A. Requirement

A customer must be a citizen of the United States or meet the Non-citizen status (MS 522.00).

B. Programs and Legal Authorities

This requirement applies to the following programs:

Program

Legal Authorities

ALTCS

• 42 USC 1396b

• 42 CFR 435.406

• ARS 36-2903.03

• AAC 9-28-404

Breast & Cervical Cancer Treatment Program (BCCTP)

• 42 USC 1396b

• 42 CFR 435.406

• ARS 36-2903.03

• AAC 9-22-2003

Freedom to Work (FTW)

• 42 USC 1396b

• 42 CFR 435.406

• ARS 36-2903.03

• AAC R9-22-1911; AAC R9-28-1311

Medicare Cost Sharing

• 42 USC 1396b

• 42 CFR 435.406

• ARS 36-2903.03

• AAC R9-29-201

SSI-MAO

• 42 USC 1396b

• 42 CFR 435.406

• ARS 36-2903.03

• AAC R9-22-1502

• ARS 36-2930

• AAC R9-22-1609

A. Definition

An individual may be a U.S. citizen based on where they were born, having a U.S. citizen parent, by marriage or by naturalization as described in this section.

B. Citizen by Birth

A person is a U.S. citizen if the person was born in the United States (including those born in current states before statehood) or in a U.S. territory.  Territories are:

• Guam;

• Puerto Rico based on date of birth;

• The Virgin Islands based on date of birth;

• The Northern Mariana Islands based on date of birth;

• American Samoa;

• Swain's Island; and

• Panama Canal Zone based on date of birth. 

EXCEPTION:  This does not include a customer who was born to foreign diplomats residing on one of the preceding jurisdictions.

NOTE:  For restrictions based on date of birth see MS 508.02.E.

C. Citizenship Through U.S. Citizen Parent

A customer born to U.S. citizen parents can meet the criteria for U.S. citizenship.  The regulation used to evaluate U.S. citizenship through a parent is based on the age of the customer on February 27, 2001, when the Children's Citizenship Act (CCA) became effective and previous laws were repealed.

IF the customer was born...

THEN the customer...

After February 27, 1983 (under age 18 on February 27, 2001)

Automatically acquires U.S. citizenship under the CCA when all of the following requirements are met:

• At least one biological or adoptive parent is a U.S. citizen by birth or naturalization,

• If the child is adopted, the adoption of the child is finalized, and

• The child is admitted to the U.S. as an immigrant. Immigrant means the child entered the U.S. on an immigrant visa and/or was admitted as a lawful permanent resident.

If the customer meets the age requirement but does not meet all other CCA requirements as stated above, then the customer attains U.S. citizenship on the date that the last requirement is met. 

U. S. Citizenship and Immigration Services (USCIS) documentation is not required to prove U.S. citizenship for a customer who meets the above requirements and permanently lives in the U.S. However, the customer can obtain documentation by applying to the USCIS for a Certificate of Citizenship to a passport acceptance facility for a passport.

On or before February 27, 1983 (18 years of age or older on February 27, 2001)

Cannot qualify for automatic citizenship under the CCA, even when one or both natural or adoptive parents were U.S. citizens at the time of the customer's birth.  

A customer born on or before February 27, 1983 must:

• Provide a USCIS document (MS 508.02.E) issued prior to the CCA showing the customer derived U.S. citizenship through a parent; or

• Be naturalized as a U.S. citizen.

D. Citizenship Through Marriage

A woman who married a U.S. citizen before September 22, 1922 established U.S. citizenship.  This does not apply to a man who married a U.S. citizen.

E. Citizenship by Naturalization

Individuals who are not U.S. citizens by birth or adoption may apply for and go through the naturalization process to become U.S. citizens.

A person born outside the U.S. can derive U.S. citizenship from parents who were naturalized as U.S. citizens if both parents (or sole custodial parent) were naturalized before:

• The person's 21st birthday if naturalization was before October 14, 1940; or
• The person's 18th birthday if naturalization was on or after October 14, 1940.

