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CITIZENSHIP-DOC-TYPE
Citizenship Documentation Type. This Data Element is used to: (1) Request verification of citizenship via an automated birth match for a client born in California; (2) Identify the verification of citizenship via an automated match to SSA; (3) Identify the type of document used for verification of citizenship;
(4) Identify why a client is currently exempt from citizenship verification requirements; or (5) Identify why a client claiming U.S. citizenship has not provided a citizenship verification document.
If citizenship verification is not required but the current application includes citizenship documentation that is a higher level group (based on the first digit of document type) than what is currently on MEDS (e.g., 2A is higher than 3A or 8K), that higher level documentation should be reported to MEDS. This, however, does not apply to a citizenship document based on a birth record match (Source code BM). MEDS will not overlay a birth record match even if the document is of a higher level.
|
Type |
Birth Record Match Request Code |
Source |
|
BR |
Birth record match requested for client born in California |
None |
Since a primary (Level 1) document satisfies both citizenship and identity requirements, if a Citizenship Document Type beginning with a “1” is reported, MEDS will automatically update the Identity Document Type with the same Level 1 information.
The Citizenship Document Codes below are listed in order of reliability. If more than one code could apply to a client, the highest appropriate code should be reported. The value 2M is populated only by MEDS based on a SAVE inquiry response.
|
Type |
Citizenship Document Codes |
CalSAWS Verification Source |
|
1A |
United States Passport - issued without limitation |
US Passport No Limitation |
|
1B |
Certificate of Naturalization (Form N-550 or N-570) |
Naturalization Papers |
|
1C |
Certificate of Citizenship (Form N-560 or N-561) |
USCIS Certif. of Citizenship |
|
2A |
U.S. Public Birth Record issued before age 5 showing birth in one of the 50 U.S. states, the District of Columbia, American Samoa, Swain's Island, Puerto Rico (DOB on or after 1/13/41), Virgin Islands of the U.S. (DOB on or after 1/17/17), Northern Mariana Islands (DOB after 11/4/86, NMI local time) or Guam (DOB on or after 4/10/1899) |
US Public Birth Record - 5 yrs |
|
2A |
CA Birth Record Match |
MEDS CA Birth Record Match |
|
2B |
U.S. Citizenship Based on Collective Naturalization for certain citizens or residents of Puerto Rico, U.S. Virgin Islands or Northern Mariana Islands |
Collective Naturalization Doc. |
|
2C |
Certification of Report of Birth (DS-1350) |
Cert of Rpt of Birth DS-1350 |
|
2D |
Consular Report of Birth Abroad of a Citizen of the United States of America (FS-240) |
Consular Report Birth Abroad |
|
2E |
Certification of Birth Abroad (Form FS-545) |
Certification of Birth Abroad |
|
2F |
U.S. Citizen I.D. Card (Form I-197 or I-179) |
US Citizen ID Card I-197/I-179 |
|
2G |
Northern Mariana Identification Card (I-873) |
Northern Mariana ID Card |
|
2H |
American Indian Card (I-872) issued by the Department of Homeland Security with the classification code "KIC" |
Am. Indian Card I-872 w/KIC |
|
2I |
Final Adoption Decree showing the child's name and a U.S. place of birth |
Adoption Decree-US Birthplace |
|
2J |
Evidence of U.S. Government Civil Service employment before 6/1/76 |
US Govt Employed before 6/1/76 |
|
2K |
Official U.S. Military record of service (e.g., DD-214 or similar official document) showing a U.S. place of birth |
US Military Service Record |
|
2L |
Proof of adoption under the Child Citizenship Act for a child born outside the U.S. |
Proof of Adoption under the Child Citizenship Act |
|
2M |
Systematic Alien Verification for Entitlements (SAVE) NOTE: The value 2M will be populated only by MEDS based on a SAVE inquiry response. |
Systematic Alien Verification for Entitlements |
|
2Z |
SSN Data Match by Social Security Administration |
Citizenship is verified by the SSA |
|
3A |
Extract of a hospital record on hospital letterhead established at the time of the person's birth showing a U.S. place of birth and created at least 5 years before the initial Medi-Cal application date. NOTE: For a child under age 5, since the record could not have been created at least 5 years before the initial Medi-Cal application date, it must have been created near the time of birth |
Hospital Extract-US Birthplace |
|
3B |
Life or health or other insurance record showing a U.S. place of birth and created at least 5 years before the initial Medi-Cal application date |
Insurance Record-US Birthplace |
|
3C |
Religious record showing a U.S. place of birth recorded within 3 months of birth |
Religious records recorded in the US within three months of birth |
|
3D |
Early school record showing a U.S. place of birth |
Early School Records |
|
3E |
U.S. Citizenship verified via CalHEERS Federal Data Services Hub (FDSH) Social Security Administration (SSA) Composite Service |
Citizenship is verified by the SSA |
|
3F |
U.S. Citizenship verified via CalHEERS Federal Data Services Hub (FDSH) Verify Lawful Presence (VLP) Service |
Citizenship is verified by the SSA |
|
4A |
Federal or State census record showing U.S. citizenship or a U.S. place of birth and the person's age (generally for persons born 1900 through 1950) |
State of Federal Census |
|
4B |
Seneca Indian tribal census record showing a U.S. place of birth and created at least 5 years before the initial Medi-Cal application date |
Seneca Tribal Census Record |
|
4C |
Bureau of Indian Affairs tribal census record of the Navaho Indians showing a U.S. place of birth and created at least 5 years before the initial Medi-Cal application date |
BIA Navaho Tribe Census Record |
|
4D |
U.S. State Vital Statistics official notification of birth registration showing a U.S. place of birth and created at least 5 years before the initial Medi-Cal application date |
US State Vital Birth Reg. |
|
4E |
An amended U.S. public birth record amended more than 5 years after the person's birth and created at least 5 years before the initial Medi-Cal application date |
Amended US Public Birth Record |
|
4F |
Statement signed by the birth physician or midwife who was in attendance at the time of birth showing a U.S. place of birth and created at least 5 years before the initial Medi-Cal application date |
Dr/Midwife Stmt-US Birthplace |
|
4G |
Institutional admission papers from a nursing facility, skilled care facility or other institution showing a U.S. place of birth and created at least 5 years before the initial Medi-Cal application date |
LTC/SNF Admission-US Birthplace |
|
4H |
Medical (clinic, doctor or hospital but not immunization) record showing a U.S. place of birth and created at least 5 years before the initial Medi-Cal application date. NOTE: For a child under age 5, since the record could not have been created at least 5 years before the initial Medi-Cal application date, it must have been created near the time of birth |
Medical Record-US Birthplace |
|
4I |
Roll of Alaska Natives maintained by the Bureau of Indian Affairs |
Roll of Alaska Natives |
|
7W |
Written Affidavits - requires affidavits signed under penalty of perjury by at least two individuals (other than the applicant or recipient) of whom at least one is not related to the applicant or recipient and who have personal knowledge of the event's establishing the client's claim of citizenship and who are able to prove their own citizenship and identity; also requires a separate affidavit signed under penalty of perjury from the applicant/recipient or other knowledgeable individual explaining why documentary evidence of the claim of citizenship does not exist or cannot be readily obtained |
Written Affidavit: MC Cit/ID Req |