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State of Wisconsin Department of Health Services BadgerCare + Eligibility Handbook Release 9-06, November 05, 2009 |
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State of Wisconsin Department of Health Services BadgerCare + Eligibility Handbook Release 9-06, November 05, 2009 |
4.2. Documenting Citizenship and Identity
4.2.2 Reasonable Opportunity Period
4.2.3.1 For New BC+ Applicants
4.2.3.2 For Ongoing BC+ Members
4.2.4 Hierarchy of Documentation
4.2.5 Agencies Paying for Documentation
4.2.6 Policy For Special Populations
4.2.7 Situations which require Special Documentation Processing
4.2.7.2 Presumptive Eligibility/Express Enrollment (EE)
4.2.7.3 Individuals Without Verification and Affect on Household Eligibility
4.2.7.4 Child Citizenship Act 2000
4.2.7.6 Individuals in Institutional Care Facilities
The Federal Deficit Reduction Act of 2005 requires persons applying for or receiving Medicaid (MA), BadgerCare Plus (BC+), or Family Planning Waiver (FPW) benefits, who have declared that they are a U.S. citizen, to provide documentation of their U.S. citizenship and identity.
Agencies must comply with the new BC+ requirement to document citizenship and identity in order for the State to obtain Federal matching funds. As part of on-going DHS quality assurance initiatives, periodic quality control reviews will be done on randomly selected cases throughout the state to monitor agency compliance. Cases will be examined to determine if proper documentation was used to verify citizenship/identity and if the proper verification code was used. The Department will work with non-compliant agencies to achieve compliance.
Any document used to establish U.S. citizenship must show either a birthplace in the U.S., or that the person is otherwise a U.S. citizen. In addition, any document used to establish identity must show identifying information that relates to the person named on the document. For a list of all the allowable documentation, see the Acceptable Citizenship and Identity Documentation.
If an individual has provided proof of citizenship in a state other than WI, the IM worker can either request that the individual resubmit the documentation or request and obtain a copy or electronic copy of the original documentation reviewed by the other state to keep on file in WI.
Agencies may accept citizenship and identity documents from a woman whose last name has changed due to marriage or divorce if the documentation matches in every way with the exception of the last name. If there is any doubt, the agency may request that the individual provide an official document verifying the change such as a marriage license or divorce decree. If an individual has changed his/her first and last name, s/he must produce documentation from a court or governing agency documenting the change.
Once the citizenship and identity requirement is met, it need not be applied again, even if the person loses BadgerCare Plus at some point and later re-applies. A person should ordinarily be required to submit evidence of citizenship and identification only once, unless other information is received causing the evidence to be questionable.
NOTE: Do not re-verify identity for a person who has had his/her identity verified through the signing of a Statement of Identity for Children Under 18 Years of Age, F-10154 (English) (Spanish).
Documentation submitted by the applicant or member to satisfy the new requirement must be maintained in the case record.
See Process Help Chapter 68.1 for tools that IM workers can use to assist clients and applicants in meeting this requirement.
The citizenship and identity documentation requirement covers all non-exempt applicants and members of:
BadgerCare Plus
Medicaid
Katie Becket
Note: Eligibility for Katie Becket is determined by Division of Long Term Care staff, therefore they will be ensuring citizenship and identity verification.
Tuberculosis-related Medicaid (TB MA) and,
Wisconsin Well Woman Medicaid
Note: TB and WWW Wisconsin Well Woman Program MA eligibility is not determined in CWW, therefore it is important to ensure that citizenship and identity verification is done only once.
The following populations are exempt from the new citizenship and identity documentation requirement:
Anyone currently receiving Social Security Disability Insurance (SSDI).
Anyone who is currently receiving Supplemental Security Income (SSI) benefits.
Anyone currently receiving Medicare.
Anyone currently receiving Foster Care (Title IV-E and Non IV-E)
Anyone currently receiving Adoption Assistance
Anyone applying for or receiving BadgerCare Prenatal Program benefits.
Former SSI and Medicare Recipients
States cannot consider individuals who received Medicare or SSI in the past to be exempt. An individual is not required to be a citizen to receive these benefits. Since SSA does not share information regarding the reason benefits were lost, it is not possible to determine if the termination was due to citizenship status or not.
