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Documents that can be Used to Satisfy the Citizenship and Identity Requirements of the Deficit Reduction Act.

Here is a shortened version of the acceptable documents in each level.  For a complete list and description of the documents, you can view the Dear State Medicaid Director letter online.

Note that documents in the second through fourth level MUST be accompanied by proof of identity:

First Level (primary documentation establishes both identity and citizenship):

  • A U.S. Passport
  • A Certificate of Naturalization (DHS forms N-550 or N-570
  • A Certificate of U.S. Citizenship (DHS forms N-560 or N-561)

Second Level (must be accompanied by identity document):

  • A U.S. birth certificate issued by one of the states or territories
  • A certification of birth issued by the Department of State (Form DS-1350
  • A Report of Birth Abroad of a U.S. Citizen (Form FS-240)
  • A Certification of Birth Abroad (FS-545)
  • A U.S. Citizen I.D. Card (DHS form I-197 or prior version, I-179)
  • An American Indian Card (DHS I-872))
  • Final adoption decree
  • Evidence of civil service employment with the U.S. government before June 1976
  • An official military record of service showing a U.S. place of birth
  • A Northern Mariana Identification Card (INS I-873)

Third Level (must be accompanied by identity document):

  • Extract of hospital record on hospital letterhead established at the time of the person’s birth and was created at least 5 years before the initial application date and indicates a U.S. place of birth.
  • Life or health or other insurance record showing a U.S. place of birth and was created at least 5 years before the initial application date.

Fourth Level (must be accompanied by identity document):

  • Federal or state census record showing U.S. citizenship or a U.S. place of birth.
  • Other document that was created at least 5 years before the application for Medicaid and shows a U.S. place of birth, including:
    • A Seneca Indian tribal census record,
    • Bureau of Indian Affairs Tribal census records of the Navajo Indians
    • U.S. State Vital Statistics official notification of birth registration,
    • An amended U.S. public birth record that is amended more than 5 years after the person’s birth, and
    •   A statement signed by the physician or midwife who was in attendance at the time of birth
  • Institutional admission papers from a nursing home, skilled nursing care facility or other institution was created at least 5 years before the initial application date and indicates a U.S. place of birth
  • Medical (clinic, doctor, or hospital) record and was created at least 5 years before the initial application date and indicates a U.S. place of birth
  • Written affidavit (in rare circumstances.  Must be supplied by at least 2 individuals, including one who is not related to the individual and must have personal knowledge of the event establishing the claim of citizenship.)


Proof of Identity

For those using the second through fourth level of documents, the individual must also prove identity.

Acceptable documentation of identity:

  • Certificate of Indian Blood or other U.S. American Indian/Alaska native tribal document
  • A driver’s license either with a photograph or other identifying information
  • School identification card with photograph of the individual
  • U.S. military draft card or draft record
  • Identification card issued by the Federal, State, or local government with the same information included on driver’s licenses
  • Military dependent’s identification card
  • Native American tribal document
  • U.S. Coast Guard Merchant Mariner Card
  • For children under 16, school records may include nursery or daycare records.  If none of the above documents are available, an affidavit from the parent or guardian may be used, but only if an affidavit was not used to prove citizenship.

 

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