210 R.I. Code R. 210-RICR-10-00-3.7

Current through December 3, 2024

Section 210-RICR-10-00-3.7 - Citizenship and Immigration Status

A. The requirements related to citizenship and immigration eligibility factors for Medicaid and CHIP-funded coverage categories are established in Federal law as follows:

1. Citizenship - The Federal Deficit Reduction Act (DRA) of 2005 (42 U.S.C. §§ 1305 and 1396r) requires states to provide Medicaid coverage to otherwise eligible applicants who are citizens and nationals of the United States when appropriate verification of self-attestations is provided.

2. Non-citizens - In accordance with the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA, 42 U.S.C. § 1305) and the Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009 (42 U.S.C. § 1396), the following non-citizens are provided with Medicaid or CHIP-funded coverage when all other eligibility requirements are met:

a. Adults. Qualified non-citizens over age nineteen (19) as defined in PRWORA eligible under the Medicaid State Plan -

(1) Prior Entry - Qualified non-citizens who entered the United States before August 1, 1996;

(2) Exempt from five (5) year bar - Qualified non-citizens who are exempt from the five (5) year bar on Medicaid coverage under Federal law at §402(b) of PRWORA (8 U.S.C. § 1612(b)), including non-citizens with the following statuses:

(AA) Refugees. Admitted under §207 of Immigration and Naturalization Act (INA) including Afghan and Iraqi Special Immigrants (SIV's) as permitted under Pub. Law 111-118;

(BB) Asylees. Granted Asylum under §208 of INA;

(CC) Deportation withheld under §243(h) of INA;

(DD) Amerasian entrants. Pursuant to §584 of the Foreign Operations, Export Financing and Related Programs Appropriations Act of 1988 (as contained in § 101(e) of Pub. Law 100-202and amended by the 9^th provision under Migration and Refugee Assistance in Title II of the Foreign Operations, Export Financing and Related Programs Appropriations Act, 1988, Pub. Law 100-461as amended);

(EE) Cuban or Haitian entrants. As defined in §501(e) of the Refugee Education Assistance Act of 1980;

(FF) U.S. Military. Lawfully residing and honorably discharged veterans (except one discharged for reasons of immigration status), or on active duty in the U.S. Armed forces, and their lawfully residing spouses and unmarried dependent children, and the un-remarried widow or widower of the veteran;

(GG) Battered non-citizens. Certain battered spouses, battered children or parents, or children of a battered person with a petition approved or pending under §§204(a)(1)(A) or (B) or 244(a)(3) of INA;

(HH) American Indians. Born outside the U.S. in Canada and is at least fifty percent (50%) American Indian blood and to whom the provisions of §289 of the INA apply; or is a member of a federally-recognized tribe as defined in § 4(e) of the Indian Self- Determination and Education Act;

(II) Victims of trafficking. Certified by the U.S. Department of Human Services (HHS) Office of Refugee Resettlement pursuant to §107(b) of the Victims of Trafficking and Violence Protection Act of 2000, as a victim of a severe form of trafficking;

(JJ) Receiving disability assistance. Legally entered the U.S. on or after August 22, 1996 and received disability related benefits for a condition that is a disability or is pending a disability determination in accordance with 42 U.S.C. § 1381.

(KK) SSI recipients. Receiving benefits for the U.S. Supplemental Security Income (SSI) program. Treated as a qualified exempt non-citizen under provisions of Pub. Law 105-306, if SSI benefits, and associated Title XIX Medicaid were continued and was lawfully residing in the U.S. and receiving SSI on Augusy 22, 1996.

(3) After the five (5) year bar - Qualified non-citizens who were subject to the five (5) year bar (waiting period) on Medicaid eligibility AFTER the five (5) year period is complete, including:

(AA) Lawful permanent residents (LPRs) Green card holders;

(BB) Parolees. Granted parole for at least one (1) year under §212(d)(5) of the Immigration and Nationality Act (INA), except when paroled for prosecution, deferred inspection, or pending removal proceedings;

(CC) Conditional entrants. Granted conditional entry under §203(a)(7) of immigration law in effect before April 1, 1980.

b. Children and youth. Rhode Island resident children under the age of nineteen (19) are not subject to the five (5) year waiting period/bar. As authorized under the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA, 42 U.S.C. § 1396) and as described in 8 C.F.R. § 103.12(a)(4) the following non-citizen children and youth are NOT subject to the five (5) year waiting period/bar regardless of their date of entry into the U.S.

(1) Qualified Non-citizens - The full range of qualified non-citizens set forth in subpart (a) above and legal non-immigrants whose admission to the United States is not conditioned on having a permanent residence in a foreign country (such immigrants include citizens of the Compact of Free Association States who are considered permanent nonimmigrants but does not include visitors for business or pleasure or students).

