The CAO must determine the citizenship or non-citizen status of each individual included in the applicant/recipient group. The following individuals can get full federally-funded Medical Assistance (MA) benefits if they meet all other eligibility conditions:
U.S. citizens or nationals
Qualified non-citizens (See Section 322.3 Non-citizen Status and Supplemental Handbook Chapter 730, Refugees)
Lawfully present children under age 21 and pregnant women.
NOTE: Qualified non-citizens subject to the five year bar and lawfully present non-pregnant adults age 21 and over may receive State-funded MA (General Assistance (GA)-related MA if they meet all conditions of eligibility for GA-related MA. For GA-related categorical requirements see Chapter 305 Category.
A non-citizen who does not meet the conditions for receiving full federally funded MA benefits based on their immigration status may receive limited federally funded MA benefits to cover an emergency medical condition if they are otherwise eligible for Medical Assistance. (See Section 322.33, Non-Citizens Who Can Get Emergency MA Benefits.)
8 USC § 1611 (a)(b)(1) (A) 55 Pa. Code § 150.11 (b)
NOTE: For any non-citizen mother who received full MA or emergency MA and gives birth with labor and delivery covered by MA, her newborn is eligible for MA for one year from date of birth, under the same conditions as if the child was born to a US citizen. (See Chapter 338, Section 338.41, Medical Assistance for Newborns.)
If an individual applicant attests to satisfactory immigration status, the applicant's current immigration status must be verified with the US Citizenship and Immigration Services (USCIS). The status of a non-citizen is established when the individual provides their immigration document type and immigration document number and the status can be verified electronically or the individual provides a current non-citizen registration card or other documentation from the USCIS showing the individual has satisfactory immigration status. The immigration status of each applying non-citizen is determined separately.
NOTE: Certain minor non-citizen children are not granted lawful non-citizen status unless the parent has applied for legal status on their behalf.
Exception: Proof of immigration status is not required if the non-citizen 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 a non-citizen 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 non-citizen 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 non-citizen or lawfully present individual 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 attest on the application for benefits for all applying household members if they are a US citizen, national, or have eligible non-citizen immigration status by checking the box provided. By checking this box, providing immigration status and signing the application, the applicant is certifying that the information is correct for each applying member of the household. If an applicant does not complete this portion of the application and sign, verifying that all of the information is true, then the applicant and the applying members of the household are not eligible for full MA.
Exception: An non-citizen who is applying for MA to cover emergency medical services does not have to provide immigration status information or attest to eligible immigration status.
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 evidence of citizenship or nationality when first applying for MA if U.S. citizenship verification was not returned from the Federal Data Service Hub (FDSH, also called "The Hub").
NOTE: This also applies to the following programs:
Medical Assistance for Workers with Disabilities (MAWD)
Breast and Cervical Cancer Prevention and Treatment (BCCPT)
Family Planning Services
NOTE: BCCPT contractors are not required to provide proof of citizenship and identity when making referrals to DHS. If citizenship and identity are not verified with the referral, the CAO must verify these when determining eligibility for MA.
An individual does not have to prove his or her citizenship or nationality more than once unless they report a change in circumstance.
Any individual who is applying for MA and declares to be a non-citizen with legal immigration status must provide proof if status is not able to be verified through the Verified Lawful Presence (VLP) services with the Hub.
NOTE: If citizenship is unable to be verified through the SSA Composite service with the Hub and the individual has lost or is having trouble providing verification of citizenship, they may complete a Citizenship and Identity Form (PA 1809). If an individual was born outside of Pennsylvania, the CAO may issue a one-time issuance (OTI) in order to obtain an out of state birth certificate. The CAO will follow the current rules for this OTI (See MAEH Chapter 378 Verification, Appendix E).
Only those documents listed in Section 322.2 Citizenship meet the MA requirements for proof of citizenship.
The DRA citizenship requirements do not apply to the following applicants or recipients:
Individuals who are getting Supplemental Security Income (SSI) benefits.
Individuals entitled to or enrolled in Medicare Part A or Medicare Part B.
Individuals who are getting Retirement, Survivors and Disability Insurance (RSDI) 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).
Children who are eligible for MA because their mother received MA or CHIP at the time of the child's birth.
Individuals who are presumptively eligible for MA. (NOTE: In order to authorize ongoing MA, citizenship or satisfactory immigration status must be verified based on the requirements outlined Section 322.2 Citizenship and Section 322.35, Proof of Non-Citizen Status).
NOTE: An individual who has stopped receiving RSDI 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 RSDI, SSI or Medicare Part A or Part B because he or she showed false proof of citizenship to the SSA. Only current recipients of RSDI, SSI or Medicare Part A or Part B are exempt from having to prove citizenship.
The CAO must:
Require verification 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 RSDI, SSI or Medicare Part A or Part B.
Require verification of citizenship for any individual who loses eligibility for RSDI, 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 intellectual disability diagnosis may refuse to cooperate. These cases must be handled on a case by case basis. The CAO may need to consult with mental health/ intellectual disability (MH/ID) 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 have MA benefits closed after the individual is provided a reasonable opportunity period of 90 days, if the individual was otherwise eligible. A notice and information about appeal rights must be sent to the individual if the CAO denies or closes MA benefits.
55 Pa. Code § 201.1(1) 42 CFR § 435.407(k)
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.
Example: The CAO 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 CAO 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 must not delay authorizing MA and is to request citizenship verification from the individual in writing, regardless of whether or not citizenship verification was previously requested and allow a reasonable opportunity period of 90 days for the individual to provide citizenship verification. The CAO must allow five days for mailing the request and set an alert for 95 days from the day the request is mailed. If the individual fails to provide citizenship verification by the end of the 90-day period, the CAO must close MA with a 15-day advance notice within 30 days from the date the 90-day reasonable opportunity period ends, if the individual has not made good faith effort to provide necessary verification. If the individual is making a good faith effort to provide the necessary documentation, and there is a reasonable expectation that verification will be provided, the worker may extend the reasonable opportunity period beyond 90 days. (See Chapter 304, Application and Chapter 376, Renewal and Chapter 322.2 Citizenship).
NOTE: MA must be denied or stopped only for the individual who fails to cooperate after the 90 day reasonable opportunity period.
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 during the reasonable opportunity period. Benefits are closed for both parent and child and MA cannot be reopened until their citizenship is verified.
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 during the reasonable opportunity period. Benefits are closed for the child and MA cannot be reopened until their citizenship is verified.
The reasonable opportunity period has ended and a mother is unable to provide citizenship papers for herself but does for her children. The children remain eligible for MA but the mother’s MA is closed and the mother’s MA cannot be reopened until her citizenship is verified.
Updated July 5, 2016 Replacing February 14, 2012