Iowa Code r. 441-75.11 - Citizenship or alienage requirements
(1)
Definitions.
"Care and services necessary for the treatment of an emergency medical condition" means services provided in a hospital, clinic, office or other facility that is equipped to furnish the required care for an emergency medical condition, provided the care and services are not related to an organ transplant procedure furnished on or after August 10, 1993. Payment for emergency medical services shall be limited to the day treatment is initiated for the emergency medical condition and the following two days.
"Emergency medical condition" means a medical condition of sudden onset (including labor and delivery) manifesting itself by acute symptoms of sufficient severity (including severe pain) that the absence of immediate medical attention could reasonably be expected to result in one or more of the following:
1. Placing the patient's health in serious
jeopardy.
2. Serious impairment to
bodily functions.
3. Serious
dysfunction of any bodily organ or part.
"Federal means-tested program" means all federal programs that are means-tested with the exception of:
1. Medical assistance for care and services
necessary for the treatment of an emergency medical condition not related to an
organ transplant procedure furnished on or after August 10, 1993.
2. Short-term, non-cash, in-kind emergency
disaster relief.
3. Assistance or
benefits under the National School Lunch Act.
4. Assistance or benefits under the Child
Nutrition Act of 1966.
5. Public
health assistance (not including any assistance under Title XIX of the Social
Security Act) for immunizations with respect to immunizable diseases and for
testing and treatment of symptoms of communicable diseases whether or not the
symptoms are caused by a communicable disease.
6. Payments of foster care and adoption
assistance under Parts B and E of Title IV of the Social Security Act for a
parent or a child who would, in the absence of numbered paragraph "1," be
eligible to have payments made on the child's behalf under such part, but only
if the foster or adoptive parent (or parents) of the child is a qualified alien
(as defined in Section 431).
7.
Programs, services, or assistance (such as soup kitchens, crisis counseling and
intervention, and short-term shelter) specified by the attorney general of the
United States in the attorney general's sole and unreviewable discretion after
consultation with appropriate federal agencies and departments, that:
* Deliver in-kind services at the community level, including through public or private nonprofit agencies;
* Do not condition the provision of assistance, the amount of assistance provided, or the cost of assistance provided on the individual recipient's income or resources; and
* Are necessary for the protection of life or safety.
8. Programs of
student assistance under Titles IV, V, IX, and X of the Higher Education Act of
1965, and Titles III, VII, and VIII of the Public Health Services
Act.
9. Means-tested programs under
the Elementary and Secondary Education Act of 1965.
10. Benefits under the Head Start
Act.
11. Benefits funded through an
employment and training program of the U.S. Department of Labor.
"Qualified alien" means an alien:
1. Who is lawfully admitted for permanent
residence in the United States under the Immigration and Nationality Act
(INA);
2. Who is granted asylum in
the United States under Section 208 of the INA;
3. Who is a refugee admitted to the United
States under Section 207 of the INA;
4. Who is paroled into the United States
under Section 212(d)(5) of the INA for a period of at least one year;
5. Whose deportation from the United States
is withheld under Section 243(h) of the INA as in effect before April 1, 1997,
or under Section 241(b)(3) of the INA as amended to December 20,
2010;
6. Who is granted conditional
entry to the United States pursuant to Section 203(a)(7) of the INA as in
effect before April 1, 1980;
7. Who
is an Amerasian admitted to the United States as described in
8 U.S.C. Section
1612(b)(2)(A)(i)(V);
8. Who is a Cuban/Haitian entrant to the
United States as described in 8 U.S.C. Section
1641(b)(7);
9. Who is a battered alien as described in
8 U.S.C. Section
1641(c);
10. Who is certified as a victim of
trafficking as described in
Section
107 (b)(1)(A) of
Public
Law 106-386 as amended to December 20,
2010;
11. Who is an American Indian
born in Canada to whom Section 289 of the INA applies or is a member of a
federally recognized Indian Tribe as defined in
25 U.S.C. Section
450b(e); or
12. Who is under the age of 21 and is
lawfully residing in the United States as allowed by
42 U.S.C. Section
1396b(v)(4)(A)(ii).
"Qualifying quarters" includes all of the qualifying quarters of coverage as defined under Title II of the Social Security Act worked by a parent of an alien while the alien was under age 18 and all of the qualifying quarters worked by a spouse of the alien during their marriage if the alien remains married to the spouse or the spouse is deceased. No qualifying quarter of coverage that is creditable under Title II of the Social Security Act for any period beginning after December 31, 1996, may be credited to an alien if the parent or spouse of the alien received any federal means-tested public benefit during the period for which the qualifying quarter is so credited.