F. Dual citizenship

An individual may be a U.S. citizen and a citizen of another country. A person claiming dual citizenship can lose U.S. citizenship only if the person voluntarily abandons it. Dual citizenship status does not affect the individual's U.S. citizenship.

A. Proof

Effective July 1, 2006, a Medicaid applicant or recipient who claims to be a U.S. citizen must provide documentation to establish both identity and citizenship.

A person must provide either:

• Primary verification of both identity and citizenship, OR
• If no primary proof is available, the most reliable proof of citizenship, such as a birth certificate, AND
• Proof of identity, such as a State issued driver's license.

In addition, a Medicaid applicant must sign a declaration of citizenship as described in section B below.

This requirement applies to:

• ALTCS
• SSI MAO
• Medicare Cost Sharing
• KidsCare
• SSDI - Temporary Medical Coverage
• Freedom to Work (FTW)
• Breast & Cervical Cancer Treatment Program (BCCTP)

NOTE: Except for signing the application form or Statement of Citizenship (DE-140) attesting that they are U.S. citizens (MS 508.02.B), the following groups of persons are exempt from having to provide documentation of citizenship and identity:

• Persons entitled to or enrolled in Medicare;
• Persons receiving Social Security Disability Insurance benefits (SSDI);
• Persons receiving SSI Cash benefits;
• Children receiving Title IV-B Foster Care benefits;
• Children receiving Title IV-E Foster Care benefits;
• Children receiving Title IV-E Subsidized Adoption benefits;
• Children under age one with current status as deemed newborn (see MS 508.02.C for additional information); and
• Persons who have a U.S. citizen code on the RP135 Demographics PMMIS screen as described in the Note below in this manual section.

For persons who receive SSI Cash, this must be documented in PMMIS (Key Code 040, 050, 060, 200, 210, or 220) or by a Title XVI WTPY either in ACE or the case record.

For persons who received SSI Cash in the past, see MS 508.02.J.

The presentation of documentary evidence should be a one-time action. Once an individual's citizenship is documented and recorded, subsequent changes in eligibility should not require documentation of citizenship. 

NOTE: Always review the RP135 Demographics PMMIS screen before requesting documentation of the customer's citizenship and identity. If the person has a Citizen Code of US on the RP135 Demographics PMMIS screen, do not request documentation of the customer's citizenship and identity because it has already been documented and recorded by either AHCCCS or another agency as follows:

Do not print the RP135 screen and then scan it into Fortis because this information will always be in PMMIS.

There are three codes that can appear in the "Citizen" field on the RP135 screen:

• US CITIZEN (the person is a U.S. citizen and it has been documented)
• NC (either the person is not a citizen or citizenship has not been documented)
• OT (the person is a non-citizen)

B. Declaration of Citizenship

1. All persons who claim to be a U.S. citizen must sign a Declaration of Citizenship attesting that they are a U.S. citizen, even if they are exempt from having to provide documentation of citizenship and identity as described in MS 508.02.A above.

NOTE: A signed Declaration of Citizenship does not establish citizenship. Therefore, persons who are not exempt from having to provide documentation of citizenship and identity, must provide citizenship and identity documents as described in MS 508.02.D through J, in addition to signing a Declaration of Citizenship.

2. U.S. Citizenship must be attested to by signing one of the following:

• The Statement of Citizenship (DE-140)
• Application for AHCCCS Health Insurance (AH-001)
• Application for Arizona Long Term Care System (ALTCS) (DE-102)
• The ACE generated ALTCS Application Form
• The ACE generated Renewal of ALTCS Benefits Form
• The ACE generated SSI/MAO Renewal Form
• Application for AHCCCS Health Insurance and Medicare Cost Sharing Benefits (DE-103)
• The DES application form, or
• The Health-E-Arizona Application form (This form must be signed on the last page of the the application or signed copy of the last page of the AH-001 must be provided.)

3. For the DE-140 to be acceptable as a citizenship declaration it must be signed using the guidelines in number 4 below.

