Questions and Answers on Verification of
Citizenship and Immigration Status
Are the verification requirements with respect to
citizenship and immigration status the same for all applicants?
No. For purposes of the verification
requirements relating to citizenship and immigration status, it is useful to
divide applicants into four groups:
United States citizens and nationals
Immigrants who are “qualified aliens” and
who, as such, may apply for the full scope of coverage under a state’s
Medicaid or SCHIP state plan
Immigrants who are “non-qualified aliens”
and therefore eligible to apply only for coverage of emergency services
Non-immigrant aliens include non-citizens lawfully admitted to the
United States, but only for a temporary or limited period of time,
such as tourists, foreign diplomats and foreign students.
Non-immigrants do not meet the definition of a qualified alien and
therefore are never eligible for a separate child health program
under SCHIP or for the full range of services available under any
state’s Medicaid program. Non-qualified aliens may qualify for
emergency services under Medicaid. But because non-immigrants
generally will be unable to establish residency in any state, they
generally will be ineligible for emergency assistance under Medicaid
as well. However, in rare cases, a non-immigrant may be able to
establish residency, in which case he or she may be eligible for
emergency assistance under Medicaid, provided that all other
eligibility criteria are met. The Medicaid eligibility of
non-immigrants is discussed in §3211.10 of the State Medicaid
What steps are states
required under Federal law to take in verifying citizenship and/or immigration
Citizens, U.S. nationals and qualified aliens applying for Medicaid and SCHIP
must execute a declaration in writing, under penalty of perjury, stating that
they are a citizen or national of the United States or, if not a citizen or
national of the United States, that they are in satisfactory immigration status.
In the case of an unemancipated minor under age 18 or an incompetent adult, a
parent, legal guardian or other person legally qualified to act on the
applicant’s behalf must sign such a declaration.
Qualified aliens also must present documentation of their immigration status.
State and county Medicaid agencies must then verify an immigrant’s immigration
status with the Immigration and Naturalization Service (INS) through the
automated Systematic Alien Verification for Entitlements (SAVE) system, or by
using an alternative verification system approved under a waiver granted by the
Secretary of Health and Human Services. (It should be noted that the INS has
published proposed a regulation under which all states would be required to
verify the immigration status of non-citizens applying for Medicaid using SAVE;
states currently using an alternative system under an approved waiver would no
longer be permitted to do so. States would have 24 months to begin using SAVE
after publication of the final rule.)
Agencies responsible for determining eligibility for a separate child health
program under SCHIP have more flexibility in determining how to verify
immigration status. SCHIP agencies can apply to the INS for participation in
SAVE or use the alternative waiver system developed by the state for Medicaid,
but they are not required to do so.
Non-qualified aliens and non-immigrants applying for emergency assistance under
Medicaid are not required to sign a written declaration or otherwise provide
documentation of immigration status.
The procedures which states should follow in complying with these verification
requirements are discussed in more detail in section 3212 of the State Medicaid