(2)
Citizenship and alienage.
a.
To be eligible for Medicaid, a person must be one of the following:
(1) A citizen or national of the United
States.
(2) A qualified alien
residing in the United States before August 22, 1996.
(3) A qualified alien under the age of
21.
(4) A refugee admitted to the
United States under Section 207 of the Immigration and Nationality Act
(INA).
(5) An alien who has been
granted asylum under Section 208 of the INA.
(6) An alien whose deportation is withheld
under Section 243(h) or Section 241(b)(3) of the INA.
(7) A qualified alien veteran who has an
honorable discharge that is not due to alienage.
(8) A qualified alien who is on active duty
in the Armed Forces of the United States other than active duty for
training.
(9) A qualified alien who
is the spouse or unmarried dependent child of a qualified alien described in
subparagraph (7) or (8), including a surviving spouse who has not
remarried.
(10) A qualified alien
who has resided in the United States for a period of at least five
years.
(11) An Amerasian admitted
as described in 8 U.S.C.
Section
1612(b)(2)(A)(i)(V).
(12) A Cuban/Haitian entrant as described in
8 U.S.C. Section
1641(b)(7).
(13) A certified victim of trafficking as
described in Section
107 (b)(1)(A) of
Public
Law 106-386 as amended to December 20,
2010.
(14) An American Indian born
in Canada to whom Section 289 of the INA applies or who is a member of a
federally recognized Indian Tribe as defined in
25 U.S.C. Section
450b(e).
(15) An Iraqi or Afghan immigrant treated as
a refugee pursuant to Section 1244 (g) of
Public
Law 110-181 as amended to December 20, 2010, or to
Section
602 (b)(8) of
Public Law
111-8 as amended to December 20,
2010.
b. As a condition
of eligibility, each member shall complete and sign Form 470-2549, Statement of
Citizenship Status, attesting to the member's citizenship or alien status. When
the member is incompetent or deceased, the form shall be signed by someone
acting responsibly on the member's behalf. An adult shall sign the form for
dependent children.
(1) As a condition of
eligibility, all applicants for Medicaid shall attest to their citizenship or
alien status by signing the application form which contains the same
declaration.
(2) As a condition of
continued eligibility, SSI-related Medicaid members not actually receiving SSI
who have been continuous members since August 1, 1988, shall attest to their
citizenship or alien status by signing the application form which contains a
similar declaration at time of review.
(3) An attestation of citizenship or alien
status completed on any one of the following forms shall meet the requirements
of subrule 75.11(2) for children under the age of 19 who are otherwise eligible
pursuant to 441-subrule 76.1(8):
1.
Application for Food Assistance, Form 470-0306 or 470-0307 (Spanish);
2. Health and Financial Support Application,
Form 470-0462 or 470-0462(S); or
3.
Review/Recertification Eligibility Document, Form 470-2881, 470-2881(S),
470-2881(M), or 470-2881(MS).
c. Except as provided in paragraph
"f," applicants or members for whom an attestation of United
States citizenship has been made pursuant to paragraph "b"
shall present satisfactory documentation of citizenship or nationality as
defined in paragraph "d," "e," or "i." A
reference to a form in paragraph "d" or "e"
includes any successor form. An applicant or member shall have a reasonable
period to obtain and provide required documentation of citizenship or
nationality.
(1) For the purposes of this
requirement, the "reasonable period" begins on the date a written request for
documentation or a notice pursuant to subparagraph
75.11(2)"i"(2) is issued to an applicant or member, whichever
is later, and continues for 90 days.
(2) Medicaid shall be approved for new
applicants and continue for members not previously required to provide
documentation of citizenship or nationality until the end of the reasonable
period to obtain and provide required documentation of citizenship or
nationality. However, the receipt of Medicaid or hawki benefits pending
documentation of citizenship or nationality is limited to one reasonable period
of up to 90 days under either program for each individual. An applicant or
member who has already received benefits during any portion of a reasonable
period shall not be granted coverage for a second reasonable period except as
required to protect the confidentiality of an individual who received only
limited Medicaid benefits provided pursuant to subrule 75.1(41) during the
first period.
