SR 08-06 Dated 07/06 |
STATE OF NEW HAMPSHIRE
INTER-DEPARTMENT COMMUNICATION
DFA SIGNATURE DATE: |
November 18, 2008 |
FROM: |
OFFICE OF THE DIRECTOR, DFA Terry R. Smith |
AT (OFFICE): |
Division of Family Assistance |
TO: |
DFA Supervisors
|
SUBJECT: |
New Citizenship and Identity Requirements for Most Applicants and Recipients of All Categories of Financial and Medical Assistance; Release of Revised Form 77C, NH State Supplement Program; Form 800, Application for Assistance; Form 800AN, Applicant Notice 30-day Letter; Form 800P, Application for NH Healthy Kids Medical Insurance or Medical Coverage for Pregnant Women; Form 807, Interview Appointment Notice; Form 808, Proof Needed to Determine Your Assistance; Form 808P, Information Necessary to Support Your Medical Coverage Application; and Form 811S, Application: Statements of Understanding |
EFFECTIVE DATE: |
July 1, 2006 |
SUMMARY
This SR releases policy requiring stricter verification of citizenship and identity for most applicants and recipients of all categories of financial and medical assistance to incorporate and expand changes that were:
§ mandated by the Centers for Medicare and Medicaid Services (CMS), and resulting changes to 42 CFR 435.406, and 42 CFR 435.407; and
§ enacted by administrative rules promulgated at He-W 606.02 and He-W 606.28.
In addition, the policy in this SR incorporates and expands upon the identity and citizenship verification policy changes associated with the Director’s Memos dated:
§ June 26, 2006, subject line, Deficit Reduction Act of 2005 – Verification of Citizenship and Identity for All Medicaid Applicants and Recipients Effective 07/01/2006; and
§ August 8, 2006, subject line, Deficit Reduction Act of 2005 – Updated Information Re: Verification of Citizenship and Identity for All Medicaid Applicants and Recipients Effective 07/01/2006.
Most applicants and recipients of all categories of financial and medical assistance must now provide original documentation as outlined in the 4-tiered chart in the POLICY section of this SR to verify identity and citizenship. However, the new requirements do not affect:
· individuals who are entitled to or enrolled in any part of Medicare (Part A, Part B, or Part D, for example);
· individuals who receive Supplemental Security Income (SSI) – verified via the State Data Exchange (SDX);
· individuals who receive Social Security Disability Insurance (SSDI);
· presumptive eligibility for children or pregnant women;
· eligibility for Healthy Kids Silver;
· newborn infants born to women who are Medicaid recipients, for 1 year from their date of birth, as long as the child remains a member of the mother’s household and the mother continues to reside in NH; and
· children receiving either Title IV-B services or Title IV-E adoption or foster care payments.
The following forms required revisions to incorporate the new policy:
· Form 77c, NH State Supplement Program;
· Form 800, Application for Assistance;
· From 800AN, Applicant Notice 30-day Letter;
· Form 800P, Application for NH Healthy Kids Medical Insurance or Medical Coverage for Pregnant Women;
· Form 807, Interview Appointment Notice;
· Form 808, Proof Needed to Determine Your Assistance;
· Form 808P, Information Necessary to Support Your Medical Coverage Application; and
· Form 811S, Application: Statements of Understanding.
FORMER POLICY |
NEW POLICY |
Photocopies of documents were accepted as verification of proof of identity and citizenship. |
Only original documents or copies certified by the issuing agency will be considered acceptable proof of identity or citizenship. |
Various documents were deemed acceptable as proof of citizenship and identity. |
Only documents as defined in the 4-tiered verification chart below will be considered acceptable proofs of citizenship and identity. |
District Office staff verified the individual’s citizenship and identity and noted such in case file. |
Notation must be made in the case file as to the specific type of original documentation that was provided for proof of identity and citizenship for federal auditing purposes. Once available, District Office staff will additionally use a checklist in New HEIGHTS to record the specific type of original documents provided by the individual to verify citizenship and identity. |
POLICY
Only the documents detailed below are considered acceptable forms of proof for citizenship and identity when applying for all categories of cash and medical assistance.
ALL CITIZENSHIP AND IDENTITY DOCUMENTS MUST BE ORIGINALS
OR COPIES CERTIFIED BY THE ISSUING AGENCY.