For the application or the renewal form to be acceptable as a citizenship declaration, it must:

• Have the question about U.S. citizen answered "Yes" or show a U.S. place of birth (for ACE generated applications or ACE generated renewal forms, the application or renewal form will need to show U.S. citizen), and
• Be signed using the guidelines in number 4 below.

4. Use the following guidelines when obtaining signatures.

IF the customer is...

THEN obtain the signature of...

An adult

• The customer's legal representative (i.e., conservator or guardian) if the customer has one
• When there is no legal representative
  • The customer, or
  • The customer's spouse, or
  • For KidsCare, other unmarried parent of a child in common (if the child is also applying), or
  • Another adult (if a Physician Statement of Incapacity, DE-217, has been obtained).

A child

The parent or legal representative.

C. Proof Documents

Individuals declaring U.S. Citizenship must provide the most reliable proof of citizenship and identity available as listed in one of the four levels described below.

All documents must be either originals or certified copies from the issuing agency. Copies or notarized copies are not acceptable.

Exception: The following copies are acceptable:

• Screen prints when systematic verification is used.
• Copies in the case file or scanned in Fortis from prior to July 12, 2006. (Sign, date and document on the copy, "received prior to July 12, 2006").
• Copies sent in or faxed from an agency that accept applications for AHCCCS Health Insurance. The copy must be documented with following:
• "Copy of Original (name of document)" or "Copy of certified (name of document)".
• Name of agency making the copy.
• Printed name of staff viewing the original or certified document and making the copy.
• Signature of staff viewing the original or certified document and making the copy.
• Date the staff made and signed the copy.

The following agencies are authorized to make a copy of an original or certified documents:

• AHCCCS (KidsCare, SSI-MAO and Long Term Care)
• DES/FAA local offices
• Federally Qualified Health Centers (FQHC)
• Children's Rehabilitative Services (CRS)
• Regional Behavioral Health Authorities (RBHA)
• Regional Behavioral Health Authority (RBHA) Providers such as crisis centers
• Arizona Department of Juvenile Corrections (ADJC)
• County and Department of Corrections (DOC) for hospitalized persons
• Division of Children, Youth and Families (DCYC)
• Indian Health Services (IHS)
• Baby Arizona Providers
• Health-e-Arizona
• Tribal Staff taking applications for AHCCCS and TANF
• Women, Infants and Children (WIC)

When AHCCCS staff is provided proof document(s) of U.S. citizenship, the AHCCCS staff person makes a copy of the original or certified document and must either:

• Enter comments in ACE that a "Copy of the Original (name of document)" or "Copy of Certified (name of document)" was viewed and copied; OR
• Document on the copy of the document with the following information:
• "Copy of Original (name of document)" or "Copy of Certified (name of document)."
• Date the AHCCCS staff person made and signed the copy.
• Printed name of AHCCCS staff person viewing the original of certified document and making the copy.
• Signature of AHCCCS staff person viewing the original or certified document and making the copy.

Proof documents are divided into four levels showing the hierarchy of documents that can be used as proof of citizenship and identity. The following provides a summary of the levels of documentation:

• MS 508.02.D provides a list of the primary (first level) documentation for both citizenship and identity. If the customer provides a primary document, no other documentation is required. The primary document provides proof of both citizenship and identity
• The next three levels as described below provide proof of citizenship only. An identity document from MS 508.02.H is also required when one of the documents in the next three levels is obtained.
• MS 508.02.E provides a list of secondary (second level) items that document citizenship.
• MS 508.02.F provides a list of third level items that document citizenship
• MS 508.02.G provides a list of fourth level items that document citizenship.

NOTE: Always document in ACE your attempts to obtain the most reliable proof. Document what you used for proof of citizenship and identity either on the Citizenship Verification screen or in ACE Comments. For example, you mail the customer a Request for Information (RFI) and the Citizenship and Identity Insert (AH-503) requesting proof of the customer's citizenship and identity. The customer provides you with an original birth certificate (second level document for citizenship), extract of hospital record (third level document for citizenship) and drivers license (identity document). Document in ACE that you used the customer's birth certificate and driver's license as best available and most reliable proof of citizenship and identity.

