the special PRUCOL-seeking procedures, and• Are determined NOT to have PRUCOL status are the only Medi-Cal recipients

who can be placed in Aid Code 55.

Note:These applicants/beneficiaries will remain in Aid Code 55 even if they leave LTC.

PRUCOL for Documented Applicants

When a documented individual claims the last PRUCOL category on the MC 13, the EW must contact the Medi-Cal Program Coordinator who will refer the applicant to the State for a review to ensure they receive the correct level of benefits based on their known immigration status or other relevant information i.e., survivors of domestic violence, trafficking or other serious crimes.

6.4 U.S. Citizens

U.S. citizenship is obtained or acquired in different ways.



6.4.1 U.S. Born Citizens

Individuals born in any of the 50 states in the United States are U.S. citizens.

6.4.2 Citizens — Areas Outside the United States

In addition to persons born in the United States and the District of Columbia, persons born in the following areas are also considered citizens for Medi-Cal purposes:

• Commonwealth of 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• Federated States of Micronesia (FSM). These “permanent nonimmigrants”

should have an Arrival-Departure Record, USCIS Form I-94, annotated either CFA/FSM or CFA/MIS.

• Republic of the Marshall Islands (MIS). These “permanent nonimmigrants” should have an Arrival-Departure Record, USCIS Form I-94, annotated either CFA/FSM or CFA/MIS.

Note:Persons born in the Republic of Palau (Koror and adjacent islands) are not considered citizens for Medi-Cal purposes.

6.4.3 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 if applied for.



6.4.4 Naturalized U.S. Citizens

Naturalized U.S. citizens are 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 status prior to naturalization.

6.4.5 Derived or Acquired U.S. Citizenship

Documentation

Certain persons 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.

Persons born in another country to U.S. citizen parent(s) may ACQUIRE U.S. citizenship by filing an application at USCIS.

Persons 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 persons 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 currently 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.

• 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

Persons 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 State 525 Market St. San Francisco, CA 94105

Immigration and Naturalization Service 630 Sansome St. San Francisco, CA 94111

Important:

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. Persons who lack documentation may not have applied for or may not have been granted it. Adoptive parents must also apply to USCIS for naturalization of their adopted child.

Citizenship Verification for Aged Persons

Citizenship records for very old persons may no longer be available (especially if they entered the U.S. before USCIS was established in 1924).

Such persons must be referred to USCIS for documentation.

Verification that USCIS did conduct a search of its records and there was no definite response as to whether the person is a citizen must be scanned in the case record when other documentation is not available. Scan a copy in IDM. No further action is required.

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 Verification Requirements for U.S. Citizens

6.5.1 Background

The federal Deficit Reduction Act of 2005 (DRA) signed into law in March, 2006 included new requirements for providing proof of United States (U.S.) citizenship or U.S. National status and proof of identity as a condition of eligibility for states to receive federal funding.

Note:The DRA requirements do not apply to persons receiving State-only Medi-Cal benefits.

Prior to the enactment of the DRA, verification of U.S. citizenship or U.S. national status was not required unless an applicant for full-scope Medi-Cal declared a birthplace outside of the U.S., or evidence suggested an applicant was falsely claiming to be a U.S. Citizen or National.

Assembly Bill 1807 (Chapter 74, Statutes of 2006) amended Welfare and Institutions Code Section 14011.2 to provide authority for California to implement the DRA requirements for verification of citizenship and identity for Medi-Cal.

6.5.2 Verification of U.S. Citizenship and Identity

Acceptable verification of citizenship status and identity must be obtained for all nonexempt U.S. citizens/U.S. national applicants and beneficiaries.

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

IMPORTANT: The U.S. citizenship and identity verification requirements do NOT apply to non-citizens including undocumented immigrants or persons receiving State only Medi-Cal benefits.

U.S. Nationals

U.S. nationals include individuals born in:



• American Samoa: (including Swains Island)• Certain inhabitants of the Commonwealth of the Northern Mariana Islands.

For the remainder of this chapter, further references to “citizens” will include

• U.S. nationals, and• Naturalized U.S. citizens.

6.5.3 Frequency of Verification

Verification of citizenship and identity is a one-time only activity for Medi-Cal applicants and/or current beneficiaries. 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.

6.5.4 Exempt Individuals

Applicants or beneficiaries in the following groups are exempt from citizenship and identity requirements:

• Current Supplemental Security Income (SSI) recipients NOTE: When a person loses SSI (Craig v. Bontá beneficiary) and eligibility is determined for Medi-Cal-only, verification of citizenship/identity is required.

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

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

• Current Medicare beneficiaries

• Minor Consent applicants and beneficiaries

• Medi-Cal Dialysis Only Program (Aid Code 71) applicants/beneficiaries

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

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

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



• Former Foster Care Children 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 Medi-Cal)

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

Note:Individuals are exempt from the requirement to provide proof of citizenship and identity only if they are currently in one of the exempt status categories above, except for Deemed Eligible infants and infants eligible under the Abandoned Baby Program.