NOTARIZED COPIES ARE NOT CONSIDERED VALID PROOFS.
TIER I |
PROOF OF BOTH CITIZENSHIP AND IDENTITY |
US Passport |
Certificate of Naturalization |
Certificate of US Citizenship |
TIER II |
FOR PROOF OF CITIZENSHIP: DOCUMENTS IN TIER I MUST BE UNAVAILABLE TO THE INDIVIDUAL BEFORE USING THIS LEVEL OF VERIFICATION. ADDITIONALLY, THE INDIVIDUAL MUST PROVIDE: 1 CITIZENSHIP DOCUMENT FROM COLUMN A BELOW ALONG WITH 1 IDENTITY DOCUMENT FROM COLUMN B BELOW. |
COLUMN A: |
COLUMN B: |
CITIZENSHIP DOCUMENTS: |
IDENTITY DOCUMENTS: |
US Birth Certificate |
Picture Driver’s License |
Certification of Report of Birth |
Picture School ID |
Report of Birth Abroad |
US Military or Draft Card |
Certification of Birth by Dept. of State |
State, Federal, or local government ID Card |
Birth Record Documented by Cross-Match with State Vital Statistics (Document must have been recorded before the individual was 5 years of age.) |
Certificate of Degree of Indian Blood or Tribal Document with Picture |
US Citizen ID Card |
Military Dependent ID Card |
Northern Mariana ID Card |
US Coast Guard Merchant Marine Card |
Evidence of US Civil Service Employment (prior to 6/1/76) |
3 or more documents together, having the individual’s name, consistent identifying information, & prior approval from the DO supervisor, including: Employer ID Cards High School/College diplomas or GED from accredited schools Marriage Certificates Divorce Decrees Property Deeds/Titles |
Final Adoption Decree |
|
US Military Record |
|
Data Verification with SAVE Program |
|
Child Citizenship Act |
|
Special Populations Needing Assistance Physically or mentally incapacitated individuals without a representative must be assisted in obtaining documentary evidence of citizenship. |
Special Identity Rules for Children Aged 15 and Under Clinic, doctor, hospital or school records including nursery/daycare records or report cards. (School records must be verified with the school). |
Special Identity Rules for Disabled Individuals in Institutional Care Facilities An identity affidavit signed by the institution’s director or administrator on behalf of the individual |
TIER III
FOR PROOF OF CITIZENSHIP: CITIZENSHIP DOCUMENTS IN TIER I OR II MUST BE UNAVAILABLE TO THE INDIVIDUAL BEFORE USING THIS LEVEL OF VERIFICATION. ADDITIONALLY, THE INDIVIDUAL MUST DECLARE BIRTH IN THE US AND MUST ALSO PROVIDE AN IDENTITY DOCUMENT FROM TIER II ABOVE. |
Hospital record on hospital letterhead, established at time of birth & 5 years prior to initial application date for assistance, showing US place of birth. Do not accept "souvenir" birth certificates from a hospital. |
Life, health, or other insurance record, created 5 years prior to initial application date for assistance, showing US place of birth. |
Official religious document, recorded with the religious organization in the US within 3 months of birth, showing US place of birth, & date of birth or individual’s age at time of recording. |
Early school records showing a US place of birth, name of child, date of admission to school, date of birth, and name(s) and place(s) of birth of applicant’s parents. |
TIER IV
FOR PROOF OF CITIZENSHIP: CITIZENSHIP DOCUMENTS FROM TIERS I, II OR III MUST BE UNAVAILABLE TO THE INDIVIDUAL BEFORE USING THIS LEVEL OF VERIFICATION. ADDITIONALLY, THE INDIVIDUAL MUST DECLARE BIRTH IN THE US AND MUST ALSO PROVIDE AN IDENTITY DOCUMENT FROM TIER II ABOVE. |
Federal or state census record showing US Citizenship or US place of birth and age. |
One of the following documents showing a US place of birth & created at least 5 years prior to initial application date for assistance: Seneca Indian tribal census; Bureau of Indian Affairs tribal census records of Navajo Indians; US State Vital Statistics official notification of birth registration A delayed US public birth record (recorded more than 5 yrs. after time of birth); Statement from the physician or midwife who was in attendance at time of birth; or Roll of Alaska Natives maintained by the Bureau of Indian Affairs. |
Institutional admission papers from a nursing facility, skilled care facility or other institution, showing US place of birth and created at least 5 years prior to application date for assistance. |
Medical (clinic, doctor or hospital) record indicating US place of birth & created at least 5 years prior to date of application for assistance. |
Written affidavit. There must be at least 2 affidavits by separate individuals, neither of which can be related to or be the applicant or recipient. The individuals must have personal knowledge of the event(s) establishing the applicant’s or recipient’s claim of citizenship, and must be able to provide proof of their own citizenship and identity. |
The following individuals are exempt from the new identity and citizenship requirements:
· individuals who are entitled to or enrolled in Medicare;
· individuals who receive SSI, verified via the SDX;
· individuals who receive SSDI;
· children or pregnant women determined to be presumptively eligible for medical assistance;
· individuals eligible for Healthy Kids Silver;
· newborn infants born to women who are Medicaid recipients, for 1 year from their date of birth, as long as the child remains a member of the mother’s household and the mother continues to reside in NH, regardless of the mother’s immigration status. This group includes children whose births were covered by Emergency Medicaid for Non-Citizens; and
· children receiving either Title IV-B services or Title IV-E adoption or foster care payments.
