Kansas Department of Health & Environment

Kansas Family Medical Assistance

Manual (KFMAM)


Eligibility Policy - 12/16/2019

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02040 Citizenship and Alien Status - Eligibility for assistance shall be limited to those individuals who are citizens or who meet qualified non-citizen status as specified in 2043.

Non-citizens who are not described in 2043, including persons not lawfully admitted to the United States and persons admitted for temporary purposes, shall not be eligible for benefits, except for emergency medical benefits as described in KEESM 2691. This is true even though the non-citizen may be receiving other government benefits such as Medicare. Other examples of non-eligible persons include those who are granted stays of deportation, persons admitted under the Family Unity provision, foreign visitors, tourists, diplomats, or students who enter the United States temporarily with no intention of abandoning their residence in a foreign country. A non-citizen who enters the United States for a limited period of time and subsequently decides to remain in the United States must go back to USCIS and obtain appropriate documentation before his or her eligibility can be established.

At the time of application, the client who signs the application form certifies under penalty of perjury the truth of the information concerning citizenship and non-citizen status of all household members for whom assistance is requested.

NOTE: For cases in which assistance is provided on behalf of a child, such as CHIP, only the citizenship or non-citizen status of the child who is the primary beneficiary is relevant for eligibility purposes.

2041 Citizens - Citizens of the United States of America include persons born in any of the 50 states, the District of Columbia, Puerto Rico, Guam, the United States Virgin Islands, American Samoa, Swains Island, and the Northern Mariana Islands. Persons born in the Panama Canal Zone from 1904 to October 1, 1979 received citizenship at birth if one or both parents were a U.S. citizen. In addition, based on the provisions of the Child Citizenship Act, children born outside of the United States who are under 18, admitted to the U.S. as a lawful permanent resident, and in the legal and physical custody of a citizen parent are considered citizens at birth per 2041.01 and meet citizenship criteria automatically.

Note: Citizens of Micronesia, Palau, and the Marshall Islands have the right to enter, work, and establish residence as a non-immigrant in the United States. They are not considered citizens of the United States and must meet the qualifications of 2042 to receive medical

2041.01 Citizens at Birth - With the exception of individuals born in the U.S. to foreign sovereigns or diplomatic officers, all individuals born in the United States are U.S. citizens. Most other individuals born outside the U.S. must become citizens through Naturalization. However, certain children born outside the United States establish citizenship at birth without completing the naturalization process. These individuals are also considered citizens at birth. Although individuals who meet the criteria were issued immigration documents in order to enter the United States, some may not have obtained a Certificate of Citizenship from the Department of Homeland Security (formerly INS).

Foreign-born individuals born to or adopted by at least one citizen parent are potentially considered citizens at birth. The following rules shall be considered when determining if a foreign-born individual is a citizen at birth.

(1) For persons born on or before January 31, 1941 - At least one parent is a citizen who lived in the U.S. prior to the child's birth.

(2) For persons born between January 14, 1941 and November 13, 1986 - If both parents are citizens, at least one resided in the U.S. prior to the child's birth. If one parent is a U.S. citizen, the citizen parent must have lived in the U.S. for at least 10 years.

(3) For persons born after November 14, 1986 who are over the age of 18 - If both parents are citizens, at least one resided in the U.S. prior to the child's birth. If one parent is a U.S. citizen, the citizen parent must have lived in the U.S. for at least 5 years.

(4) For children under age 18 - The Child Citizenship Act of 2000 went into effect on February 27, 2001 and provides automatic citizenship to certain foreign-born children. Automatic citizenship occurs on the date the following criteria have all been met:

- The child has at least one U.S. citizen parent (by birth or naturalization);
- The child is currently residing permanently in the United States in the legal and physical custody of the U.S. citizen parent; and
- The child is a lawful permanent resident.

This includes both natural and adopted children. These children generally enter the country with an IR-3 visa. It is not a requirement that the above criteria are achieved in a specified order, rather that the automatic citizenship is conferred upon the child on the date when all criteria have been achieved.

Individuals who were under 18 and living in the U.S. on February 27, 2001 and met the new criteria also became citizens on that date.

See 2046 for citizenship documentation requirements

2042 Qualified Non-Citizen Status - Eligibility for medical (including Medicaid and CHIP) benefits is limited to the following groups of qualifying non-citizens who also meet state residency requirements. Documentation requirements are specified in KEESM appendix item A-1, Non-Citizen Qualification Chart. The 5 year ban on receipt of assistance described in 2044 does NOT apply to the following non-citizens.