Presumptive Eligibility (PE) Programs

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

• Presumptive Eligibility for Pregnant Women

• Presumptive Medi-Cal Eligibility under the Breast and Cervical Cancer Treatment Program (BCCTP)

• Child Health and Disability Prevention (CHDP) Gateway program

• Medi-Cal Accelerated Enrollment at the Single Point of Entry

• National School Lunch Program.

Note:Citizenship and identity must be verified at the time the EW makes the eligibility determination for ongoing Medi-Cal during the application process, unless the client meets one of the exemptions.

6.5.5 Scope of Coverage

New Applicants

New applicants declaring U.S. citizenship who meet all other eligibility requirements are eligible for Full Scope Medi-Cal benefits while they obtain acceptable proof of citizenship and identity.



If the client has not provided acceptable documents after the Reasonable Opportunity Period (ROP) ends, full scope benefits are reduced to restricted scope benefits with a proper ten-day Notice of Action (NOA).

Beneficiaries

Current beneficiaries remain eligible as long as they are making a good faith effort to provide documents. Benefits are reduced to restricted-scope ONLY if they stop making a good faith effort.

6.5.6 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 persons born in California. Information from MEDS, 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: The DHCS 0004 must be scanned into IDM.

6.5.7 Social Security Number Data Match

On January 4, 2010, the Department of Health Care Services (DHCS) implemented a Social Security Number (SSN) matching process to verify the citizenship and identity of Medi-Cal applicants and beneficiaries 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 beneficiary for this purpose.

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.

Using SSN Data Match Results

The SSN data match results should be used:



• After determining that the Medi-Cal applicant or beneficiary is not exempt and has not yet complied with the DRA requirements, AND

• Prior to the current DRA compliance process of requesting acceptable proof of citizenship/identity.

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

Proof Already Provided

If the applicant or beneficiary’s proof of citizenship/identity is on file (e.g., applicant provided acceptable proof at initial intake interview), this information, if not previously entered, should be entered into CalWIN so that it can be recorded onto MEDS.

This will help the client to comply with the DRA requirements in the event that the SSA Citizenship/Identity Verification request is unsuccessful.

Reminder: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.

Resolving Mismatches

Follow the procedures below if the non-exempt applicant or beneficiary’s SSN data match is unsuccessful:

• FIRST, make a reasonable effort to address the mismatch by checking for correctable errors (e.g., typographical errors, confirm SSN with client, etc.) and update CalWIN with the correct information.

• SECOND, 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.



6.5.8 Acceptable Citizenship/Identity Documents

To establish U.S. citizenship, the 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.

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

• Tier five includes identity documents.

Note:Expired documents are acceptable proof of citizenship/identity.

[Refer to “Citizenship,” page 6-6 for a complete list of U.S. Citizenship documents.]

If a client originally provided a less reliable document but later provides a document of higher reliability, the case information must be updated to reflect the higher level of verification.

6.5.9 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.

Note:EWs should encourage clients to provide original documents in person whenever possible. If the client does not wish to make an appointment, originals may be submitted by mail if the client chooses to do so.

Note:If a client is unable to provide one of the acceptable documents verifying citizenship but provides an original or certified copy of a document which the EW believes is reliable documentation of U.S. citizenship (i.e, document shows a U.S. place of birth or declaration of U.S. citizenship), the EW must forward a copy to the Medi-Cal Program Coordinator for follow-up with the state to determine if it is acceptable prior to granting full scope benefits.



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/beneficiary.

• 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 beneficiary’s claim of citizenship

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

• The applicant/beneficiary and the individuals completing the affidavit must provide proof of their own citizenship and identity. NOTE: Copies of their 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 beneficiary 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” (SC 101 CZ).

Identity Documents

To establish identity, the document must show evidence that provides identifying information that relates to the person named on the document.

The following documents are acceptable proof of identity when Level 1 documentation is not available:

• Certificate of Degree of Indian Blood, or other U.S. American Indian/Alaska Native tribal document (must have a photograph of the applicant/beneficiary, or have other personal identifying information relating to the individual).

• Driver’s license issued with a photograph of the individual or other identifying information 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, a school record may include nursery or day-care records

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

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

Children Under 18

For children under 18, the signature of the parent, guardian or caretaker relative on the application/Statement of Facts, signed under penalty of perjury is acceptable proof of identity for the child. Once the child turns 18, no further verification of identity is required. The affidavit of identity is permanently valid.

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.



6.5.10 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.

• The original signed DHCS 0005 must be scanned into IDM - Permanent Verifications for QC purposes 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” for QC purposes.

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). A DHCS 0005 signed by a CAA employed by HHS/VMC is valid and is acceptable proof that the original document was viewed.



6.5.11 Receipt of Original Documents

Extreme care must be used when handling original documents. Follow the policy below when an original document is received:

• If a client brings in an original document, a copy must be made and submitted to IDM to be scanned and the original returned to the client immediately. The “Proof of Citizenship or Identity Received” (DHCS 0005) must also be completed/signed and a copy given to the client.

