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Issue Alert - 07-04-01

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Date:

Apr 10, 2007

Program Area:

Medicaid

Issue Summary:

Many Medicaid applicants and recipients will have to produce specific documents to verify their identity and their U.S. citizenship beginning April 2007

Persons Affected:

Medicaid applicants and recipients who claim U.S. citizenship and are not in foster care, not receiving SSI or Medicare, and not a newborn entitled to Medicaid because his/her mother received Medicaid at the time of birth

For More Information:

Center for Civil Justice 320 S. Washington, 2nd Floor Saginaw, MI 48607 (989) 755-3120, (800)724-7441 Fax: (989) 755-3558 E-mail: info@ccj-mi.org

Michigan Poverty Law Program 611 Church Street, Suite 4A Ann Arbor, MI 48104-3000 (734) 998-6100 (734) 998-9125 Fax


Background

The Deficit Reduction Act of 2005  and interim regulations issued by the Centers for Medicare and Medicaid Services (“CMS”), 42 C.F.R. 435.406 -.407, impose new requirements for verification of U.S. citizenship and identity for all Medicaid applicants and recipients who are claiming that they are citizens.  Michigan is implementing those requirements beginning April 1, 2007.

The Department of Human Services (“DHS”) Program Policy Bulletin announced the new policy in PPB 2007-004, which is available online.  New policies are contained in PAM 130, PEM 221, and PEM 225, and there is a new Verification Checklist Form DHS 3503C.  DHS bulletins and policy manuals are available online at http://www.mfia.state.mi.us/olmweb/ex/html/ or by using the quick link at the Michigan Poverty Law Program (MPLP) website, http://mplp.org/.  For the bulletin, click on “Bulletin Log” under the Financial Assistance heading.  For the policies, click on “Program Administration” for PAM items and “Program Eligibility” for PEM items, under the Financial Assistance  heading. For the form, click on “Reference Forms and Publications” under the Reference heading.

DHS also has  issued a Powerpoint training for its staff, which is available online at the Michigan Poverty Law Program (MPLP) website, http://www.mplp.org/.

What's Happening?

Who is affected by the new verification requirements?

According to training materials issued by the Department of Human Services, the new verification requirements will be applied to Medicaid applications RECEIVED by the Department of Human Services on or after April 1, 2007, and to Medicaid cases in which a redetermination of Medicaid eligibility is DUE on or after April 1,2007.   Applications received prior to April 1, 2007 or in which a redetermination of eligibility was due prior to April 2007 will not be subject to the verification requirements, even if they are processed in or after April 2007.   See Powerpoint training slide 30, “Transition Period.”

The verification requirements apply only to individuals who mark “Y” or  answer “yes” to the Medicaid application form question asking whether the individual is a U.S. citizen and who are not excluded (see below).      Individuals who do not claim U.S. citizenship (obviously) do not need to verify citizenship and must verify identity only if it is questionable.  PEM 221 p. 1, PEW 225 p. 15.   DHS caseworkers must contact individuals who leave blank  the citizenship question on the application to determine whether or not these individuals  are claiming citizenship.  See Powerpoint training slide 6. 

 

Reminder:  undocumented non-citizens and non-citizens who do not meet the immigration-related criteria for full Medicaid coverage can qualify for Medicaid for Emergency Services Only (ESO Medicaid) without providing verification of their immigration status, if they meet the other Medicaid eligibility criteria.  Non-citizens seeking full Medicaid coverage must provide verification of an immigration status that makes them eligible for full coverage.  PEM 225.  However, individuals claiming U.S. citizenship cannot qualify for any type of Medicaid coverage, including ESO Medicaid, if they fail to provide verification of citizenship.

Verification of citizenship and identity are two separate verification requirements.  The first is documentation that the applicant is in fact a U.S. Citizen.  The second is documentation that the applicant is who he or she says he is.  While the two verification requirements may be satisfied by one piece of documentation, such as a passport, often individuals will need to submit two separate documents.  For example, a person might submit a birth certificate (which is acceptable to verify citizenship but not identity) and a state ID (which acceptable verification of identity but not citizenship).  See below for acceptable forms of verification for each item.