2043 Eligible Non-Citizens - The following non-citizens are eligible for medical benefits.

2043.01 - Refugees admitted under 207 of the Immigration and Nationality Act (INA);

2043.02 - Asylees granted asylum under 208 of the INA;

2043.03 - Aliens whose deportation has been withheld under Section 243 (h) of the INA;

2043.04 - Cuban or Haitian entrants as defined in section 501 of the Refugee Education Assistance Act of 1980;

2043.05 - Persons admitted as an Amerasian Immigrant pursuant to section 584 of the Foreign Operational Export Financing, and Related Programs Appropriations Act of 1988;

2043.06 - Persons who are honorably discharged veterans or are on active duty in the United States armed forces. In addition, the spouse and/or dependent children of such persons would also be deemed as meeting qualified non-citizen status. (Includes individuals who served in the Philippine Commonwealth Army during WW II or as Philippine Scouts following the war. This change is pursuant to the Balanced Budget Act of 1997.);

2043.07 - Persons who have obtained lawful permanent residence status and who entered the U.S. on or before August 22, 1996. This includes persons who did not obtain lawful permanent resident status until after August 22, 1996 (Also see 2047.);

2043.08 - Persons granted parole or conditional entry status and who entered the U.S. on or before August 22, 1996. This includes persons who did not obtain such status until after August 22, 1996; and

2043.09 - Persons who do not meet one of the other qualifying statuses, but who have been battered or subject to extreme cruelty by a U.S. citizen or lawful permanent resident spouse or parent and who entered the U.S. on or before August 22, 1996. Such persons must have a pending or approved Violence Against Women Act (VAWA) case or family-based petition before USCIS. This also includes the person's children who have also been battered or subject to extreme cruelty.

2043.10 - American Indians born in Canada to whom the provisions of Section 289 of the USCIS apply and members of an Indian Tribe as defined in Section 4(e) of the Indian Self-Determination and Education Assistance Act. This provision is intended to cover Native Americans who are entitled to cross the U.S. border into Canada. This includes among others, the St. Regis Band of the Mohawk in New York State, the Micmac in Maine, and the Abanaki in Vermont.

2043.11 - Non-citizens who are certified victims of severe forms of trafficking, and some family members, who are admitted to the U.S. as refugees under section 207 of the INA. See KEESM 2144

2044 Non-Citizens Who Qualify After 5 Years From the Date of Entry or the Date Status Was Granted - The following non-citizens who entered the U.S. after August 22, 1996 qualify for medical benefits (if otherwise eligible) after they have been in the country for 5 years from the date of entry, or have had the listed statuses for five years.

If they have not been in the country for five years from date of entry, they do not meet non-citizen criteria and are ineligible.

The date of entry for persons who entered the country on or after August 22, 1996 is the date the individual attained one of the qualifying statuses listed below. The date the immigrant actually entered the country is not relevant unless it is prior to August 22, 1996. The five year bar begins to run from the date the immigrant obtains a qualified status.

2044.01 - Persons lawfully admitted for permanent residence;

2044.02 - Persons granted parole or conditional entry status;

2044.03 - Persons who do not meet one of the statuses listed in (2044.01) or (2044.02) above, but who have been battered or subject to extreme cruelty by a U.S. citizen or lawful permanent resident spouse or parent with pending or approved Violence Against Women Act (VAWA) cases or family-based petitions before USCIS. This also includes the person's children who have also been battered or subject to extreme cruelty.

2045 Documentation of U.S. Citizenship and Identity - Documentation of U.S. citizenship and identity is required prior to receiving Title 19 Medicaid and Title 21 CHIP coverage for individuals claiming to be U.S. citizens. This requirement does not apply to the following individuals:

(1) - Current or former SSI recipients

(2) - Current or former Medicare beneficiaries

(3) - Current or former recipients of Social Security Disability benefits

(4) - Children in foster care or recipients of foster care maintenance

(5) - Children who are recipients of adoption support payments

(6) - Children born on or after July 1, 2006 to a Medicaid recipient as outlined in 2320.

Note: Newborns born to a Title XXI recipient are not required to provide the verification of citizenship and identity to initially receive coverage. Verification of citizenship and identity is required at the end of their continuous eligibility period.

Documentation of citizenship and identity may be maintained in paper or electronic format. Electronic records may include databases or other records that meet the requirements of acceptable documentation as further outlined below. When the case file is maintained in a paper format, all documents used to verify citizenship and identity must be recorded on the ES-3850, Record of Identity and Citizenship. For those cases maintained in an electronic format, an electronic version of the ES-3850 is sufficient.

When an electronic case file is converted to a paper case file, the ES-3850 must be completed. For those electronic records which cannot be printed, the ES-3850 must indicate what source was used to verify the information, along with indication of when it was verified.

All documents used to verify citizenship and identity must be recorded in the case file indefinitely per 1602 (8).