• 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.

Citizenship and Identity Documents On File

Any citizenship/identity document that is already on file in the case record or in IDM that meets the requirements in Tiers 1 through 5 is considered acceptable and must not be re-verified. The DHCS 0005 does NOT need to be completed.

6.5.12 Reasonable Opportunity Period

All applicants and beneficiaries 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 and their ability to obtain the verification and the client’s good faith efforts.

This time frame is determined on a case-by-case basis, depending on how much time the client needs. Follow up will be necessary to ensure that documents are in the case file as soon as possible.

The “Proof of Citizenship or Identity Needed for Medi-Cal Applicants and Beneficiaries 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 beneficiaries 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.



Applicants

The following rules apply to applicants declaring U.S. citizenship:

• New applicants who meet all other eligibility requirements must be provided Full Scope Medi-Cal benefits while they obtain acceptable citizenship and identity documents.

• The time frame allowed to provide required documents is determined on a case-by-case basis, depending on how much time the client needs. Follow up with the client is necessary to ensure the documents are provided.

Exception:Individuals receiving Presumptive Eligibility/Accelerated Enrollment programs

• Application processing time frames may be extended when necessary to provide clients with a reasonable opportunity to provide proof of citizenship/identity if the applicant is making a “good faith effort” to obtain or provide documents.

• Applicants who meet all other eligibility criteria, but do not provide verification of citizenship and identity after the ROP ends, are reduced to restricted scope Medi-Cal benefits (emergency and pregnancy-related services, and state-only long term care benefits).

Beneficiaries

The following rules apply to beneficiaries at the annual redetermination:

• Current beneficiaries who meet all other eligibility criteria remain eligible for full-scope Medi-Cal benefits as long as they are making a good faith effort to provide verification of citizenship and identity.

• Beneficiaries must be given a reasonable opportunity to provide verification of citizenship/identity if required at redetermination if not previously provided or verified. The time allowed must be extended as long as the client is making a good faith effort to provide acceptable documents.

• Beneficiaries who fail to provide verification of citizenship/identity are reduced to restricted benefits (emergency and pregnancy-related services, and state-only long term care benefits) only at the point when he/she is no longer making a good faith effort, and the ROP ends. A ten-day Notice of Action is required to reduce benefits.



Clients with Mismatching SSN Results

Applicants and beneficiaries 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 beneficiary’s Medi-Cal must be reduced from full scope to restricted benefits within 30 days following the end of the 90-day period.

Note:If the individual’s citizenship and identity are verified via SSN data match (DOC-TYPE = 2Z) but removed by the EW after Medi-Cal has been approved, the client will continue to receive full scope benefits on MEDS. However, DRA compliance is required if the client is not exempt. The client now has a Reasonable Opportunity Period to provide the required documents. This period remains in effect as long as the person is making a good faith effort.

6.5.13 Documents Received After Restricted Benefits are Granted

For applicants or beneficiaries whose benefits are reduced from full-scope to restricted scope for failure to provide evidence of citizenship/identity, their full-scope benefits may be restored back to the month restricted 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 eligibility effective the first of the month in which the verification is provided.

6.5.14 Adding a Person to an Existing Case

When adding a person who is not currently receiving Medi-Cal to an existing case/MFBU, that person is considered a new applicant and full scope 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 Medi-Cal, he/she is considered a beneficiary and continues to receive ongoing Medi-Cal during their ROP, if all other eligibility factors are met.

6.5.15 Good Faith Effort

An applicant/beneficiary is making a good faith effort if he/she demonstrates an attempt to obtain 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.

Note:Staff must thoroughly explain “good faith effort” to ensure clients understand that they may have additional time to provide the documents.

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.

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).

• Providing a copy of a check receipt or other verification indicating that a citizenship or identity document has been ordered.

• 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 persons who could attest to the applicant’s/beneficiary’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, as well as the basis for a determination that a client is no longer making a good faith effort in Maintain Case Comments.

6.5.16 Providing Client Assistance

Staff must assist applicants/beneficiaries 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 whatever 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 to 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” (SC 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 is available on the SSA Intranet under DEBS Forms.

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

Example 1: Client born outside of California



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 Medi-Cal 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

A family applies for Medi-Cal and both parents indicate they are naturalized U.S. citizens but have lost their naturalization certificate/papers. Prior Medi-Cal case records show alien registration numbers/documents for both parents. 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

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 Medi-Cal 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 Medi-Cal.

Example 4: No Record of Birth

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

A mother applies for Medi-Cal 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:EWs can find the Vital Statistics office for each state at http://www.vitalrec.com

Example 6: Disabled Individual

A disabled adult man applies for Medi-Cal at a mental health facility. The applicant states he is a U.S. born citizen but has neither a birth certificate nor any verification of identity as 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 SC 109 to request a certified birth certificate and the DL975 for the client to obtain a California ID at reduced cost.