(2) Legally Residing Non-Citizens -

(AA) Temporary resident status. Pursuant to §§210 or 245A of the Immigration and Nationality Act (INA) 8 U.S.C. §§ 11011178;

(BB) Temporary protected status. Pursuant to §244 of the INA (8 C.F.R. § 244);

(CC) Cuban-Haitian entrants. As defined in § 202(b) of Pub. Law 99-603(8 U.S.C. § 1152), as amended;

(DD) Family unity. Pursuant to § 301 of Pub. Law 101-649(8 U.S.C. § 1151), as amended, as well as pursuant to § 1504 of Pub. Law 106-554(8 C.F.R. § 245a);

(EE) Deferred enforced departure (DED). In accordance with a decision made by the President;

(FF) Deferred action status. As set forth in INA Service Operations Instructions at OI §242.1(a)(22);

(GG) Adjusted status. The spouse or child of a United States citizen whose visa petition has been approved and who have a pending application for adjustment of status.

(3) INA Non-citizens - The following categories of non-immigrant children under §101(a)(15) of the Immigration and Nationality Act (INA) (8 U.S.C. § 1101) are also eligible for coverage under Title XXI:

(AA) Immediate family. Parents or children of individuals with special immigration status under §101(a)(27) of the INA as permitted under §101(a)(15)(N) of the INA (8 U.S.C. § 1101);

(BB) Fiance(e) of a citizen as permitted under §101(a)(15)(K) of the INA (8 U.S.C. § 1101);

(CC) Religious workers under §101(a)(15)(R) (8 U.S.C. § 1101);

(DD) U.S. Attorney General's discretion. The Attorney General of the United States has determined the non-citizen is in possession of critical reliable information concerning a criminal or terrorist organization, enterprise or operation as permitted under §101(a)(15)(S) of the INA (8 U.S.C. § 1101);

(EE) Victims of trafficking. As permitted under §101(a)(15)(T) of the INA (8 U.S.C. § 1101);

(FF) U.S. Department of Justice. When assisting in a criminal investigation as permitted under §101(a)(15)(U) of the INA (8 U.S.C. § 1101);

(GG) Battered non-citizens;

(HH) Petition pending. A petition pending for three (3) years or more as permitted under §101(a)(15)(V) of the INA (8 U.S.C. § 1101).

c. Pregnant women. All pregnant women who otherwise meet the requirements for Medicaid are eligible without regard to immigration status.

3. Non-qualified non-citizens - In accordance with the provisions of PRWORA, non-citizens who are not pregnant and do not have current documentation of a qualified non-citizen status are not eligible for Medicaid or CHIP coverage except in instances of a medical emergency. Rhode Island resident children under the age of nineteen (19) are not subject to eligibility requirements related to citizenship and immigration status. The provisions governing Medicaid coverage for non-citizens who are RI residents in emergency circumstances are set forth in Part 40-05-1 of this Title.

4. Alternative forms of coverage - Lawfully present qualified non-citizens who are ineligible for Medicaid/CHIP funded coverage, may qualify for commercial health insurance coverage through the State's health insurance marketplace known as HealthSource RI (HSRI). To facilitate access to affordable health coverage, any non-citizen who applies for Medicaid and is denied on the basis of immigration status is automatically evaluated for an HSRI plan and is informed if such coverage options are available in the eligibility determination notice.

B. The State verifies self-attestations and attestations of citizenship and satisfactory immigration status through designated electronic Federal and State data sources through the IES to the full extent feasible. Rhode Island resident children under the age of nineteen (19) are not subject to eligibility requirements related to citizenship and immigration status

1. Exemptions - The provisions set forth in this Part related to citizenship and immigration status do not apply to the following exempt persons/coverage groups:

a. Persons eligible on the basis of the current or past receipt of Supplemental Security Income (SSI) as specified under Part 40-05-1 of this Title.

b. Anyone entitled to or enrolled in any part of Medicare, including applicants for the Medicaid Premium Payment Program (MPPP) pursuant to Part 40-05-1 of this Title.

c. Recipients of Social Security Disability Insurance (SSDI) and/or federally authorized and funded rehabilitative services, administered through the Rhode Island Department of Human Services (DHS) or the Rhode Island Office of Rehabilitative Services (ORS) seeking any type of Medicaid coverage;

d. Children and youth, up to age twenty-one (21), who are in the care and custody of the Rhode Island Department of Children, Youth and Families (DCYF) and/or participating in foster care and adoption subsidy assistance and maintenance programs and former foster care youth eligible under the Federal Chafee Independent Act pursuant to Part 30-00-1 of this Title;

e. Newborns deemed eligible for Medicaid or CHIP in accordance with Part 30-00-1 of this Title.

2. Citizenship - An applicant has met the Medicaid citizenship eligibility requirement when the applicant is an adult and has made a self-attestation of United States citizenship, or the applicant is a minor or incapacitated person and an adult living in the same household or an authorized representative has made a declaration of citizenship on the behalf of the minor or incapacitated person; and the declaration has been verified by an authorized electronic data source.