 

Note:  These verification requirements do not apply to the Adult Medical Program and County Health Plans.

 

Persons claiming U.S. Citizenship who do NOT have to verify citizenship and identity

No verification of citizenship and identity is needed for:

 

o      Medicare recipients

o      SSI (Supplemental Security Income) recipients

o      Children in foster care

o      Safe Delivery/Safe Haven babies

o      Newborns who automatically receive 12 months of Medicaid under PEM 145 because their mother was receiving Medicaid at the time of birth

PEM 225 p. 2.

 

Note:  Under technical corrections passed by Congress in December 2006, no verification of citizenship and identity is needed for:

 

o      Social Security recipients whose eligibility is based on disability

o      Adoption assistance or adoption subsidy (Title IV-E) recipients

DHS should not require verification from individuals in these categories.  However, it appears that DHS policy will not reflect the exemption from verification for these additional groups of recipients until July 2007.  

 

Clients who receive Adoption Subsidies under Title IV-E or receive Social Security based on disability should seek legal advice if they are asked to provide verification of citizenship or identity.  (See “Finding Help” at the bottom of this alert.)

 

Persons claiming U.S. Citizenship who do NOT have to verify identity

No verification of identity is needed for children under age 16.  PEM 221 p. 1.

 

How often must verification be submitted?

Documents used to verify citizenship are considered permanent and must only be submitted once.  PEM 130 p. 1; Powerpoint  training slide 3.  Driver’s licenses that are  used as verification of identity must be current and valid; therefore, identity may have to be re-verified periodically if a driver’s license is used.  PEM 221 p.1.   The DHS training materials state that identity must be re-verified at each application and each annual redetermination.  Powerpoint  training slide 24.  This would seem to be incorrect if the client is relying on primary level evidence (see below).

 

What types of verification are acceptable?

Clients may submit photocopies of documents, rather than originals, when verifying citizenship and identity.  However, a faxed copy is not acceptable. Powerpoint  training slide 8. 

 

The documents that will be accepted as verification are separated into different “levels” of evidence.  Clients may not use a lower level of evidence unless the higher levels of evidence do not exist. 

 

Primary level evidence of BOTH citizenship and identity

o      U.S. Passport

o      Certificate of naturalization (Form N-550 or N-570)

o      Certificate of U.S. Citizenship (N-560 or N-561)

 

Secondary evidence of citizenship

o      Birth certificate (issued by state, commonwealth, or local jurisdiction) issued before the individual was 5 years old, showing birth in:

o      one of the 50 states;

o      D.C.;

o      Puerto Rico (on or after 1/13/41);

o      Guam (on or after 4/10/99);

o      U.S. Virgin Islands (on or after 1/17/17);

o      American Samoa, Swain’s Island, or Northern Mariana Islands (after 11/4/86). 

o      Certificate of report of birth (DS-1350) for U.S. citizen born outside the U.S.

o      Report of birth abroad of a U.S. Citizen (FS-240) for children born outside U.S. to military personnel

o      Certificate of birth issues by State Department (DS-1350 or FS-545) for U.S. Citizen born outside the U.S.

o      U.S. Citizen ID card (Form I-197 or I-179)

o      Northern Mariana ID Care (I-873)

o      American Indian Card (I-872 ) with code “KIC”

o      Final adoption decree with child’s name and U.S. Place of birth, or statement from State-approved adoption agency certifying the child’s name and U.S. place of birth as it appears in the original birth certificate if the adoption is not finalized

o      Evidence of U.S. Civil Service employment prior to June 1, 1976

o      U.S. Military record of service showing U.S. place of birth (DD 214 or similar document)

 