Example 7: Client Has No Money to Obtain Verification

A hospitalized applicant applies for Medi-Cal 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 Woman

An applicant who is two months pregnant applies for Medi-Cal. She declares U.S. citizenship, but citizenship cannot be verified immediately. The EW initiated a MEDS AP 19 birth record match which was unsuccessful. The EW inform the client about the Presumptive Eligibility (PE) program for pregnant women and how to enroll in PE at a clinic or other provider’s office and start receiving pregnancy-related care right away. The EW explains acceptable documents including affidavits. If the client is unable to provide verification, the EW must grant full scope benefits under the 200% Income Disregard program if applicable, and complete the SC 109 to request a certified birth certificate.



6.5.17 Single Point of Entry (SPE) Applications

When an application is received from 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 Medi-Cal.

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 MC 321 HFP 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.

• 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 a reasonable opportunity to provide it.

• If the child is under 18 and there was a MEDS birth record match or citizenship information is on 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 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 SC 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.

6.5.18 CalWORKs Cases

The CalWORKs citizenship and identity verification requirements fulfill the Medi-Cal requirements while clients are receiving CalWORKs. Once a client transitions to a Medi-Cal 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.

6.5.19 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.

6.5.20 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:

STEP Who ACTION

1. CST Prints the MEDS INQE screen for each person with all other necessary MEDS screens during the File Clearance process

2. Intake EW

Prior to Face-to-Face Intake interview:

• Reviews SC 41 to determine MFBU members with citizenship status• Searches IDM and prior case files for CIT/ID verification• Reviews for exemptions to CIT/ID requirements• Reviews INQE for CIT/ID 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 CIT/ID document(s).



3. Intake EW

Collects original CIT/ID Documents at Face-to-Face interview.

IF Verification is...

THEN...

Provided • Follows Report CIT/ID Data CalWIN Process to record receipt of CIT/ID documents to MEDS.

• Completes DHCS 0011 to certify receipt of acceptable documents.

NOT Provided

• Approves full scope benefits if all other eligibility factors are met

• Checks INQE after 2 business days to see if the client has a successful SSN data match result (DOC TYPE = 2Z). • If YES, no further action is required. A successful match

fulfills the citizenship and identity requirements.• If NO, continue with the steps below.

• Completes “Request for California Birth Record” (DHCS 0004) with the client to request an AP 19 Birth Record Match if the client was born in CA.

• Follows Request Birth Record Match CalWIN process to submit a request for a CA birth record match.

• If the client was not born in CA or if the birth record match is not successful, explains acceptable documents per Tiers 1-5.

• Completes “Proof of Citizenship or Identity Needed” (DHCS 0006) and gives to client with a 10-day due date.

• 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 SC 109 to request a certified copy of the client’s birth certificate and/or DL 937 to request a CA ID.

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

• Enters Special Indicator “Pending CIT/ID Verifications” in Display Individual Demographics Detail window for each person with pending verifications.

NOTE: 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 SC 109/DL 937 on file.

NOTE: The SC 109 must be scanned into IDM under Permanent Verifications.

STEP Who ACTION



Mail-In Applications

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

STEP WHO ACTION

1. Applicant Requests Medi-Cal in person or by phone

2. CST • Completes SAWS 1/SC 41 Process• Gives/mails complete Intake packet with SC 1481/DHCS 0001 to client• Informs client of Mail-In option or scheduling an appointment• Completes 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 with required verifications.



4. Intake EW • Reviews SOF to determine which MFBU members are citizens• Searches IDM/case record for CIT/ID verification• Reviews for CIT exemptions• Reviews INQE for CIT/ID coding• Processes Mail-In application.

NOTE: If there is no data on INQE and MEDS shows client was active in another county, contact the other county to request CIT/ID documents.


THEN...

Provided • Follows Report CIT/ID Data CalWIN process to record receipt of CIT/ID documents to MEDS

• Completes DHCS 0011 to certify receipt of original documents.

Not Provided • Approve full scope benefits if all other eligibility factors are met

• Check INQE after 2 business days to see if the client has a successful SSN data match result (DOC TYPE = 2Z). • If YES, no further action is required. A successful

match fulfills the citizenship and identity requirements.

• If NO, continue with the steps below.• If client was born in CA, contacts client to complete

“Request for CA Birth Record” (DHCS 0004)• Follows Request Birth Record Match CalWIN process

to initiate an automated birth record match• If client was not born in CA or data match is not

successful, explains acceptable documents Tiers 1-5• If client has one of the documents, completes “Proof of

Citizenship or Identity Needed” (DHCS 0006) and mails to client with a 10-day due date

• If verification is still not provided or client is unable to obtain documents, complete the SC 109 to request a certified copy of the client’s birth certificate and/or DL 937 for the client to obtain a CA ID REMINDER: The SC 109 and DL 937 must be scanned into IDM under Permanent Verification.