If the customer claims to be a U.S. Citizen, but cannot provide a document described in MS 508.02.D through G, see MS 508.02.J for information on helping the customer obtain the needed information.

D. First Level: Primary Documentation for Proof of Both Citizenship and Identity

The following are acceptable primary documents that prove both citizenship and identity. If the customer provides one of the documents listed in this section no other document is required:

Type

Description

U.S. passport

A U.S. passport, even if expired. (A limited passport which is issued for less than 5 years, is not sufficient.)

Naturalization Certificate

(N-550 or N-570)

Issued to Naturalized Citizens.  If a child's name is included on the parent's Naturalization Certificate, the child does not automatically become a U.S. citizen unless the child meets the requirements in MS 508.01.E.

NOTE: Although the Naturalization Certificate states that making copies of the certificate is prohibited by U.S. law, the Department of Homeland Security has advised us that  the prohibition relates only to copying for illegal purposes. It is legal to make copies to document the customer's eligibility for AHCCCS.

Certificate of Citizenship

(N-560 or N-561)

Issued by USCIS to individuals who derived citizenship through parents.

Under age one with current status in PMMIS as deemed newborn

NOTE: This proof is obtained by the AHCCCS staff.

The individual is under age one and has current status in PMMIS (RP285 or RP145) as a deemed newborn, citizenship and identity are verified.

One of the following Key Codes verify deemed newborn status: 440, 445, 447, 450, or 455.

If PMMIS (RP285 or RP145) shows one of the above Key Codes, scan a copy of the RP285 or RP145 screen into Fortis.

NOTE: When the child turns one-year old or no longer qualifies under Deemed Newborn, obtain a copy of the birth certificate, or obtain confirmation of Birth through the Vital Records Data Base (MS 508.02.J) to document citizenship and an Affidavit Attesting Identity (DE-178) from a parent (see MS 508.02.H) to document identity.

E. Second Level: Secondary Documentation for Proof of Citizenship Only

The following are acceptable secondary documents that prove citizenship only. When a customer provides a document listed in this manual section, also obtain a document listed in MS 508.02.H to prove the customer's identity.

Type

Description

U.S. public birth record

Shows birth in one of the 50 states, the District of Columbia, American Samoa, Swain's Island, Puerto Rico (on or after January 13, 1941), U.S. Virgin Islands (on or after January 17, 1917), Northern Mariana Islands (on or after November 4, 1986) or Guam (on or after April 10, 1899).

A birth record document must be issued by the State, Commonwealth, territory or local jurisdiction. It must have been issued before the person was 5 years of age.

NOTE: This proof is obtained by the AHCCCS staff.

AHCCCS staff can use the Arizona Vital Statistics Web Based Birth records for individuals born in Arizona 1950 and later. See MS 508.02.J for additional information.

Certificate of Birth Abroad

(FS-545 or DS‑1350)

Or

Report of Birth Abroad (FS-240)

Issued by the Department of State to U.S. citizens born abroad. 

U.S. Citizen ID card (I-197) or the prior version I-179

USCIS issued the I-179 from 1960 until 1973. In 1973, USCIS revised the form and renumbered it as Form I-197. USCIS issued the I-197 from 1973 until April 7, 1983.

USCIS issued Form I-179 and I-197 to naturalized U.S. citizens living near the Canadian or Mexican border who needed it for frequent border crossing.

Although neither form is currently issued, either form that was previously issued is still valid.

Northern Mariana Identification Card (I-873)

Issued by the USCIS to a collectively naturalized U.S. citizen who was born in the Northern Mariana Islands before November 4, 1986.

American Indian Card (I-872)

Issued by the USCIS to U.S. citizen members of the Texas Band of Kickapoos living near the U.S/Mexican border.  The classification code "KIC" appears on the card and a statement on the back identifies the bearer as a U.S. citizen.

Evidence of civil service employment

Employment as a civil servant by the U.S. government before June 1, 1976.