Note: Confirm the receipt of SSI, SSDI, and Medicare through the following data exchanges:
For SSI: use DXSX
For SSDI: use DXSA
For Medicare: DXSA
Note: Qualified providers who conduct BC+ express enrollment determinations must not apply the new citizenship and identification documentation requirement to persons seeking eligibility through express enrollment. Persons determined eligible for BC+ through express enrollment are not subject to the documentation requirement until they file a formal application with the local Income Maintenance Agency.
All applicants and members must be given a reasonable period of time to present documents establishing that they are a U.S. citizen or national, and their identity. This newly designated time frame for purposes of citizenship and identity documentation is called the “reasonable opportunity period.”
An individual applying for BC+ currently receives the 30 day application A request for BadgerCare Plus coverage. The request may be a signed and dated application form or any other signed and dated request containing the applicant's name and address. The applicant must submit a signed and completed application form to complete the application process. processing period as the reasonable opportunity period in which to provide valid citizenship and/or identification verification. However, the reasonable opportunity period can be extended if s/he is trying to provide the necessary documentation, or has requested assistance from the IM worker. His/her application filing date The filing date is the day a valid application/registration form is delivered to the appropriate Income Maintenance agency or the next business day if it is delivered after the agency's regularly scheduled business hours. The filing date on an ACCESS application is the date the application is electronically submitted or the next business day if submitted after 4:30 PM or on a weekend or holiday. The filing date sets the begin date of benefits. will be honored if the necessary documentation is ultimately obtained. Unlike the policy for members, eligibility for BC+ is not granted to applicants until the requirement is met.
The "reasonable opportunity period" for members begins when they are notified of the new requirement. At or about the same time that they are notified of their upcoming review, they will receive the newly developed Citizenship Documentation Requirement letter (English), (Spanish). This reasonable opportunity period starts with the receipt of the letter and ends at the end of the review month. As such, the reasonable opportunity period for members will be about forty-five days. Members making a good faith effort to secure the necessary documentation, but who are unable to do so during the reasonable opportunity period, may have their BC+ eligibility extended, even though the documentation requirement has not been satisfied.
If the member requests it, the IM worker must provide assistance to secure the necessary documentation. BC+ eligibility may continue for as long as the member is deemed by the IM worker to be making a good faith effort to comply.
The "good faith effort" policy for the citizenship and identity documentation requirements provides more time during which the member can provide the necessary verification to meet this new requirement. This policy allows for the extension of the reasonable opportunity period without jeopardizing the original filing date or review date.
By "good faith effort" we mean the individual is taking steps to obtain the necessary documentation and has notified his/her worker of such efforts or has requested assistance from the worker to obtain the necessary documentation.
Utilizing the "good faith" policies for applicants and members does not impact an agency's timeliness performance that is reported to the state. Any cases that have a verification extension are not considered untimely until the extension date is past due with no final action taken by the worker. It is possible to provide several back to back extensions without a timeliness penalty as long as the worker takes action at the end of each extension period.
The application processing period can be extended to allow an applicant A person who has submitted a request for enrollment in BC+ for whom no decision has been made regarding the person or group's eligibility for enrollment. who is making a good faith effort to supply the required documentation. The IM worker must provide assistance to secure the necessary documentation if the applicant requests it. When the applicant provides the documentation, the IM worker must run eligibility from the original application filing date.
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Example 1: Mary applies for BC+ for herself and son on August 15, 2008. She has all of the necessary verification items for her son but does not have a copy of her Florida birth certificate. Her son’s BC+ eligibility can be confirmed. Mary’s worker enters the appropriate codes to pend BC+ eligibility for Mary. On September 5th, Mary informs her worker that she has contacted Florida and will receive a copy of her birth certificate in 3 to 4 weeks. Mary’s worker extends the verification due date another 4 weeks to allow Mary to comply with the new requirement. Mary presents her worker with her birth certificate on September 29th. The worker enters <BC> in the MA Citizenship verification field, runs eligibility and confirms Mary’s BC back to the original application date of August 15th.
Once an applicant supplies the documentation, certify his/her eligibility from the original filing date on the application. Under no circumstances, however, should applicants be certified as eligible for program benefits before the citizenship and identity documentation requirement is satisfied. |
Members making a good faith effort to secure the necessary documentation, but who are unable to do so during the reasonable opportunity period, may have their BC+ eligibility extended, even though the documentation requirement has not been satisfied. If the member requests it, the IM worker must provide assistance to secure the necessary documentation. BC+ eligibility may continue for as long as the member is deemed by the IM worker to be making a good faith effort to comply.