FORMS REVISIONS
To conform to the mandated changes regarding stricter verification requirements for citizenship and identity, the following standardized text was added to Form 800AN, Form 807, Form 808, and Form 808P wherever "Examples of Acceptable Proof" of citizenship and identity are listed:
IDENTITY — For all household members - If age 16 or older, a picture ID is required: US passport, Driver’s license with picture, US military photo ID, picture school ID. For children aged 15 and under: medical, daycare, or school records may be used. Contact your FSS for more examples if you do not have an original document of one of these proofs.
CITIZEN/IMMIGRATION STATUS of each individual applying for assistance - US passport, US birth or baptismal certificate, INS Form 551, INS Form I-94, naturalization papers. Contact your FSS for more examples if you do not have an original document of one of these proofs.
Additional forms revisions released in this SR are detailed below:
· Form 77c, NH State Supplement Program: Text was added under the Where Do You Apply? heading to require that applicants bring original documents to the initial interview as proof of their citizen/alien status;
· Form 800, Application for Assistance: New text was added in the Citizenship and Identity section to require verification of citizenship and identity for all applicants of cash assistance as well as MA applicants. An additional unrelated text change was made on the last page, Statements of Understanding, to indicate that unused FS benefits will be removed from EBT accounts after 365 days of inactivity (per SR 08-24, dated October, 2008), instead of 270 days as previously indicated.
· Form 800AN, Applicant Notice 30-day Letter: Additional changes were made to the first page based on federal clarification of 7 CFR 273.2(e)(3). The form was revised in December 2006 to add specific dates and times for the initial application interview, as mandated by Food Stamp Program regulations. Subsequent information was provided by Food Stamp Program staff at the federal level related to when those interviews had to take place, requiring further updates to the form. Because the Form 800AN is electronic, the District Office is responsible for ensuring that the newly revised template is available in the shared drive for the office so that all office personnel may print it out on pink letterhead as needed;
· Form 800P, Application for NH Healthy Kids Medical Insurance or Medical Coverage for Pregnant Women: Text was revised to indicate that applicants must provide original documents in person at initial eligibility interviews and that photocopies are not acceptable proof of citizenship and identity; and
· Form 811S, Application: Statements of Understanding: In an unrelated revision regarding the length of inactivity during which Food Stamp benefits could remain in an individual’s EBT account, 270 days was changed to 365 days as the time period for expunging unused Food Stamp benefits from EBT cards, per SR 08-24, dated October, 2008.
The instructions to the above forms were not revised, as the use of the forms remains unchanged. All current versions of the forms can be used until the supply is exhausted. New versions of the forms will then be printed. Form 800AN, distributed electronically with the release of this SR, may be used immediately upon receipt.
NEW HEIGHTS SYSTEMS PROCEDURES
New HEIGHTS has incorporated the "Examples of Acceptable Proofs" text into all New HEIGHTS-generated forms or letters.
Automation of the 4-tiered citizenship and identity requirements is currently in development. New HEIGHTS will release information on the automation once it is available.