(3) Retroactive
eligibility pursuant to 441-subrule 76.13(3) is available only after
documentation of citizenship or nationality has been provided pursuant to
paragraph 75.11(2)"d," "e," or "i." The
retroactive months are outside the "reasonable period" during which Medicaid
coverage may be provided without required documentation of citizenship or
nationality.
d. Any one
of the following documents shall be accepted as satisfactory documentation of
citizenship or nationality:
(1) A United
States passport.
(2) Form N-550 or
N-570 (Certificate of Naturalization) issued by the U.S. Citizenship and
Immigration Services.
(3) Form
N-560 or N-561 (Certificate of United States Citizenship) issued by the U.S.
Citizenship and Immigration Services.
(4) A valid state-issued driver's license or
other identity document described in Section 274A(b)(1)(D) of the United States
Immigration and Nationality Act, but only if the state issuing the license or
document either:
1. Requires proof of United
States citizenship before issuance of the license or document; or
2. Obtains a social security number from the
applicant and verifies before certification that the number is valid and is
assigned to the applicant who is a citizen.
(5) Documentation issued by a federally
recognized Indian Tribe showing membership or enrollment in or affiliation with
that Tribe.
(6) Another document
that provides proof of United States citizenship or nationality and provides a
reliable means of documentation of personal identity, as the Secretary of the
U.S. Department of Health and Human Services may specify by regulation pursuant
to 42 U.S.C. Section
1396b(x)(3)(B)(v).
e. Satisfactory documentation of citizenship
or nationality may also be demonstrated by the combination of:
(1) Any identity document described in
Section 274A(b)(1)(D) of the United States Immigration and Nationality Act or
any other documentation of personal identity that provides a reliable means of
identification, as the secretary of the U.S. Department of Health and Human
Services finds by regulation pursuant to
42 U.S.C. Section
1396b(x)(3)(D)(ii),
and
(2) Any one of the following:
1. A certificate of birth in the United
States.
2. Form FS-545 or Form
DS-1350 (Certification of Birth Abroad) issued by the U.S. Citizenship and
Immigration Services.
3. Form I-97
(United States Citizen Identification Card) issued by the U.S. Citizenship and
Immigration Services.
4. Form
FS-240 (Report of Birth Abroad of a Citizen of the United States) issued by the
U.S. Citizenship and Immigration Services.
5. Another document that provides proof of
United States citizenship or nationality, as the secretary of the U.S.
Department of Health and Human Services may specify pursuant to
42 U.S.C. Section
1396b(x)(3)(C)(v).
f. A person for whom an attestation of United
States citizenship has been made pursuant to paragraph "b" is
not required to present documentation of citizenship or nationality for
Medicaid eligibility if any of the following circumstances apply:
(1) The person is entitled to or enrolled for
benefits under any part of Title XVIII of the federal Social Security Act
(Medicare).
(2) The person is
receiving federal social security disability insurance (SSDI) benefits under
Title II of the federal Social Security Act, Section 223 or 202, based on
disability (as defined in Section 223(d)).
(3) The person is receiving supplemental
security income (SSI) benefits under Title XVI of the federal Social Security
Act.
(4) The person is a child in
foster care who is assisted by child welfare services funded under Part B of
Title IV of the federal Social Security Act.
(5) The person is receiving foster care
maintenance or adoption assistance payments funded under Part E of Title IV of
the federal Social Security Act.
(6) The person has previously presented
satisfactory documentary evidence of citizenship or nationality, as specified
by the United States Secretary of Health and Human Services.
(7) The person is or was eligible for medical
assistance pursuant to 42
U.S.C. Section 1396a(e)(4)
as the newborn of a Medicaid-eligible mother.
(8) The person is or was eligible for medical
assistance pursuant to 42
U.S.C. Section 1397ll(e) as
the newborn of a mother eligible for assistance under a State Children's Health
Insurance Program (SCHIP) pursuant to Title XXI of the Social Security
Act.
g. If no other
identity documentation allowed by subparagraph 75.11(2)"e"(1)
is available, identity may be documented by affidavit as described in this
paragraph. However, affidavits cannot be used to document both identity and
citizenship.
(1) For children under the age of
16, identity may be documented using Form 470-4386 or 470-4386(S), Affidavit of
Identity, signed by the child's parent, guardian, or caretaker relative under
penalty of perjury.
(2) For
disabled persons who live in a residential care facility, identity may be
documented using Form 470-4386 or 470-4386(S), Affidavit of Identity, signed by
a residential care facility director or administrator under penalty of
perjury.
h. If no other
documentation that provides proof of United States citizenship or nationality
allowed by subparagraph 75.11(2)"e"(2) is available, United
States citizenship or nationality may be documented using Form 470-4373 or
470-4373(S), Affidavit of Citizenship. However, affidavits cannot be used to
document both identity and citizenship.