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Example 2: Ben completes his BC+ review on September 5th. The only item he was not able to verify was his citizenship. He was born in Washington but does not have a copy of his birth certificate. Ben calls his worker Tom on September 15th and tells him that his father who still lives in Washington, will mail him his birth certificate. Because Ben has been communicating with Tom, Tom enters <GF> in the MA Citizenship verification field with <GF> for Good Faith effort, runs eligibility and confirms the case. Tom then goes back and pends the BC+ eligibility by entering a <?> in the MA Citizenship verification field to allow Ben additional time to provide the necessary documentation. Ben presents the birth certificate to Tom on October 15th. Tom changes the <?> code to <BC>, runs eligibility and confirms Ben’s BC+ eligibility.
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Note: Presumptive Eligibility members are not considered members for purposes of citizenship verification. Therefore someone applying for ongoing BadgerCare Plus or Family Planning Services after a presumptive eligibility period must be treated as an applicant and cannot be made eligible until the documentation has been provided.
The list of valid documents used to verify citizenship and identity is divided into five levels in accordance with federal regulations. Level 1 consists of documents of the highest reliability and can prove both citizenship and identity. Levels 2 through 4 consists of documents that can prove citizenship only with Level 2 being the most reliable and Level 4 the least reliable. Level 5 consists of documents that can prove identity only. Applicants and members must provide documentation from the highest level available that can be obtained during the reasonable opportunity period.
If an individual needs to verify citizenship and/or identity at the point of application or renewal s/he should try to fulfill the requirement with proof s/he already has available. If an applicant/member contacts the agency, work with him/her to check Documentation Levels 1 through 5 to determine if anything on the list is readily available to the applicant/member. If an applicant/member was born in Wisconsin, use the online Birth Query to verify citizenship.
In certain circumstances the agency can authorize payment of documentation for an applicant/member. See the 4.2.5, Agencies Paying for Documentation.
Level 1 – Evidence of Citizenship and Identity
Primary evidence documents both citizenship and identity. Primary evidence of citizenship and identity is the most reliable way to establish that the person is a U.S. citizen. If an individual presents documents from level 1, no other information is required; however, relatively few BC+ applicants and members may be able to provide documents from this group.
Level 2 – Evidence of Citizenship
Secondary evidence of citizenship is the next most reliable way to establish someone is a US citizen. Many BC+ applicants and members will be able to present documents from level 2 during the reasonable opportunity period and should be encouraged to do so. Note, however, that a document from this group is evidence of U.S. citizenship only and must be accompanied by evidence of identity.
NOTE: Completing an on-line birth query (level 2 documentation) can be done for all persons born in Wisconsin. Enter tran code MNOS on CARES Client Assistance for Re-employment & Economic Support. `This system supports the Income Maintenance operations for DHFS and DWD. CARES is used to determine eligibility, issue benefits, track premium payments and manages support for BC+, EBD Medicaid, W-2, Child Care and Work Programs mainframe screen, hit enter, then F2. There is no cost to the agency to use this method of verification.
Level 3 – Evidence of Citizenship
Third level evidence of U.S. citizenship is acceptable and may be presented by applicants and members who are unable to obtain level 1 or level 2 evidence during the reasonable opportunity period. As with level 2 evidence, a document from this group is evidence of U.S. citizenship only and must be accompanied by evidence of identity.
Level 4 – Evidence of Citizenship
Fourth level evidence of U.S. citizenship is acceptable evidence of the lowest reliability. While most BC+ applicants and members will be able to present documents at this level, they should do so only if unable to obtain evidence of citizenship from the other levels during the reasonable opportunity period. As with second and third level evidence, a document from this group is evidence of U.S. citizenship only and must be accompanied by evidence of identity.
Level 5 – Evidence of Identity
Level 5 documentation can only be used to verify identity. Documentation of citizenship from levels two through four must be accompanied by evidence of the applicant’s or member’s identity from Level 5.
The applicant may provide three or more corroborating documents, such as a marriage license, divorce decree, high school or college diploma, property deed/title, death certificate, or employer ID card, to prove identity. This option can only be used if the applicant submitted level 2 or 3, not level 4, citizenship documentation. The applicant may not use a document that was also used for citizenship verification.
Naturalized Citizens
Naturalized citizens must provide level 1 or 2 citizenship documentation. The Citizenship Affidavit is also available for this population if no document from level 1 or 2 is available. This group cannot use level 3 or 4 documentation.
