The CAO must determine the citizenship or alien status of each individual included in the applicant/recipient group. The following individuals can get full Medical Assistance (MA) benefits if they meet all other eligibility conditions:
55 Pa. Code § 150.1 42 CFR § 435.406
U.S. citizens
Refugees (see Supplemental Handbook Chapter 730, Refugees)
Certain lawfully admitted qualified aliens (see Section 322.3, Alien Status) OPS120502
An alien who does not meet the conditions for receiving full MA benefits may receive limited MA benefits to cover an emergency medical condition. (See Section 322.33, Aliens Who Can Get Emergency MA Benefits.) 8 USC § 1611 (a)(b)(1) (A) 55 Pa. Code § 150.11 (b)
NOTE: When an undocumented or temporary alien mother or a lawfully admitted alien mother gives birth with labor and delivery covered by MA, her newborn can get MA for one year from the date of birth, under the same conditions as if the child was born to a U.S. citizen. (See Chapter 338, Section 338.41, Medical Assistance for Newborns.)
If the CAO determines that an individual may be an alien, the CAO must check his or her current immigration status with the U.S. Citizenship and Immigration Service (USCIS). The immigration status of each alien is determined separately.
NOTE: A minor noncitizen child is not granted lawful alien status unless the parent has applied for legal status for the child.
Exception: Proof of immigration status is not required if the alien is applying for MA for an emergency medical condition.
55 Pa. Code § 150.1(e) 55 Pa. Code § 150.11 (c)
The income and resources of an alien who is a legally responsible relative (LRR) and who is not applying for or receiving MA must either be counted or deemed, depending on the program that other household members are applying for. The CAO must follow the same rules for a non applying alien as for any other non applying legally responsible relative. 55 Pa. Code § 178.1 55 Pa. Code § 181.1
The CAO determines the eligibility of a qualified alien by applying the same MA rules as it would for any other MA applicant.
A member of the applicant/recipient group who is age 18 or older must sign the U.S. Citizen or Alien Status declaration statement on an application for benefits for all applying household members. The signature certifies that the household members are U.S. citizens or aliens with lawful immigration status. If an applicant does not sign the citizen/alien statement, then the applicant and the applying members of the household are not eligible for MA. 55 Pa. Code § 150.1(a)
Exception: An alien who is applying for MA to cover emergency medical services does not have to sign the declaration. 55 Pa. Code § 150.11(c)
Based on the Deficit Reduction Act (DRA) of 2005, effective July 1, 2006, each individual who claims to be a U.S. citizen or national must provide satisfactory documentation of citizenship or nationality when first applying for MA or at renewal if proof was not provided before.
55 Pa. Code § 150.1 Pub Law No. 109-171 Sec 6036
NOTE: This also applies to the following programs:
Medical Assistance for Workers with Disabilities (MAWD)
Breast and Cervical Cancer Prevention and Treatment (BCCPT)
NOTE: These requirements apply when reviewing continued MA eligibility for all TANF cash closings, including Extended Medical Coverage (EMC) and changes to eligibility status (for example, sanctioned individuals). Before closing TANF cash benefits or completing eligibility status changes, the CAO must review the case record for proof of citizenship and identity. If no proof is in the case record, the CAO must change the verification code for citizenship on the CIS CAINDL screen to “S” (statement).
NOTE: CHIP and BCCPT contractors do not need to provide proof of citizenship and identity when making referrals to DHS. The CAO must refer applications to CHIP when the household is not eligible for MA on the basis of income, whether or not citizenship or identity has been verified. If the household income is equal to or less than the MA income limit and the household has not met the requirements for proving citizenship or identity, the CAO must not refer the household to CHIP.
An individual does not have to prove his or her citizenship or nationality more than once unless:
There has been a six-year gap between the date when his or her MA benefits were stopped and the new requested date of MA coverage.
The CAO worker thinks the first documents provided were not valid.
Any individual who declares to be an alien with legal immigration status must provide proof.
To prove U.S. citizenship, a document must show that:
The individual was born in the U.S.
The individual is a U.S. citizen.
NOTE: If the individual has lost or is having trouble providing verification of citizenship, they may complete a Citizenship and Identity Form (PA 1809)
Only those documents listed in Section 322.2 meet the MA requirements for proof of citizenship.
The DRA citizenship requirements do not apply to the following applicants or recipients:
Individuals who are applying for or receiving GA-related categories of MA.
Pregnant women who are presumptively eligible (PS17) for MA.