Note: For verification of citizenship and identity, it is acceptable to access the file in Tier 3 to determine if documentation has previously been provided before accessing the Tier 2 sources. Both Tier 2 and Tier 3 must be followed before proceeding to Tier 4.


Acceptable documents and the hierarchical protocol for obtaining acceptable documents are described in the KEESM Appendix Item A-12. When obtaining documents the following applies:

2045.01 Primary Document - A document that verifies both citizenship and identity as defined in KEESM Appendix Item A-12. The availability of a Primary Document shall be explored prior to using a secondary or other document. Persons born outside of the United States who were not citizens at birth per 2040 must submit a Primary Document.

2045.02 Secondary Documents - If a primary document is not used, two different documents must be used to establish citizenship and identity. The statement of the applicant/recipient that a Primary Document is not available is sufficient to seek a secondary or other document. In addition, the receipt of a secondary or other document indicates that a primary document is not available.

2045.03 Third and Fourth Level Documents - These may only be used if primary or secondary documents are not available. The document provided for citizenship must show a place of birth and it must match the place of birth reported by the applicant/recipient. A second document verifying identity is also needed.

If a second, third, or fourth level document is received this is accepted as a statement from the consumer that no other primary document was available.

2045.04 Written Declaration of Citizenship - A written declaration may be used as verification of citizenship if no other documents are available. The EES Program Administrator/KanCare Clearinghouse Manager or designee must approve the declaration in order for it to be considered acceptable verification.

Declarations must be provided by at least two individuals, one of whom is not related to the individual, who have personal knowledge of the event(s) establishing the claim of citizenship. KEESM Appendix P-8, Third Party Declaration of Citizenship, may be used for this purpose. The person(s) making the declaration must:

(a) provide proof of his/her own citizenship and identity,

(b) provide information regarding why documentary evidence establishing the individual's claim of citizenship does not exist or cannot be readily obtained as part of the declaration, and

(c) sign the declaration under penalty of perjury in the presence of a witness.

When a declaration is used to document citizenship, the original must be retained in the case file indefinitely.

2045.05 Written Declaration of Identity - A written declaration may be used to establish identity for children under age 16 or disabled adults if no other documents are available. If a declaration is used to establish citizenship it cannot also be used to establish identity. KEESM Appendix item P-7, Declaration of Identity for Children and item P-9, Declaration of Identity for Disabled Adults, must be used for this purpose. The EES Program Administrator/KanCare Clearinghouse manager must approve the declaration in order for it to be considered acceptable verification.

The person making the declaration must:

(a) be a United States citizen,

(b) sign the declaration under penalty of perjury in the presence of a witness, and

(c) for children, must be the parent, legal guardian, or caretaker relative of the child;

(d) for disabled adults, must be the director or administrator of a residential care facility where the individual resides.

When a declaration is used to document identity, the original must be retained in the case file indefinitely.

2045.06 Multiple Documents - When none of the above items of identity are available, a consumer may submit three or more of the following documents as verification of identity:

(a) employer identification cards
(b) high school or college diplomas, including GED
(c) marriage certificates
(d) divorce decrees
(e) property deeds/titles

Multiple documents can only be used for identity if a second or third level of citizenship has been provided.

2045.07 Reasonable Opportunity to Provide Documentation - The following provisions apply when an applicant or recipient declares U.S. citizenship, but is unable to provide verification.

The agency may not request verification of citizenship and identity from the applicant or recipient if that information is available through an available resource. The agency shall make every effort to verify citizenship and identity through those resources. The following automated and manual verification resources shall be utilized:

Tier 1 – The Federal Data Services Hub. The Hub accesses the Social Security Administration (SSA) database in real-time to verify citizenship and identity status.

The Electronic Access to Social Security (EATSS) database. If the Hub is not available, EATSS may be accessed to verify citizenship and identity status for those individuals who are current or former recipients of SSI, Medicare or Social Security disability benefits (2045). EATSS may not be used to verify citizenship or identity of individuals who do not meet that criteria.

Tier 2 - The Kansas Immunization Register (KSWebIZ) database. The KSWebIZ interface is a statewide database that includes immunization records for all Kansas residents that may be used to verify identity only for children.

The Department of Revenue (Driver’s License) database. The Driver’s License interface may be accessed to verify identity only of an individual with a valid Kansas license.

Tier 3 – Research by the agency. If the agency has been unable to verify citizenship and identity through the available automated and manual interfaces, staff shall review the case file and imaged documents to determine whether a hard copy verification has already been provided.

Tier 4 – Contact with the applicant or recipient. If the agency is unable to verify citizenship and identity via any of the means above, verification shall initially be waived and a reasonable opportunity period applied as described below. The individual shall be contacted to provide verification and notified of the reasonable opportunity period.