• Ensures all client contacts are documented in Maintain Case Comments

• Enters Special Indicator “Pending CIT/ID Verifications” in Display Individual Demographics Detail window if verifications are pending.

NOTE: At this point, cases with pending CIT/ID verification may be transferred to Continuing. Cases must not be transferred without either an SSN Data Match, a California Birth Record Match, acceptable CIT/ID documents or SC 109/DL 937 on file.

STEP WHO ACTION



6.5.21 Processing Annual Redeterminations

Face-to-Face Annual RD; CalWORKs/Food Stamps/Medi-Cal

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 CIT/ID exemptions• Reviews MEDS INQE for CIT/ID coding

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.

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

• Mails RD packet with DHCS 0002 included.

2. At RD Interview


THEN...

Provided • Follows Report CIT/ID Data CalWIN process to record receipt of documents to MEDS.

• Completes the DHCS 0011 to certify the receipt of acceptable documents.

NOT Provided • If client was born in CA, completes DHCS 0004 with client• Follows Request Birth Record Match CalWIN process to

initiate a data match• Explains acceptable documents in Tiers 1-5• Provides “Fact Sheet” (SCD 265) with contact numbers• Schedules return appointment to bring CIT/ID verifications• Enters Special Indicator “Pending CIT/ID Verifications” in the

Display Individual Demographics Detail window.

If the client does not keep the scheduled appointment and the data match is not successful, contact the client by phone to request documents or send the DHCS 0006 with a 10-day due date.


THEN...

Provided • Follows Report CIT/ID Data CalWIN process to record receipt of documents to MEDS.

• Completes the DHCS 0011 to certify receipt of acceptable documents.

NOT Provided • Completes SCD 109 to request a certified birth certificate and/or DL 937 for client to obtain a CA ID at reduced cost

• Follows up to ensure birth certificate and/or ID is received.

REMINDER: The SCD 109 and DL 975 must be scanned into IDM under Permanent Verification.



Mail in Redeterminations - Non-MCSC

If the client does not keep the scheduled appointment for the CalWORKs/Food Stamps face-to-face interview, the EW must mail the Medi-Cal MC 210 RV 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:

STEP WHO ACTION

1. Clerical Follows standard procedures to notify EW

2. CST • Completes the DHCS 0005 to certify receipt of original documents• Makes a copy of the documents and date stamps the copy

REMINDER: Do not date stamp the original CIT/ID documents

• Returns originals to client immediately along with the DHCS 0005• Provides the original DHCS 0005 and copies of documents to the EW.

NOTE: The document(s) and copy of DHCS 0005 must be scanned into IDM under Permanent Verifications.

3. EW • Follows the Report CIT/ID Data CalWIN process to record receipt of documents to MEDS.

• Completes the DHCS 0011 to certify receipt of acceptable documents.

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

STEP WHO ACTION

1. Clerical • Receives RD packet and/or CIT/ID documents in the mail room.• Immediately makes a copy and date stamps the copy.• Completes the DHCS 0005 to certify receipt of original documents.• Scans the DHCS 0005 and copies of documents into IDM.• Returns the original DHCS 0005 and original documents to the EW.

2. EW • Completes the DHCS 0011 to certify receipt of acceptable document(s).• Returns original(s) and DHCS 0011 to the client via Certified Mail with a

return receipt.• Follows the Report CIT/ID Data CalWIN process to record receipt of

documents to MEDS.

NOTE: 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 Medi-Cal case, follow the steps below:

STEP WHO ACTION

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

2. EW • Searches IDM and prior case files for CIT/ID verification already on file. • Reviews for CIT/ID exemptions.• Reviews INQE for CIT/ID coding.

NOTE: If verification is not found and MEDS shows client previously active in another county, contact the other county for CIT/ID documents.

• If CIT/ID verification on file, follows standard process to add a person.• Follows Report CIT/ID Data CalWIN process to record receipt of

documents to MEDS.

NOTE: For CalWORKs, determine if a face-to-face interview is required.

• Contacts client to complete DHCS 0004 if client was born in CA.• Follows Request Birth Record Match CalWIN process to initiate birth

record match.• If the data match is not successful, schedules appointment for client to

bring in CIT/ID verification.• Explains acceptable documents in Tiers 1-5.• Provides “Fact Sheet” (SC 265) with Contact #’s.• Enters Special Indicator “Pending CIT/ID verifications” in the Display

Individual Demographics window.• Completes the DHCS 0011 if client provides original documents.• Follows standard process to add a person when verifications are

received.



Annual Redeterminations - MCSC

STEP WHO ACTION

1. EW Receives RD packet assignment to process.


THEN...

Provided • Completes/updates RD if all eligibility factors are met• Follows Report CIT/ID Data CalWIN process to record receipt of

documents to MEDS.

