Citizenship and Alien Status Requirements for the Medicaid Program

Date:  October 26, 2004 

 

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b. Establishing that the USCIS is acquiescing in the 

immigrant’s presence in the U.S.: 

 

It is important for the eligibility worker to understand that 

there are two ways to establish that the USCIS is acquiescing in 

the immigrant’s presence in the U.S.  First, the immigrant may 

have a document from the USCIS that demonstrates acquiescence.  

For example, the immigrant may have a document from the USCIS in 

which the USCIS advises the immigrant that it is reviewing the 

immigrant’s application for a change in status.  Acquiescence can 

be demonstrated, however, even if the immigrant has no 

documentation from the USCIS but, rather, the USCIS has failed to 

respond to the immigrant’s correspondence within a reasonable 

period of time.  For example, the worker may determine that the 

USCIS is acquiescing in the immigrant’s presence in the U.S. when 

the immigrant has applied to the USCIS for a change in status, 

presents documentation (such as a return receipt form) 

establishing that the USCIS has received an application but has 

failed to respond within a reasonable period of time or has 

failed to take any action to enforce the immigrant’s departure. 

 

A few examples illustrate how the eligibility worker may 

determine whether the immigrant is PRUCOL because he or she is 

permanently residing in the U.S. with the knowledge and 

permission or acquiescence of the USCIS even if the immigrant 

does not have a document or other form from the USCIS that grants 

the immigrant a particular immigration status: 

 

 Example 

1: An immigrant has written to the USCIS to request 

a change in his immigration status.  He has completed the 

appropriate USCIS application form.  He has a U.S. Postal Service 

Return Receipt indicating that the USCIS received his letter.  

Alternatively, he might have a USCIS receipt that verifies the 

fee for filing the form was paid.  In addition, he may have a 

Notice of Action (I-797) from the USCIS stating that his 

application was received and is being reviewed.  All of this 

documentation shows the Medicaid eligibility worker that the 

USCIS knows the individual is present in the U.S. and is 

acquiescing in his or her presence, at least for the time-being.  

 

 Example 

2:  Same fact pattern as above, but the USCIS has 

failed to respond in any way to the immigrant’s letter after 

having a reasonable time in which to respond.  In this case, the 

immigrant has established that the USCIS knows he is present in 

this country.  The USCIS’s acquiescence may be inferred by the 

USCIS’s silence; that is, its failure to respond in any way to 

the immigrant’s letter after having been afforded a reasonable 

period of time in which to do so. 

 

H. GENERAL DOCUMENTATION REQUIREMENTS 

 

1. SOCIAL SECURITY NUMBERS 

 

Effective April 1, 2003, applicants for Medicaid, Child Health Plus 

A and Family Health Plus who are required to provide a Social 

Security Number (SSN) or proof of application for a SSN must 

continue to do so, but are no longer required to document the SSN.  

This means that applicants are required to tell the district what  

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Date:  October 26, 2004 

 

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their SSN is, but they are not required to show proof of the SSN 

initially.  The only time documentation is necessary is if the SSN 

cannot be verified or validated through the Welfare Management 

System (WMS) SSN Validation process (GIS 03 MA/008).  Documentation 

of application for SSN continues to be required when appropriate.  

Districts must continue to confirm that the SSN provided is correct. 

 

Some immigrants may not have a SSN. The Social Security 

Administration (SSA) may issue Social Security Numbers (SSN) to 

immigrants if State Law requires a SSN as a condition of eligibility 

for Public Benefits.  New York State’s laws and regulations require 

a Social Security Number for public benefits, including Medicaid 

[Social Services Law Section 134-a(2), 18 NYCRR Sections 351.2(c), 

360-1.2]. All applicants for Medicaid thus must provide a Social 

Security Number or proof that they have applied for one or tried to 

apply for one.  The only exceptions are pregnant women, undocumented 

immigrants and temporary non-immigrants applying for the treatment 

of an emergency medical condition and certain battered women 

immigrants who prove their status under the Violence Against Women 

ACT (VAWA), as set forth in the section titled “Battered Immigrant” 

of this directive. 

 

A Medicaid eligibility worker should try to help the immigrant apply 

for a SSN.  The worker should refer the applicant to a local Social 

Security office and provide the applicant with a letter on agency 

letterhead requesting a Social Security Number be issued.   A sample 

letter “Agency Letter Request for Social Security Number” is 

attached to this directive as Attachment A-1. 

 

If an applicant still cannot get a SSN, then the applicant can 

submit a statement to the Medicaid eligibility worker describing how 

s/he tried to get an SSN.  A sample “Social Security Number 

Attestation Form” is attached to this directive as Attachment A-2. 

 

A Medicaid application cannot be delayed or denied if the immigrant 

does not have a SSN or cannot get “proof” from the Social Security 

Administration that they tried to apply.  If the applicant makes no 

attempt to supply a SSN or a statement attesting to the applicant’s 

efforts to apply for a SSN, the application can be denied. 

 

2. LOST AND/OR EXPIRED DOCUMENTS 

 

Immigrants’ eligibility for benefits is based on the immigration 

status they receive from the United States Citizenship and 

Immigration Services (USCIS). Immigrants are required by law to 

carry immigration documents as evidence of their status.  

 

Generally, expired USCIS documents cannot be used to establish an 

immigrant’s status.  The only exception is an expired I-151 or I-551 

”Green Card”.  That is because the expiration date on a “Green Card” 

is only an indicator of when the card must be renewed.  It is not an 

indication that the immigrant’s status has expired.  Lawful 

Permanent Resident status does not have an expiration date. 

 

Any other expired USCIS document an immigrant may present can not 

stand alone to establish the immigrant’s status.  A Medicaid 

eligibility worker must see other supporting USCIS documentation to 

properly determine the immigrant’s status. 

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