3. Immigration status - An applicant has met the Medicaid/CHIP immigration status requirement when the applicant has made a self-attestation of satisfactory immigration status; or an attestation of such status has been made on the applicant's behalf by an adult living in the same household or an authorized representative in instances in which the applicant is a minor or incapacitated. An attestation of immigration status may also be accepted when provided by a responsible person with first-hand knowledge of the immigration status of the applicant, but only if the attestation is verified by an authorized electronic data source or approved form of documentation. Special provisions apply in certain circumstance as follows:

a. Veterans. For purposes of determining whether the exemption from the five (5) year bar for qualified non-citizen veterans and their families applies, the State must verify that the veteran is in honorably discharged or active military duty status, or is the spouse or unmarried dependent child of such person. If the State is unable to verify this information through electronic means, self-attestation with paper documentation providing proof of the veteran's status and/or relationship to the veteran is accepted.

b. Participants in other Federal means-tested programs - The State does not re-verify the citizenship or immigration status of an applicant for Medicaid/CHIP funded coverage who is currently participating in a State administered means-tested Federal program, providing verification of citizenship and immigration status is a condition of eligibility, has been successfully completed, and record of such is maintained and can be accessed through the IES.

4. Verification sources - The primary electronic data sources for verifying citizenship and immigration status used by the State is the Federal State Verification and Exchange System (SVES) which operates through the Verify Lawful Presence (VLP) interface with the Federal data hub (MACC group members subject to MAGI determinations); and, an electronic data exchange with the U.S. Citizenship and Immigration Services (USCIS). As indicated in § 3.7(C) of this Part below, if verification through these sources does not succeed, the State may use alternative electronic or paper forms of verification.

5. Record of verification - The State maintains a record of having verified citizenship and immigration status for each applicant in the IES in accordance with the requirements in 42 C.F.R. § 431.17(c).

6. Agency assistance - A State agency eligibility specialist is available to provide assistance to an applicant who is unable to provide a declaration or attestation, correct errors or inconsistences, or obtain any required documents as a result of a disability, homelessness, and/or the absence of someone who can act as authorized representative on his/her behalf.

7. Authorized representative - An authorized representative may submit proof of citizenship, identity and/or satisfactory immigration status on the behalf of an application or beneficiary.

8. Limits - Verification of citizenship and satisfactory immigration status occurs at the point of initial application. Unless an applicant/beneficiary reports a change in citizenship or immigration status, or the State receives information indicating such a change has or may occur, the State may not initiate or require reverification of either eligibility factor at the point of annual renewal, on a quarterly basis as part of the post-eligibility verification (PEV) process set forth in Part 30-00-5 of this Title, or subsequent to a break in coverage.

3.7.1Prompt Resolution and Reasonable Opportunity

A. Verification of citizenship and/or immigration status through primary electronic data sources and interfaces may not succeed. In such instances, the verification process proceeds as follows:

1. Prompt resolution - It is the State's responsibility to promptly attempt to resolve any inconsistencies issues, including typographical or other clerical errors, between information provided by the applicant and information from a primary electronic data source, and resubmit corrected information through such electronic services or an alternative electronic mechanism.

2. Reasonable Opportunity - If prompt resolution fails to provide verification within five (5) working days, the State provides a reasonable opportunity period. During the reasonable opportunity period, the State continues efforts to complete verification of the citizenship and/or satisfactory immigration status, or request documentation if necessary.

a. Notice. The State must provide notice to an applicant indicating that a reasonable opportunity period is being initiated. The period begins on the date the notice is received by the applicant which is presumed to be five (5) days after the date on the notice. The notice provides the applicant with the following:

(1) Temporary, provisional eligibility - A statement indicating that a reasonable opportunity period has been initiated. During this period, temporary, provisional Medicaid eligibility is provided to applicants in the household for whom verification is pending for up to ninety (90) days. Temporary, provisional eligibility begins on the first (1^st) day of the month in which the application was filed and ends when verification is completed, the applicant fails to cooperate or cannot provide any requested verification, or the reasonable opportunity period expires, whichever comes first.

(2) Alternative forms of proof - An additional documentation request (ADR) is included in the notice. The ADR identifies the outstanding verification issues (discrepancy, error, missing data); indicates the corrective action required and how to obtain assistance from the state agency, if appropriate; and provides a list of alternative accepted forms of verification, including paper documentation.

b. Additional State responsibilities - During the reasonable opportunity period:

(1) No limits on coverage - The State may not delay, deny, reduce or terminate coverage for a person who has been determined otherwise eligible for Medicaid during the reasonable opportunity period, in accordance with 42 C.F.R. § 435.911(c).

(2) Extensions - The State may extend the reasonable opportunity period in instances in which the applicant is making a good faith effort to obtain any necessary documentation or the State needs more time to verify status through other available electronic data sources or to assist an applicant in obtaining documents needed to verify his or her status.

(3) End of eligibility - At least thirty (30) days prior to the termination of the period of temporary, provisional eligibility, the State provides an adverse action notice containing the reason for the terminating eligibility and denying the application for Medicaid. The notice must contain the right to appeal the eligibility determination decision.

c. Applicant's responsibilities. An applicant must respond to the notice ADR in no more than thirty (30) days plus an additional five (5) days to cover mailing time - a total of thirty-five (35) days. An applicant may show good cause for failing to respond, by providing proof of mail delays or an emergency situation and request an extension of the reasonable opportunity period. An applicant also has the right to appeal and request a hearing. Reapplication is required.

210 R.I. Code R. 210-RICR-10-00-3.7

Adopted effective 12/29/2022