NOT Provided

• Searches IDM and prior case files to determine of CIT/ID verification is already on file

• Reviews for CIT/ID exemptions• Reviews INQE for CIT/ID coding• Completes and updates the RD if all eligibility factors are met

NOTE: If verification is not found and MEDS shows the client was previously active in another county, contact the other county for CIT/ID documents.

• Follows Report CIT/ID Data CalWIN process to record receipt of documents to MEDS, OR

• If the client is unable to provide CIT/ID verification and client was born in CA, complete DHCS 0004 by phone or by mail.

• Follows Request Birth Record Match CalWIN process to initiate a data match.

• If no data match is returned, contacts client and explains acceptable documents in Tiers 1-5.

• If the client can provide one of the documents, schedules an appointment with Outstationed EW to bring in verifications.

• Enters Special Indicator “Pending CIT/ID Verifications” in the Display Individual Demographics Detail window.

2. EW Changes Caseload # as appropriate.



Client at Outstationed Office

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

STEP WHO ACTION

1. Client Brings in CIT/ID documents.

2. O/S EW • Completes and signs the DHCS 0005 and gives a copy to client.• Makes copies of original CIT/ID documents.• Date stamps the COPIES.• Return originals to client immediately along with the DHCS 0005.• Places in basket to be returned to MCSC for scanning.• Schedules another appointment with client if there are still missing CIT/ID

verifications.

3. Clerical Assigns RD packet and/or CIT/ID verifications to Processing EW.

4. Processing EW

• Follows Report CIT/ID Data CalWIN process to record receipt of CIT/ID documents to MEDS.

• Completes and updates the RRR in CalWIN.

5. O/S EW or Processing 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.

• Changes Caseload # as appropriate.

REMINDER: The DHCS 0011, SCD 109 and DL 975 must be scanned into IDM under Permanent Verifications.

Documents Received by Mail

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

STEP WHO ACTION

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

certified mail with a return receipt.• ID’s and assigns to processing EW.

2. Processing EW

• Reviews copies of documents.• Follows Report CIT/ID Data CalWIN process to record CIT/ID documents to

MEDS for all case members.



Adding A Person - MCSC

If the client calls and requests to add a person in the case, follow the steps below:

STEP WHO ACTION

1. Client Calls the 408-758-3600 to add a person (excluding DE newborns).

2. Outreach EW

• Searches IDM and prior case files to determine if CIT/ID verification is on file.• Reviews for CIT/ID exemptions.• Reviews INQE for CIT/ID coding.• Follows MCSC process to add a person if documents are on file.• Completes Report CIT/ID Data CalWIN process to record receipt of CIT/ID

documents.• Completes DHS 0004 if client is born in CA.• Completes Request Birth Record Match CalWIN process to request a CA

birth record match.• If missing CIT/ID documents, schedules appointment with O/S EW for client to

being in verification.• Completes SCD 109 and/or DL 937 if client is unable to provide documents.

3. O/S EW Changes Caseload # as applicable.

6.5.22 Follow Up Process for Pending Verifications

The following process applies to both Intake and Continuing when CIT/ID verifications are pending:

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 CIT/ID verifications.



6.5.23 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 beneficiary 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 Persons

Question 1: Are Former Foster Care Children exempt from the DRA requirement?

Answer 1: Yes, they are exempt while in Aid Code 4M.

Question 2: Which exempt categories are exempt indefinitely and which are not?

Answer 2: 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 Medi-Cal); and

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



Question 3: What is Retirement and Survivors Insurance that is received based on a person's own disability?

Answer 3: Recipients receiving Retirement and Survivor’s Insurance (RSI) 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 persons receiving RSI based on their own disability.

Question 4: Are recipients of Railroad Retirement benefits exempt?

Answer 4: No. However, individuals who are receiving or eligible to receive railroad retirement benefits can be eligible for Medicare. Individuals receiving Medicare are exempt.

Question 5: A person applies for Medi-Cal and claims to be a U.S. citizen but does not have a birth certificate. Three months later, he starts receiving Social Security Disability Insurance benefits. Do we approve full scope benefits from the date of application?

Answer 5: Yes. When an applicant provides proof of citizenship and identity or proof they meet one of the exemptions after their application date, grant eligibility back to the date of application (including retroactive months if otherwise eligible).

Question 6: 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 Medi-Cal back to the date of application?

Answer 6: Yes.

Question 7: When a foreign-born applicant or beneficiary 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 7: 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 8: If a Medi-Cal 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 8: Approve full scope Medi-Cal 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 9: Are children in Foster Care (aided under Aid Code 45) exempt from the DRA citizenship/identity requirements?

Answer 9: Yes.

Question 10: Are former SSI/Medicare recipients exempt?

Answer 10: 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 Medi-Cal beneficiary's DRA exemption status changes to non-exempt, they must be treated as a beneficiary for purposes of DRA citizenship/identity requirements and must continue to receive full scope Medi-Cal during the reasonable opportunity period.