The worker can authorize payment for a birth certificate from the state where the applicant was born and/or a WI State ID if an applicant/member:
Has no documentation from Levels 1-5;
Needs either an out of state birth certificate and/or has no identity documentation; and
Requests financial assistance.
Note: If a member has obtained and already paid for his/her own documentation and later asks the IM agency for reimbursement of those costs, the IM agency should not provide reimbursement. If an individual has requested and paid for documentation before applying but does not yet have the documentation, do not confirm program eligibility for this individual. Eligibility can only be granted once the individual receives documentation and provides it to the agency.
If an individual was born in Wisconsin and not found in the Wisconsin online birth query, agencies may authorize payment for a WI birth certificate to verify citizenship.
IM agencies should pay for a birth certificate or state ID card before using the "Special Populations" option (4.2.6). If there is an opportunity to obtain a document that meets federal guidelines then that should be pursued.
However, when an applicant/member lacks any identity documentation needed to apply for a birth certificate or lacks any citizenship documentation to be able to apply for an ID card, it is appropriate to consider using the Written Affidavit for citizenship and/or "Special Populations Policy.
In order to obtain birth certificates or state ID cards for applicants/members, agencies need to follow the process outlined in Chapter (68.2.5) of Process Help.
It is expected that all non-exempt individuals requesting or receiving BC+ provide acceptable documentation to verify citizenship and identity from the federally approved Levels 1 through 5 at application or review. However, certain special populations may be particularly disadvantaged with regard to providing the required documentation. For some persons within a special population, it will be allowable to accept other documents besides those listed in Levels 1-5, once it is determined that the person is unable to produce any Level 1-5 documentation.
This policy only applies when it is determined that an individual within a special population is in a situation where s/he does not have the ability to obtain citizenship or identity documentation from Level 1-5 This policy should be used with discretion and only when an individual has no other means of meeting the requirement.
Examples of individuals in special populations include, but are not limited to, persons who:
Are physically or mentally incapacitated and whose condition renders them unable to provide necessary documentation.
Are chronically homeless and whose living arrangement makes it extremely difficult to provide the necessary documentation.
Are minors.
Have religious beliefs that prevent them from securing the documentation.
There are two ways for individuals in special populations to meet the citizenship and identity documentation requirement:
Present other documents besides those listed in Levels 1-5 to meet the requirement as long as the document meets the general documentation requirement stated here:
“Any document used to establish U.S. citizenship must show either a birthplace in the U.S. or that the person is otherwise a U.S. citizen. Any document used to establish identity must show identifying information that relates to the person named on the document.”
Some examples of documents that could be used to establish citizenship for special populations as long the document shows a birthplace in the U.S. or that the person is otherwise a U.S. citizen are:
Hospital “souvenir” birth certificate
Baptismal certificate
Native American documentation
Below are examples of documents that could be used to establish identity for special populations as long the document shows some identifying information (e.g., name, address, telephone number, etc.) that relates to the individual:
Social Security Card
Driver education course completion certificate
School record or transcript
Credit card with signature
Voter registration materials
Permanent Resident card
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Example 1: Due to their religious practices, an Amish family is not able to present a birth certificate for their child because the child was not born in a traditional hospital setting and no record of the child’s birth exists within the state system. In addition, the child is home schooled so there is no school identification card to present for identification verification. However, the family is able to produce a signed letter from their church leader that states the child’s birth place and birth date. This document can be used to satisfy the citizenship and identification requirement under the policy for Special Populations. |
The newly developed Statement of Citizenship and/or Identity for Special Populations form (F-10161) can be used to meet the new requirement only when no other documentation is available from Levels 1-5 or item #1 above.
This form can be completed by a related or unrelated individual who knows the applicant/member, an authorized representative A person authorized to act on a client's behalf for any of the Forward Health Programs. An authorized representative may be designated by the client and may exercise all the rights and responsibilities of a client., an IM Agency worker, a worker for a housing agency who is aware of the individual’s living situation, a BC+ provider for a minor, etc. Additional requirements concerning the F-10161 are as follows:
The person completing the form attesting to another person’s citizenship must be a US citizen.
IM agencies are not required to verify the citizenship of the person signing the form.
Do not accept a form attesting to the citizenship of another individual when you know the person completing the form is not a US citizen.
