Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.17-020 - Medicaid and CHIP Coverage for Lawfully Residing Alien Children Under Age 19 and Pregnant Women

Current through Register Vol. 49, No. 6, June, 2024
Medical Services - Appendix C, Verification of Citizenshipi
				Alien Status and SSN Enumeration
I.
Citizenship Verification - Acceptable Documents for Proof of
			 Citizenship
When citizenship cannot be verified through the Federal Data
				Services Hub (FDSH) or the SSA match, the worlcer must access Vital Records
				through ARFinds for verification of birth. If citizenship documentation cannot
				be obtained through Vital Records, specific forms of documentation may be
				acceptable evidence of citizenship. If an individual presents evidence from the
				listing o
f Primary Documentation,
no other information
				is required.
To establish U.S. citizenship, the document must show a U.S.
				place of birth and that the person is a U.S. citizen. The documents must be
				original or certified copies. Copies of documents already obtained wilt be
				accepted as assumed made from the original unless questionable (e.g. stamped
				"copy", or unreadable).
In general, the caseworker should obtain primary evidence of
				citizenship before using the secondary documentation or tertiary list. The
				following forms of documentation may be accepted:
Primary documentation-
The highest reliability that conclusively establishes identification and
				citizenship.
* A U.S. Passport.
* A Certificate of Naturalization (United States Department of
				Homeland Security (USDHS) Forms N-550 or N-570).
* A Certificate of U.S. Citizenship (USDHS Forms N-560 or
				N-561).
Secondary documentation-
Secondary evidence of citizenship is documentary evidence of satisfactory
				reliability that is used when primary evidence of citizenship is not
				available.
* A U.S. birth certificate.
* A Certification of birth issued by the Department of State
				(Form DS-1350).
* A Report of Birth Abroad of a U.S. Citizen (Form
				FS-240).
* A Certification of Birth Abroad (FS-545).
* An American Indian Card issued by the Department of Homeland
				Security with the classification code "KIC". (Issued by DHS to identify U.S.
				citizen members of the Texas Band of Kickapoos living near the U.S./Mexican
				border).
* Final adoption decree.
* Evidence of civil service employment by the U.S. government
				before June 1976.
Medical Services - Appendix C, Verification of
				Citizenship, Alien Status and SSN Enumeration
* An official military record of service showing a U.S. place
				of birth.
* A Northern Mariana Identification Card (issued by the USDHS
				to a collectively naturalized citizen of the United States who was born in the
				Northern Mariana Islands before November 4,1986).
Third level
				documentation-
Third level evidence of U.S. citizenship is
				documentary evidence of satisfactory reliability that is used when neither
				primary nor secondary evidence of citizenship is available. This documentation
				includes:
* Extract of U.S. hospital record of birth established at the
				time of the person's birth, created at least 5 years before the initial
				application date and indicating a U.S. place of birth.
* Life or health or other insurance record created at least 5
				years before the initial application date showing a U.S. place of birth.
* Religious records recorded in the U.S. within 3 months after
				the birth which show that the birth occurred in the U.S. showing the date of
				the birth of the individual or the individual's age at the time the record was
				made. These must be official records recorded with the religious organization
				(e.g., baptismal certificates). Entries in a family bible are not considered
				recorded religious records.
* Early school records which show the name of the child, the
				date of admission to the school, the date of birth {or age at the time the
				record was made), a U. S. place of birth, and the name(s) and place(5) of birth
				of the applicant's parents.
Fourth level documentation
-
Fourth level evidence of U.S.
				citizenship is documentary evidence of the lowest reliability. This level
				should
only
be used in the rarest of circumstances. This level of
				evidence is used only when primary evidence is not available, both secondary
				and third level evidence do not exist or cannot be obtained within the
				reasonable opportunity period, and the applicant alleges a U.S. place of birth.
				This documentation includes:
* Federal or State census record showing U.S. citizenship or a
				U.S. place of birth, as well as the applicant's age.
* Birth records that were recorded with vital statistics 5
				years after a birth (a delayed birth record).
* Institutional admission papers from a nursing home, skilled
				nursing care facility or other institution created at least 5 years before the
				initial application date and which indicate a U.S. place of birth.
Medical Services - Appendix C, Verification of
				Citizenship, Alien Status and SSN Enumeration
* Medical (clinic, doctor, or hospital) record which was
				created at least 5 years before the initial application date and indicates a
				U.S. place of birth unless the application is for a child under 5.
* Other document that was created at least five years before
				application for Medicaid. These documents are Seneca Indian tribal census
				record, Bureau of Indian Affairs tribal census records of the Navaho Indians,
				U.S. State Vital Statistics official notification of birth registration, an
				amended U.S. public birth record that is amended more than 5 years after the
				person's birth or a statement signed by the physician or midwife who was in
				attendance at the time of birth.
* The Roll of Alaska Natives maintained by the Bureau of Indian
				Affairs.
* Written affidavit. This should be in rare circumstances when
				the applicant or recipient cannot provide evidence from another listing.
Written affidavits
may be used in circumstances
				when the state is unable to secure evidence of citizenship from another
				listing. The affidavits must be supplied by at least two individuals, one of
				whom is not related to the recipient. Each must attest to having a personal
				knowledge of the event(s) establishing the recipient's claim of citizenship.
				Those making affidavits will be subject to prosecution for perjury. If the
				persons claiming knowledge of another's citizenship has information, which
				explains why documentary evidence establishing the claim of citizenship does
				not exist or cannot be readily obtained, the affidavit should contain this
				information as well.
A second affidavit from the recipient or other knowledgeable
				individual explaining why documentary evidence does not exist or cannot be
				readily obtained must also be requested.
II. Identity
If citizenship is verified with a document on the secondary or
				lower level listed above, providing proof of identity will be required.
				Acceptable forms of identity are:
1.
			 Driver's license issued by the State or Territory either with a photograph of
			 the individual or other identifying information of the individual such as name,
			 age, sex, race, height, weight or eye color.
2. Identification card issued by the Federal,
			 State or local government with the same information included on driver's
			 licenses {e.g., ID card issued by DF&A) .
3. School identification card with a
			 photograph of the individual.
Medical Services - Appendix C, Verification of
				Citizenship, Alien Status and SSN Enumeration
4. U.S. military card or draft
			 card.
5. ly/lilitary dependent's
			 identification card.
6. Certificate
			 of Degree of Indian Blood or other U.S. American Indian/Alaska Native tribal
			 document. This document must carry a photograph of the applicant or
			 recipient.
7. Native American
			 Tribal document.
8. U.S. Coast
			 Guard Merchant Mariner card.
9.
			 Sentencing order from a correctional facility.
uoii:
If the
				expiration date has expired, the ID is still acceptable.