POLICY MANUAL REVISIONS
Revised Family Assistance Manual Topics
Section 301.07 Verification of Identity
Section 305.05 Verification of Citizenship
Revised Adult Assistance Manual Topics
Section 305.05 Verification of Citizenship and Identity
IMPLEMENTATION
Policy
The policy released in this SR is retroactively effective to July 2006. The release of policy was postponed due to the delayed release of the final CMS regulations that necessitated administrative rule and system revisions. However, no District Office action is needed to implement retroactively because many of the policies were implemented via the Director’s Memos that were identified in the SUMMARY section of this SR. As such, the citizenship and identity of affected recipients have already been verified and this official release of policy impacts new applicants only.
Forms
All forms and rules in this SR are effective October 2008.
Because the Form 800AN is electronic, the District Office is responsible for ensuring that the newly revised template is available in the shared drive for the office so that all office personnel may print it out on pink letterhead as needed.
The previous paper versions of the following forms may continue to be provided to applicants and recipients until the current stocks are exhausted. When the current supplies are depleted, the new versions will be printed:
Form 77c, NH State Supplement Program;
· Form 800, Application for Assistance;
· Form 800P, Application for NH Healthy Kids Medical Insurance or Medical Coverage for Pregnant Women;
· Form 807, Interview Appointment Notice;
· Form 808, Proof Needed to Determine Your Assistance;
· Form 808P, Information Necessary to Support Your Medical Coverage Application; and
· Form 811S, Application: Statements of Understanding.
CLIENT NOTIFICATION
Existing recipients were notified through special text that was added to the New HEIGHTS-generated CS0001, Interview Appointment Notice, and CS0005, Mail-In Application for Redetermination, for the duration of one year beginning in July of 2006.
Additionally, notification of the change in citizenship and identity verification requirements for financial and medical assistance was published in the NH Rulemaking Register, Office of Legislative Services, on July 18, 2008. A public hearing on the amended Administrative Rules He-W 606.02 and He-W 606.28, was held on August 8, 2008.
No additional client notification is planned or needed.
TRAINING
A DFA remote Centra training was held on July 30, 2007. No additional training is planned.
FORMS MANUAL POSTING INSTRUCTIONS
Remove and Destroy |
Insert
|
Forms Manual
Form 77c, NH State Supplement Program SR 06-06/April, 2006 1 sheets |
Form 77c, NH State Supplement Program SR 08-06/October, 2008 1 sheets |
Form 800, Application for Assistance SR 08-17/February, 2006 4 sheets |
Form 800, Application for Assistance SR 08-06/October, 2008 4 sheets |
Form 800AN, Applicant Notice 30-day Letter SR 06-15/ December, 2006 1 Sheet |
Form 800AN, Applicant Notice 30-day Letter SR 08-06/ October, 2008 1 Sheet |
Form 800P, Healthy Kids Application SR 07-27/November, 2007 4 Sheets |
Form 800P, Healthy Kids Application SR 08-06/October, 2008 4 Sheets |
Form 807, Interview Appointment Notice SR 95-3/January, 1995 1 Sheet |
Form 807, Interview Appointment Notice SR 08-06/October, 2008 1 Sheet |
Form 808, Proof needed to Determine Your Assistance, SR 05-07/December, 2005 1 Sheet |
Form 808, Proof needed to Determine Your Assistance, SR 08-06/October, 2008 1 Sheet |
Form 808P, Information Necessary to Support Your Medical Coverage Application SR 99-02/January, 1999 1 Sheet |
Form 808P, Information Necessary to Support Your Medical Coverage Application SR 08-06/October, 2008 1 Sheet |
811S, Application: Statements of Understanding SR 08-17/February, 2006 1 Sheet |
811S, Application: Statements of Understanding SR 08-06/October, 2008 1 Sheet |
DISPOSITION
This SR may be destroyed or deleted after its contents have been noted and the revised manual topics released by this SR have been posted to the On-line manuals.
DISTRIBUTION
This SR will be distributed according to the electronic distribution list for Division of Family Assistance policy releases. This SR, and revised On-Line Manuals, will be available for agency staff in the On-Line Manual Library, and for public access on the Internet at http://www.dhhs.nh.gov/DHHS/DFA/LIBRARY, effective January 5, 2009.
This SR, and printed pages with posting instructions, will be distributed under separate cover to all hard copy holders of the Adult Assistance Manual, the Family Assistance Manual, and the Forms Manual.
DFA/KD:s