Secondary evidence of identity

o      Current, valid driver’s license issued by a state or territory, with a photo or identifying information such as age, sex, race, weight, height, or eye color (Note:  DHS policy mandates a photo but federal regulations allow the alternative information)

o      ID card issued by federal, state, or local government, with a photo or identifying information such as age, sex, race, weight, height, or eye color (Note:  DHS policy mandates a photo but federal regulations allow the alternative information)

o      Document indicating receipt of benefits under a program requiring proof of ID, such as SSI or Social Security benefits

o      School ID card with a photo

o      U.S. military card or draft record

o      Military dependent’s ID card

o      Native American tribal document

o      U.S. Coast Guard merchant mariner card

o      Certificate of degree of Indian blood, or other U.S. Indian/ Alaska Native Tribal document with photo or other personal identifying information

Third level evidence of citizenship

o      Extract of a hospital record on hospital letterhead established at time of person’s birth and created 5 years before initial Medicaid application date, which indicates a U.S. place of birth

o      Life, health, or other insurance record showing a U.S. place of birth and created at least 5 years before initial Medicaid application date

Fourth level evidence of citizenship

o      Federal or state census record showing U.S. place of birth or U.S. citizenship, and person’s age

o      Document showing U.S place of birth created at least 5 years prior to initial date of Medicaid application, from:

o      Seneca Indian tribal census,

o      Bureau of Indian Affairs tribal census of the Navajo,

o      U.S. Vital Statistics official notification of birth registration,

o      Amended U.S. birth record issued more than 5 years after date of birth,

o      Statement signed by midwife or physician present at the birth

o      Institutional admission papers from nursing facility, skilled care facility or other institution showing U.S. place of birth

o      Medical record indicating U.S place of birth, created at least 5 years prior to initial Medicaid application date (not including an immunization record)

o      Written affidavits from two individuals having personal knowledge of the events establishing the person’s citizenship

o      At least 1 must not be a relative

o      Both must provide proof of their own citizenship and identity

o      Neither may be the person whose citizenship is being verified

Must also have affidavit showing why documentation is unavailable, from the applicant/recipient or someone else (could be included with one of the two)

 

How will clients know what documents they must provide?

During the client interview with DHS, the DHS worker should ask questions to help identify documents that the client has or can obtain to verify citizenship and identity, when required. Powerpoint training slide 15. 

If verifications are required, DHS must provide the client with a Verification Checklist (DHS 3503 and/or 3503C) that lists the documents that are required and the due date for providing them.  PAM 130 p. 4.  Unfortunately, the DHS 3503C does not list all of the options for documenting citizenship; it only lists documents in the primary level and some of the documents in the secondary level of evidence.  

DHS policy also requires the caseworker to tell clients how to obtain the requested documents.  PAM 130 p. 2.

 

How much time will clients have to provide verification?

DHS  must give the client at least 10 days to provide the documents requested on the verification checklist.   If the client cannot provide the documents “despite a reasonable effort” DHS must “extend the time limit at least once.”  PAM 130 p.4 (emphasis added). 

 

Federal regulations require DHS to give applicants and recipients “a reasonable opportunity” to provide verification, but also state that the time allowed should be consistent with the time allowed to submit documentation of other eligibility factors.  42 C.F.R. 435.510(j). 

 

The federal regulation on allowing time for verification cross-references the regulation  on standards of promptness for processing Medicaid applications (45 days for non-disability-related, 90 days for disability-related applications), which specifically prohibits the state from using the standard of promptness as a reason for denying an application.  42 C.F.R. 435.911(e)(2). 

 

What happens while the client is trying to get verification?

For new applicants, Medicaid cannot be approved until the verification is received by DHS.   However, clients currently receiving Medicaid should remain eligible for Medicaid while they are making a good faith effort to obtain requested documents.  Powerpoint training slides 14 & 21.

 

DHS must assist clients who have difficulty obtaining verification, if the client requests help. PAM 130 p.2.   If both the client and DHS are unsuccessful in obtaining verification for an applicant or recipient, DHS must request help from DHS.  PAM 130 p. 3.

 

Clients and their advocates should make DHS aware of the client’s good faith efforts to obtain verification, and request DHS help when needed.