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Example 2: A 15 year old minor female applies for the Family Planning Waiver program. She does not have a copy of her birth certificate, but because she was born in Wisconsin, the IM worker is able to complete an online birth query to verify her citizenship. The applicant does not have a driver license. She does not have a school ID because the school district in which she lives does not issue a school identification card. Further, she does not have nor is she able to provide any other acceptable document from Levels 1-5. In this case, an F-10161 can be signed by a Family Planning Waiver program provider on the behalf of a minor female to verify her identity and meet the new federal requirement. |
NOTE: An F-10161 can be signed by the authorized representative of an individual who is not able to procure any other documents on his/her own.
While an IM worker is obligated to assist an applicant or member who asks for help in meeting the citizenship and identity requirement, this does not necessarily mean the IM worker must sign the F-10161. The signatory to the F-10161 must know and be able to truthfully attest to the applicant/member’s citizenship or identity. If an IM worker can do this for an applicant/member, then s/he may sign the form.
Maintain copies of any documents secured under this temporary policy in the case record. Enter Case Comments to document why this policy was used and note whether the F-10161 or another document was used to verify citizenship and identity.
NOTE: An individual who met the citizenship requirement by using documents obtained under the Special Populations policy or by using the F-10161 has complied with the federal requirement and is not required to provide other documentation at his/ her next review.
If you are aware of an individual who meets the special population category outlined above and whose BC+ application has been denied or eligibility has ended because of his/her inability to provide acceptable documentation, contact the individual to see if the new Special Populations policies may be applied. See Documentation Level 7 Acceptable Citizenship and Identity Documentation.
A person being added to a case is subject to the new verification requirement at the time of his/her application. Inform the applicant of the documentation requirement and give him/her the “reasonable opportunity period” to comply. Do not grant eligibility for the individual until he/she has submitted valid documentation. If documentation is not received timely, deny MA for that individual only. Do not require other non-exempt household members to submit citizenship or identification documentation until their next review.
Qualified providers who conduct BC+ presumptive eligibility/express enrollment determinations must not apply the new citizenship and identification documentation requirement to persons seeking presumptive eligibility. Persons determined presumptively eligible for BC+ are not subject to the documentation requirement until they file a formal application with the local Income Maintenance agency.
IM workers should not delay an individual household member’s eligibility when awaiting another household members’ citizenship or identity verification. The individual pending for citizenship/identity should be counted as part of the group when determining eligibility for other group members. See Process Help Chapter 68.2 for processing instructions.
Certain foreign-born individuals have derivative U.S. citizenship as a result of the Child Citizenship Act (CCA). Within the context of the BC+ citizenship verification requirement, this means that for any applicant or member claiming citizenship through the CCA, IM workers should not request documentation for that person. In these cases, IM workers need to acquire documentation proving the citizenship and identity of at least one U.S. citizen parent. The parent’s U.S. citizenship is the basis for the child receiving derivative citizenship.
For persons who meet the citizenship verification requirement through the means allowed in the CCA, this is considered level 2 evidence. Therefore this counts for citizenship only and the individual needs to provide another document to verify identity. The code <CA> should be used in the BC+ Citizenship Verification field.
See 4.1.1 Child Citizenship Act of 2000
As a reminder, do not request or require citizenship and identity documentation from individuals who have not declared that they are citizens. Non-citizens who apply for IM programs are not subject to this policy. Legal non-citizens are subject to the verification process through SAVE and undocumented non-citizens do not have any status that can be verified. Undocumented non-citizens can apply for Emergency MA or BC+ Prenatal Program and should not be subject to the citizenship verification policy.
When an individual who had legal non-citizen status subsequently gains US Citizenship, this is recorded in SAVE. Therefore SAVE can be used to verify these individuals' citizenship. The verification result from SAVE will be used to verify these individuals' citizenship. The verification result from SAVE will be "individual is a US Citizen". Please consult Operations Memo 04-10, for instructions on using SAVE. Use the <SV> code in the MA Citizenship verification field when using SAVE for this population. These individuals do still need proof of identity since the SAVE verification is considered to be Level 2 citizenship documentation.
Disabled individuals in institutional care facilities may have their identity attested to by the facility director or administrator when nothing else is available. Use the Statement of Identity for Persons In Institutional Care Facilities (F-10175) for this purpose. A medical institution can be, but is not limited to, skilled nursing facilities (SNF), intermediate care facilities (ICF Intermediate Care Facility), institutions for mental disease (IMD Institute for Mental Disease), and hospitals.
This page last updated in Release Number: 08-08
Release Date: 12/05/08
Effective Date: 12/05/08