Census records

Shows name, U.S. nationality or a U.S. place of birth, and customer's date of birth or age. 

Adoption finalization papers

Shows the customer's name and place of birth in one of the 50 states, the District of Columbia, Puerto Rico (on or after January 13, 1941) Guam, the U.S. Virgin Islands (on or after January 17, 1917), American Samoa, or the Northern Mariana Islands (on or after November 4, 1986).

When the adoption is not finalized and the state or other U.S. jurisdiction listed above will not release a birth certificate before the final adoption, you may use:

• A statement from a State or jurisdiction-approved adoption agency showing the customer's name and place of birth and
• A statement that the original birth certificate was the source of the information

Evidence of birth in the Republic of Panama

Shows birth on or after February 26, 1904 and before October 1, 1979, and evidence that at least one parent was a U.S. citizen and employed by the U.S. government or the Panama Railroad Company or its successor in title.

Evidence of birth or citizenship in Puerto Rico

• Shows birth on or after April 1, 1899 and the customer's written statement that he or she was residing in the U.S., a U.S. possession, or Puerto Rico on January 13, 1941; or

• Shows Puerto Rican citizenship and the customer's written statement that he or she was residing in Puerto Rico on March 1, 1917 and that the customer did not take an oath of allegiance to Spain.

Evidence of birth or residence in the U.S. Virgin Islands

• Shows birth in the U.S. Virgin Islands and the customer's written statement of residence in the U.S., a U.S. possession, or the U.S. Virgin Islands on February 25, 1927;

• Shows birth in the U.S. Virgin Islands and the customer's written statement indicating residence in the U.S., a U.S. possession or territory, or the Canal Zone on June 28, 1932; or

• Customer's written statement indicating residence in the U.S. Virgin Islands as a Danish citizen on January 17, 1917 and residence in the U.S., a U.S. possession, or the U.S. Virgin Islands on February 27, 1927 and indicating that the customer did not make a declaration to maintain Danish citizenship.

Evidence of birth, in the  Trust Territory of the Pacific Islands (TTPI) citizenship, or continuous residency in the Northern Mariana Islands

• Evidence of birth in the Northern Mariana Islands, Trust Territory of the Pacific Islands ("TTPI") citizenship, and residence in the Northern Mariana Islands, the U.S., or a U.S. territory or possession on November 3, 1986, and the customer's statement that he or she did not owe allegiance to a foreign state on November 4, 1986;

• Evidence of continuous residence in the Northern Mariana Islands since before November 3, 1981, voter registration before January 1, 1975, and the customer's statement that he or she did not owe allegiance to a foreign state on November 4, 1986; or

• Evidence of continuous domicile in the Northern Mariana Islands since before January 1 1974, and the customer's statement that he or she did not enter the Northern Mariana Islands as a nonimmigrant and that he or she did not owe allegiance to a foreign state on November 4, 1986.

Official Military Record of service

The document must show a U.S. place of birth or that the individual is a U.S. citizen (for example a DD-214 or similar official document showing a U.S. place of birth or that the individual is a U.S. citizen).

U.S. consular official's statement

Given to an individual born outside the U.S. who derives citizenship through a parent but does not have an FS-240, FS-545, or DS-1350.

Marriage to a U.S. citizen

Evidence that shows a female was married to a U.S. citizen before September 22, 1922.

NOTE: This proof is obtained by the AHCCCS staff.

If a customer who claims to be a naturalized citizen is able to provide the alien identification number, request a SAVE. If the SAVE verification comes back stating the customer is naturalized, this is proof of U.S. citizenship.

A child automatically acquires citizenship when they meet criteria of the Child Citizenship Act of 2000 (CCA). The CCA went into effect on February 27, 2001. The CCA was passed to expedite the citizenship process for an adopted or biological child born outside of the United States or its territories with at least one U.S. citizen parent.