Individuals who are getting Supplemental Security Income (SSI) benefits.
Individuals entitled to or enrolled in Medicare Part A or Part B.
Individuals who are getting Social Security Administration (SSA) benefits.
Individuals who are getting Title IVB or Title IVE foster care or adoption assistance (PC/PCN 31, 32, 33, 34, 35, 36 or 37).
Individuals who are applying for or receiving TANF cash benefits.
NOTE: An individual who has stopped receiving Social Security Administration (SSA) or SSI benefits or who no longer has Medicare Part A or Part B is not exempt from providing citizenship documentation. It is possible for an individual to lose SSA, SSI or Medicare Part A or Part B because he or she showed false proof of citizenship to the SSA. Only current recipients of SSA, SSI or Medicare Part A or Part B are exempt from having to prove citizenship. The CAO must:
Require proof of citizenship at the next client contact or at the next renewal for any current MA recipient who has not had to provide proof because he or she used to get SSA, SSI or Medicare Part A or Part B.
Require proof of citizenship for any individual who loses eligibility for SSA, SSI or Medicare Part A or Part B.
NOTE: Because TANF cash recipients receive TANF-related MA benefits, the same citizenship requirements used for MA apply to TANF applicants and recipients, as much as is possible under current law. Therefore, CAOs must ask TANF applicants to provide proof of citizenship for themselves and other people for whom they are applying. At renewal, TANF recipients must be asked to provide proof of citizenship for themselves and other budget group members if they have not already done so. However, a TANF applicant or recipient may not be denied cash assistance or closed for failure to provide proof of citizenship that does not meet MA requirements.
NOTE: Newborns that are eligible for MA or CHIP because their mother was getting MA or CHIP at the time of birth are considered to have satisfactory documentation of citizenship and identity by the sole fact of being born in the U.S. Citizenship and Identity documentation for the newborn is not required at birth or at any renewal or future application for MA or CHIP.
Noncooperation means the refusal or failure of an applicant or recipient or that individual’s representative to work with CAO staff in trying to obtain required documentation or in explaining why it is not possible to provide proof of citizenship.
There are two kinds of noncooperation:
An applicant or recipient refuses to provide citizenship documents.
An applicant or recipient fails to cooperate by not returning requested items needed to obtain citizenship documentation (for example, an out-of-state birth certificate).
Exception: An applicant or recipient with a mental health or mental retardation diagnosis may refuse to cooperate. These cases must be handled on a case by case basis. The income maintenance caseworker (IMCW) may need to consult with mental health/mental retardation (MH/MR) caseworkers for help in obtaining needed documents.
An individual who refuses to cooperate with providing proof of citizenship or who fails to provide requested items needed to obtain proof of citizenship may be denied or have MA benefits closed. A notice and information about appeal rights must be sent to the individual if the CAO denies or closes MA benefits.
NOTE: An incomplete PA 1809 does not mean an individual has not cooperated. If information is missing from the PA 1809, the CAO must contact the individual to get the missing information. If the individual is unable to provide it, then he or she has cooperated as much as he or she could.
When an individual refuses to cooperate or does not provide requested items needed to obtain proof of citizenship for TANF-related or SSI-related MA, the individual is also ineligible for GA-related MA.
Example: The IMCW gives the MA applicant or recipient an application for an out-of-state birth certificate and a list of other pending items (for example, proof of income and resources) needed to process the application. The IMCW gives the individual a due date for the items. The due date has passed, and all items have been received except the application for the out-of-state birth certificate. The CAO has tried to contact the individual, but phone calls were not returned, and the individual has not responded to a CIS contact letter with a due date. If the individual does not return the out of state birth certificate application after reasonable efforts were made to contact the individual, then the individual is being non-cooperative. An ineligible or adverse action notice is sent at the end of the 30-day application or renewal period to deny or close MA benefits for failure to provide certain information. (See Chapter 304, Application and Chapter 376, Renewal.)
NOTE: MA must be denied or stopped only for the individual who fails to cooperate.
Examples:
There is a parent and one minor child. All other eligibility requirements are met, but the parent does not provide citizenship documents for herself and her child. Both are denied for benefits.
There is a parent and one minor child and all other eligibility factors are met. The parent has provided citizenship documents for himself but not for the child. The child is denied for benefits.
A mother is unable to provide citizenship papers for herself but does for her children. The children are found eligible for MA with the parents' income being deemed.
Updated February 14, 2012, Replacing October 26, 2008