An application shall not be delayed or denied because the agency was unable to verify citizenship or identity. If otherwise eligible, the application shall be processed and approved granting a reasonable opportunity period to the individual to provide the verification. The reasonable opportunity period shall be three (3) calendar months commencing from the date the case is authorized. If the individual fails to provide verification (or the agency is unable to independently verify) by the end of the reasonable opportunity period, coverage shall end allowing for timely notification. If verification is provided within the month after the month coverage ends, eligibility may be reinstated without a new application/request. The following examples illustrate:

Note: The reasonable opportunity period may be extended in situations where the individual is making a bona fide effort to obtain the verification but circumstances outside his/her control are delaying the effort. A decision to extend the period must be thoroughly documented and supported in the case file.

2046 Documentation for Citizens at Birth - For most foreign born individuals attesting to be U.S. citizens, primary documentation as established in 2045 is necessary. However, secondary or subsequent documents may be used to verify citizenship and identity for person considered citizens at birth.

2047 Documentation of Legal Status - Applicants/recipients who are identified as non-citizens on their application shall be required to verify their non-citizens status. The agency shall determine if the person is a non-citizen who may be eligible to receive assistance. Only those non-citizens who are residents and meet one of the categories of qualifying non-citizens status described in 2044 may participate.

The agency may not request verification of legal non-citizen status from the applicant or recipient if that information is available through an available resource. The agency shall make every effort to verify the legal non-citizen status through those resources. Verification is accomplished through the Department of Homeland Security and additional verification steps may be necessary. The KEES system and the SAVE process is used to obtain the information. Verification is not requested for non-applicants.
The following automated and manual verification resources shall be utilized:


Tier 1 – The Non-Citizen VLP (Verify Lawful Presence) through the Federal HUB (including subsequent SAVE processes).

Tier 2 – The Manual SAVE process. Should the agency be unable to verify non-citizen status in this manner, additional research is required. Detailed instructions on primary and secondary verification procedures are contained in the SAVE User Manual. (See KEESM Appendix A-10) No action to deny, reduce, or terminate benefits may be taken based solely on information obtained from DHS through the SAVE primary verification system.

NOTE: Secondary verification should be requested when the person's entrance date is in question. For persons adjusting status to legal permanent resident, the primary web-based verification system will communicate the date of adjustment rather than the original date of entrance. The secondary system will always provide the original date of entrance.


Tier 3 – Research by the agency. If the agency has been unable to verify legal non- citizen status through the available automated and manual interfaces, staff shall review the case file and imaged documents to determine whether a hard copy has already been provided. Verification through the automated systems may be attempted again if additional information is found in the file that will assist in the process.

Tier 4 – Contact with the applicant or recipient. If the agency is unable to verify legal non-citizen status via any of the means above, verification shall initially be waived and a reasonable opportunity period applied as described in 2047.01. The individual shall be contacted to provide verification and notified of the reasonable opportunity period.

2047.01 Reasonable Opportunity for Non-Citizens - An application shall not be delayed or denied because the agency was unable to verify the non-citizen status of an individual declaring to be a qualifying non-citizen. If otherwise eligible, the application shall be processed and approved granting a reasonable opportunity period. The reasonable opportunity period shall be three (3) calendar months commencing from the date of approval. If proof of qualifying non-citizen status is provided, the Reasonable Opportunity period ends and additional information is not necessary. If prior medical assistance has been requested and the individual is otherwise eligible, coverage shall be approved for these prior months as well.

The following processes shall be utilized:

a. Research by the agency - Staff shall review the application, case file and imaged documents to determine if the applicant has previously declared they meet a qualifying non-citizen statuses.

b. Contact with the applicant or recipient – If there is not enough information available to determine if the applicant is a qualifying non-citizen, phone contact is required to obtain additional information necessary to confirm whether or not the individual meets a qualifying non-citizen status. Staff shall attempt to obtain document types, immigration ID numbers and other details during this contact. If unable to reach the applicant, the individual is not provided with a Reasonable Opportunity period and a request for information is generated.

c. Systematic Alien Verification for Entitlements (SAVE) – The Tier 1 and Tier 2 processes are completed as indicated in 2047. If SAVE does not provide the information needed to complete a full determination of eligible status, then a Reasonable Opportunity period is provided.

2047.02 Non-citizens Unable to Provide Documentation - If the alien is unable to provide any documentation of their status, the agency shall advise the person to contact the nearest USCIS office for verification.

2047.03 Documentation Obtained Later - If documentation of qualifying status is received at a later date, the specialist shall act on the information as a reported change in accordance with timeliness standards for these changes. See 7130 as appropriate.

2047.04 Unable to verify through KEES - If unable to verify through the non-citizenship status or if conflicting information is received, an inquiry shall be sent to the Eligibility Policy Unit for guidance.

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