• The parent is a citizen by birth, or is naturalized. (Provide proof documents of the parent’s U.S. citizenship and identity using MS 508.00 as a guide for types of documents that can be used for proof.)
• The child is under the age of 18. (Provide document to verify the child’s age, i.e., the child’s birth certificate)
• The child immigrates to the U.S. and has lawful permanent resident status. (Provide proof of child’s lawful permanent resident status, i.e., the child’s Permanent Resident Card, I-551; and verification of the document through SAVE as described in MS 522.04.)
• The child lives in the legal and physical custody of the U.S. citizen parent. (Provide proof that the citizen parent is residing in the U.S. and that the child is living with the parent, e.g., current mail addressed to parent; and a Statement of Facts from the parent that the child is residing with the parent.)
• An adopted abroad child acquires U.S. citizen status effective the date the child meets all the previously listed CCA requirements and the full and final adoption is completed. (Provide a copy of the final adoption papers.)

H. Documents that Prove Identity

The following is a list of types of documents that provide proof of identity only. When a document listed in MS 508.02.E through G is provided, also obtain a document listed in this manual subsection to prove the customer's identity. 

1. The following documents can be used to prove identity for all individuals. With the exception of the WTPY, expired documents are acceptable as proof of identity.

• A WTPY if WTPY indicates that the Social Security number is verified.

• A driver's license or identification card containing a photograph, issued by a state or an outlying possession of the United States.

Note: If the driver's license or identification card does not contain a photograph, the document can still be used as long as it contains identifying information such as a name, age, sex, race, height, weight, or eye color. 

• School identification card with a photograph

• U.S military card or draft record

• Identification card issued by federal, state, or local government agencies 

Note: If the identification card does not contain a photograph, the document can still be used as long as it contains identifying information such as a name, age, sex, race, height, weight, or eye color.

• Military dependent's identification card

• Certificate of Degree of Indian Blood, or other U.S. American Indian/Alaska Native tribal document with a photograph

NOTE: If the tribal document does not contain a photograph, the document can still be used as long as it contains identifying information such as a name, age, sex, race, height, weight, or eye color.

• United States Coast Guard Merchant Mariner Card

• Court documents for children in foster care

• A cross-match with a Federal or State governmental, public assistance, law enforcement, or corrections agency's data system

• Three or more corroborating documents such as, but not limited to: employee ID cards, high school and college diplomas, marriage licenses, divorce decrees, and property/deed titles. (NOTE: Only can be used if customer provided 2nd or 3rd level citizenship documentation and the document was not used to verify citizenship).

2. The following documents (current or expired) can be used to prove identity for children under age 16:

• School Record or report card

• Clinic, doctor, hospital, or immunization record

• Daycare or nursery school record

3. Affidavit for Identity

If no other document is available, an Affidavit Attesting Identity (DE-178) can be used for:

• Children under age 16, or;
• Children aged 16 to 18, when school identification cards or driver's licenses are not available where the child resides or the child is unable to attend school or get a driver's license due to disability, or;
• Incapacitated adults, or;
• Disabled individuals in institutional care facilities.

The Affidavit Attesting Identity (DE-178) is available to AHCCCS staff in the Forms Database.

The Affidavit Attesting Identity (DE-178) must be signed under penalty of perjury by one of the individuals described below stating the date and place of birth of the child, incapacitated adult, or disabled individual.

I. Native American Tribes

When dealing with members of Native American communities or tribes, obtain an ID card or other document that verifies that the person is a member of the community or a tribe if it is available.  In addition, ask for documentation of citizenship.  If that documentation is not available, contact the Central Office, Program Support Administration for additional instructions.

It is possible that some requirements for enrolled members of federally recognized tribes can be waived if there is proof that the person is an enrolled member.

For a list of federally recognized tribes see: http://a257.g.akamaitech.net/7/257/2422/01jan20051800/edocket.access.gpo.gov/2005/05-23268.htm

J. No Document

If the customer cannot provide documentation to establish citizenship, the following information may help the individual to obtain the needed information.  Listed below are some situations you may encounter and referral sources to assist the applicant:

In no case, should an application be denied or an active recipient discontinued without first referring the case to the Program Support Administration by sending an e-mail to "DMS-Citizenship."