Question 11: 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 11: 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 12: For a former SSI beneficiary 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 12: The beneficiary 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 beneficiary and proof of citizenship/identity must be requested immediately. The beneficiary must continue to receive full scope Medi-Cal during the reasonable opportunity period.



Presumptive Eligibility: Accelerated Enrollment

Question 1: When is proof of citizenship/identity required for children who are on Accelerated Enrollment (AE) and Child Health and Disability Prevention (CHDP)?

Answer 1: The EW must ask for proof of citizenship/identity when evaluating ongoing Medi-Cal 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 Medi-Cal eligibility. The AE/CHDP benefits continue until the end of the reasonable opportunity period or until the determination of ongoing Medi-Cal eligibility.

Question 2: Is a person who is presumptively disabled exempt from citizenship/identity requirements?

Answer 2: 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 1: Is a hospital Birth Confirmation Report acceptable as a Birth Record for DRA citizenship purposes?

Answer 1: 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 2: Is a passport card an acceptable document for citizenship/identity purposes under the DRA rules?

Answer 2: 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 3: Children approved for free school lunches can apply for Medi-Cal using the National School Lunch Program (NSLP) application. Since the application is completed under penalty of perjury, is the signature on the NSLP application the equivalent of a signature on the MC 210 or MC 321HFP for verification of identity for children under 18?

Answer 3: 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 Medi-Cal.



Question 4: 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 4: 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 5: Is an Abstract of Birth from a County acceptable proof of citizenship?

Answer 5: 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 6: 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 Medi-Cal Coordinator for a state decision. If the state confirms it is acceptable, how do we code this on MEDS?

Answer 6: Only the state can enter the Document Type code in MEDS.

Question 7: 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 7: Yes



Question 8: Is a marriage certificate that indicates a U.S. place of birth and date of birth an acceptable document for citizenship?

Answer 8: 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 9: Is the application signed by the parent, guardian or caretaker relative, a valid verification of identity for a child 16 years of age or older if the parent signed the MC210 when the child was under 16 but now the child is over 16?

Answer 9: Yes. An application signed by a parent, guardian or caretaker relative for a child under 16 is a valid verification even after the child turns 16. Providing proof of citizenship and identity is a one time occurrence.

Question 10: As verification of identity for a child under 16, is the application signed by the parent, guardian or caretaker relative only applicable if the application was signed after DRA implementation?

Answer 10: No. The application is valid proof of identity for children under 16 even if it was signed before the implementation of DRA.

Question 11: 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 11: Yes.

Question 12: Is the MC 13 required?

Answer 12: A declaration of citizenship/immigration status is required for citizens and immigrants applying for Medi-Cal. The declaration is the basis for requesting evidence under the DRA requirements. An MC 13 is not required when the there is declaration of citizenship on another form signed under penalty of perjury. In all other instances, an MC 13 is required as part of the Medi-Cal application.

Reasonable Opportunity Period (ROP)

Question 1: Are persons receiving Medi-Cal under Craig v. Bonta treated as applicants or beneficiaries for purposes of citizenship identity requirements?

Answer 1: Persons receiving Medi-Cal under Craig v. Bontá are considered beneficiaries for purposes of meeting the DRA requirements. Their Medi-Cal benefits must continue during the reasonable opportunity period.



Pregnant Women

Question 1: Do we automatically grant a pregnant woman restricted benefits if she cannot obtain the required citizenship or identity documentation?

Answer 1: EWs must inform pregnant women about the presumptive eligibility program to expedite coverage of pregnancy care if they do not have an easily accessible citizenship or identity document. If a pregnant woman chooses to end the reasonable opportunity period anytime, she can receive restricted scope Medi-Cal if she is otherwise eligible. This will ensure that they receive pregnancy-related care as soon as possible.

Use of Affidavits

Question 1: Can a relative other than a parent who is not a Medi-Cal recipient verify identity for a child under 16?

Answer 1: 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 2: Is the affidavit of identity valid indefinitely?

Answer 2: Yes, the affidavit of identity is valid indefinitely. That is even if the child becomes an adult applying for himself.

Question 3: 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 3: 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 1: 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 Medi-Cal in the CalWORKs case?

Answer 1: No. Persons, including children, who are determined eligible for federal CalWORKS benefits are automatically eligible for no-cost Medi-Cal effective the date of their Cal-WORKS eligibility. Citizenship/identity requirements do not affect Medi-Cal eligibility that is established based on ongoing CalWORKs eligibility.

Question 2: Do individuals who were CalWORKS eligible in the past need to provide verification to establish Medi-Cal eligibility?

Answer 2: Individuals who have met the citizenship and identity requirements for ongoing CalWORKS eligibility do not have to provide that information again to establish Medi-Cal eligibility in the future. However, EWs must update MEDS to indicate how the Medi-Cal citizenship and identity requirements were met if that information is not already in MEDS.

Question 3: Would a CalWORKS beneficiary 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 3: They are treated as beneficiaries 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 beneficiaries. If they stop making a good faith effort to obtain documents, they are not eligible for full scope Medi-Cal and must be reduced to restricted scope benefits if the reasonable opportunity period ends.