(1)
Two affidavits of citizenship are required. The person who signs the affidavit
must provide proof of citizenship and identity. A person who is not related to
the applicant or member must sign at least one of the affidavits.
(2) When affidavits of citizenship are used,
Form 470-4374 or 470-4374(S), Affidavit Concerning Documentation of
Citizenship, or an equivalent affidavit explaining why other evidence of
citizenship does not exist or cannot be obtained must also be submitted and
must be signed by the applicant or member or by another knowledgeable person
(guardian or representative).
i. In lieu of a document listed in paragraph
"d" or "e," satisfactory documentation of
citizenship or nationality may also be presented pursuant to this paragraph.
(1) Provision of an individual's name, social
security number, and date of birth to the department shall constitute
satisfactory documentation of citizenship and identity if submission of the
name, social security number, and date of birth to the Social Security
Administration produces a response that substantiates the individual's
citizenship.
(2) If submission of
the name, social security number, and date of birth to the Social Security
Administration does not produce a response that substantiates the individual's
citizenship, the department shall issue a written notice to the applicant or
member giving the applicant or member 90 days to correct any errors in the
name, social security number, or date of birth submitted, to correct any errors
in the Social Security Administration's records, or to provide other
documentation of citizenship or nationality pursuant to paragraph
"d" or "e."
(3)
Deeming of sponsor's income and
resources.
a. When an alien admitted
for lawful permanent residence is sponsored by a person who executed an
affidavit of support as described in
8 U.S.C. Section
1631(a)(1) on behalf of the
alien, the income and resources of the alien shall be deemed to include the
income and resources of the sponsor (and of the sponsor's spouse if living with
the sponsor). The amount deemed to the sponsored alien shall be the total gross
countable income and resources of the sponsor and the sponsor's spouse for the
FMAP-related or SSI-related coverage group applicable to the sponsored alien's
household as described in
441-75.13 (249A) less the
following deductions:
(1) For FMAP-related
coverage groups: The same income deductions, diversions, and disregards allowed
for stepparent cases as described at 75.57(8)"b" and a $1,500
resource deduction.
b. An indigent
alien is exempt from the deeming of a sponsor's income and resources for 12
months after indigence is determined. An alien shall be considered indigent if
the following are true:
(1) The alien does
not live with the sponsor; and
(2)
The alien's gross income, including any income actually received from or made
available by the sponsor, is less than 100 percent of the federal poverty level
for the sponsored alien's household size.
c. A battered alien as described in
8 U.S.C. Section
1641(c) is exempt from the
deeming of a sponsor's income and resources for 12 months.
d. Deeming of the sponsor's income and
resources does not apply when:
(1) The
sponsored alien attains citizenship through naturalization pursuant to Chapter
2 of Title II of the Immigration and Nationality Act.
(2) The sponsored alien has earned 40
qualifying quarters of coverage as defined in Title II of the Social Security
Act or can be credited with 40 qualifying quarters as defined at subrule
75.11(1).
(3) The sponsored alien
or the sponsor dies.
(4) The
sponsored alien is a child under age 21.
(5) For SSI-related Medicaid, the sponsored
alien becomes blind or disabled as defined under Title XVI of the Social
Security Act after admission to the United States as a lawful permanent
resident.
(6) For SSI-related
Medicaid, three years after the date the sponsored alien was admitted to the
United States as a lawful permanent resident.
(4)
Eligibility for payment of
emergency medical services. Aliens who do not meet the provisions of
subrule 75.11(2) and who would otherwise qualify except for their alien status
are eligible to receive Medicaid for care and services necessary for the
treatment of an emergency medical condition as defined in subrule 75.11(1). To
qualify for payment under this provision:
a.
The alien must meet all other eligibility criteria, including state residence
requirements provided at rules
441-75.10 (249A) and
441-75.53 (249A), with the
exception of rule 441-75.7 (249A) and subrules
75.11(2) and 75.11(3).
b. The
medical provider who treated the emergency medical condition or the provider's
designee must submit verification of the existence of the emergency medical
condition on either:
(1) Form 470-4299,
Verification of Emergency Health Care Services; or
(2) A signed statement that contains the same
information as requested by Form 470-4299.
This rule is intended to implement Iowa Code section 249A.3.
Notes
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