 

What about the cost of verification?

When clients cannot afford to pay for necessary documents, clients and their advocates should request that the fees for obtaining birth certificates, state IDs, etc., be waived for clients who need the verification in order to qualify for Medicaid.   Some government offices will waive fees if the client produces the verification checklist showing that it is needed for Medicaid eligibility.

 

When clients cannot afford fees and government offices will not waive fees, clients should request DHS help.  Although policy does not require the state agencies to assist with the costs of obtaining verification of citizenship and identity, advocates and clients should push for help in these situations.

 

What about computer matching?

The state agencies have indicated that some computer matching has been done to identify Medicaid recipients who have Michigan birth certificates, which verified their citizenship.  However, the policies issued effective April 1, 2007 do not indicate how and when computer matches will be used as an alternative to requiring clients to obtain hard copies of their Michigan birth certificates.

 

Are there other problem areas?

Homeless individuals, including those who may be doubled-up with others, may be unable to obtain a state ID or driver’s license because they cannot prove to the satisfaction of the Secretary of State that they have a Michigan address (which may in turn prevent from  obtaining  a birth certificate due to a lack of an ID).   Federal Medicaid law prevents states from  imposing residency requirements in their Medicaid program that preclude eligibility for “any individual who resides in the State, regardless of whether or not the residence is maintained permanently or at a fixed address,”  42 U.S.C. 1396a(b)(2).  However, the new DHS policy does not explain how homeless persons will be protected from denial of Medicaid based on SOS residency requirements that prevent them from meeting the Medicaid verification requirements.

 

Other problems are bound to occur.  There already appears to be some confusion among some workers as to whether the new verification requirements apply to non-citizens.  

What Should Advocates Do?

  1. Document problems that clients experience because of the new policies themselves, or because of DHS caseworkers failing to apply the policies correctly.  The Center for Civil Justice (jdoig@ccj-mi.org) and the Michigan Poverty Law Program (hirschel@umich.edu), which are monitoring the implementation of these new requirements in Michigan,  are interested in collecting examples of problems with the new requirements.  Please send a short email to CCJ and/or MPLP at the addresses noted, explaining the problems your client’s experience.
  2. Advise clients on alternative documents that may be acceptable if they do not have the particular documents that have been requested.
  3. Assist clients who need help in obtaining documents.
  4. Advise clients to promptly request help or extensions of time from DHS if they have difficulty obtaining the required verification and assist clients in documenting their attempts to obtain documents and  that help has been requested.
  5. Assist clients in requesting hearings if they are wrongfully denied or terminated from Medicaid.   Clients have 90 days from the date that notice of denial/termination is sent to request a hearing, but recipients must request a hearing within 12 days of the date the notice is sent in order to retain benefits while the hearing request is pending.
  6. Help clients seek legal advice if you are not a legal advocate.  See the information on “Finding Help” below.

What Should Clients Do?

  1. Let your DHS caseworker know if you have difficulty obtaining verification of citizenship or identity, and ask for the caseworker’s help.  Keep a record of the dates and times of any voice mail messages you leave.  Submit written, dated  requests for help, and keep a copy of what you submit.  If you local DHS office has a log book to record materials that are dropped off, be sure to use it.
  2. Seek legal help if you are denied Medicaid or your Medicaid is terminated because of the verification requirements (see “Finding Help” below).
  3. If you are told your Medicaid is being terminated, remember that DHS must receive your hearing request within 12 days of the date on the notice of termination, in order to keep your Medicaid during the hearing process.

 

  1. if you receive an Adoption Subsidy under Title IV-E or receive Social Security based on disability, seek legal advice if you are asked to provide verification of citizenship or identity. 

Finding Help

Most legal aid and legal services offices handle these types of cases, and they do not charge a fee. You can locate various sources of legal and related services, including the free legal aid office that serves your county, at MichiganLegalAid.org. You can also look in the yellow pages under "attorneys" or call the toll-free lawyer referral number, (800) 968-0738.