Question 4: 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 Medi-Cal is established?

Answer 4: No. MEDS will be populated by the state for those who are CalWORKs eligible that they have met the citizenship/identity requirements.

Question 5: Are beneficiaries being discontinued from CalWORKS required to verify citizenship at the next Medi-Cal redetermination?

Answer 5: No. The only exception would be if a CalWORKS beneficiary claiming to be a U.S. citizen loses CalWORKS because they did not verify their citizenship.



6.6 Residency/Medi-Cal Entitlement Chart

[Refer to Common-Place Handbook, “Immigration,” page 10-1; “Noncitizen Categories,” page 11-1; “USCIS Codes,” page 12-1; and “Immigration Forms,” page 13-1, for complete noncitizen information.]

Status Required VerificationMedi-Cal Eligibility

1. U.S. Citizen Client's statement, birth certificate, or naturalization papers.

Full-scope; not eligible for restricted benefits

2. Noncitizen admitted for lawful permanent residence who is not an IRCA (amnesty) alien

USCIS Form I-551, earlier Forms I-151, AR-3, and AR-3a (Alien Registration Receipt Card).

NOTE: IRCA aliens with an I-551 have one of the following class codes: R16, R26, S16, S26, W16, W26, W36. Refer to next page.

Full-scope

3. Noncitizens with a foreign passport stamped: PROCESSED FORM I-551 TEMPORARY EVIDENCE OF LAWFUL ADMISSION FOR PERMANENT RESIDENCE VALID UNTIL _______ EMPLOYMENT AUTHORIZED

Valid until I-551 received. Set control for receipt of I-551. If more than one year since date of entry or date is expired or date is blank:

Ask for I-551 or do SAVE secondary verification procedure.

Full-scope

4. Noncitizen has applied for adjustment to permanent status

I-181A, Notice to noncitizen from USCIS. Application for LPR status has been accepted as “properly - filed.”

Restricted (Emergency Care and Pregnancy Related Services)

5. Noncitizen's request for adjustment to permanent status has been approved

I-181B, Notice to Alien from USCIS. Granted LPR status and will be issued an USCIS Form I-551.

Full-scope



6.7 Expiration of Documents

Expired USCIS documents of any kind are acceptable verification of noncitizen status.

6. Refugee/Entrant/ Parolee lawfully admitted with I-94 or I-945(Must not have letter A-L)

I-94 annotated with conditional entry; political asylum, refugee, parolee. [Refer to “Medi-Cal Refugee Programs,” page 34-1.]

Full-scope

7. Asylum Applicant I-94 annotated as asylum applicant/I-589 applicant. Application for asylum still pending.

Restricted benefits

8. Alien with I-94 (noted with any letter A-L)

Lawfully admitted to U.S.A. for temporary residence in accordance with Sections 101(a) [150 (A) through (L) of the INA].

Restricted benefits (Emergency Care and Pregnancy Related Services)

Undocumented alien, except pregnant women. (Must meet CA residency, linkage and other eligibility requirements)

None (or expired documentation) Restricted benefits for (Emergency Care and Pregnancy Related Services)

Undocumented pregnant women. (Must meet CA residency, linkage and other eligibility requirements)

None (or expired documentation) Restricted benefits (Emergency Care and Pregnancy Related Services)

Noncitizen with I-688A I-688A; noncitizen has filed for temporary resident status under IRCA

Restricted benefits

Visitors, students, etc. (Must meet CA residency, linkage and other eligibility requirements)

Temporary unexpired visa, foreign passport

Restricted benefits

Status Required VerificationMedi-Cal Eligibility



6.8 Inconsistent Birthdates

Inconsistent birthdates can result from the Immigration Naturalization Service (USCIS) changing a birthdate at the noncitizen's request without first validating their documentation. Social Security Administration (SSA) will not change a noncitizen's birthdate on their records without valid documentation to support the claim.

6.8.1 Procedure

Use this chart when there are birthdate discrepancies:

If... Then...

AGE is not an eligibility factor and the noncitizen presents both USCIS and SSA documents which show two different birthdates.

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

Age is the noncitizens's only linkage with Medi-Cal.

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

6.8.2 Primary SAVE

Inconsistent birthdates have no effect on the primary SAVE verification process. The birthdate is not a necessary data element in primary verifications as only the alien registration number is required.

6.8.3 Secondary SAVE

Inconsistent birthdates can lengthen the secondary SAVE verification process:

• If the G-845S form does not have the primary verification Batch Control Number written on the form, or

• If the photo copy of the USCIS documentation (with photographs and birthdate) is not attached to the backside of the G-845S form.



To assist USCIS with the timely processing of the secondary verification paperwork, the EW must indicate on the G-845 form that, “A birthdate discrepancy must be clarified because the noncitizen has one birthdate recorded with SSA and another birthdate recorded through USCIS.”


