Social Security numbers
A state Medicaid agency may require an applicant to provide his/her social security number (SSN). However, Medicaid regulations clarify that the agency has an affirmative obligation to assist an applicant in obtaining an SSN from the Social Security Administration if he or she has not yet applied or cannot recall his or her SSN.[1] Further, “the agency must not deny or delay services to an otherwise eligible applicant pending issuance or verification of the individual’s SSN by SSA.”[2]
Notwithstanding these regulations, some agencies still require (at least in practice) applicants to provide verification of their SSN.[3] Typically, they may do so by showing a Social Security card; a driver’s license[4]; or a tax form, loan document, or pay stub listing the SSN. Also, agency assistance may be limited to handing an applicant the correct form from SSA. It is therefore important to confirm the verification practices used in a particular jurisdiction.
In some cases, jail and prison officials may know an inmate’s Social Security number (e.g., through notes in an inmate’s record or self-reporting) but not have official documentation. To preempt some of the logistical challenges described above, jail and prison officials could develop a form letter of “SSN verification” and negotiate with Medicaid offices to accept this letter as a valid proof of SSN, at least for the initial application.
In addition, jail and prison administrators might want to initiate an interagency agreement with SSA to issue replacement Social Security cards for individuals who were or are enrolled in SSI/SSDI programs. SSI/SSDI records should include information about beneficiaries’ SSNs.
Birth Certificates and Proof of Identity
Since the passage of the Deficit Reduction Act (DRA) of 2005 [5] (see sec. 6036), Medicaid applicants claiming to be U.S. citizens are now required to prove their citizenship. Before the passage of the DRA, many if not most states allowed applicants to self-attest to their citizenship status, though there are some exemptions.[6]
Applicants who are subject to the new DRA provisions can satisfy the new verification requirement by providing “primary evidence” of U.S. citizenship (i.e., a U.S. passport, Certificate of Naturalization, or Certificate of U.S. Citizenship). If they cannot provide such documentation, they must produce multiple pieces of “secondary evidence.”[7] To satisfy the “secondary evidence” requirements, applicants normally provide copies of their (1) birth certificates and (2) a sanctioned form of identification.
If individuals do not have birth certificates or other forms of identification, corrections officials may consider purchasing replacement documents. There is variation among states in how replacement birth certificates and other vital records can be obtained, as well as associated costs with replacing documents. One Web site (www.vitalrec.com) provides an online directory of vital-records offices throughout the United States and its territories with contact information and fees for replacing particular documents.
In the light of cost and logistical limitations, it may be challenging for corrections officials to obtain birth certificates and other traditional identification documents. Jail and prison officials can take different approaches to ensure that case managers and other corrections staff have resources to assist applicants in meeting identification requirements outlined in DRA:
- Medicaid
If a birth certificate were unavailable or unobtainable, a Medicaid agency could accept other documents such as “institutional admission papers from a nursing facility, skilled care facility or other institution,” if the document was created at least 5 years before the initial application date and included a U.S. place of birth.[8] Presumably, a corrections inmate record would suffice, although prison officials would need to confirm this with their state agency overseeing Medicaid.
The acceptable forms of proof of identity (required unless an applicant provides “primary evidence” of U.S. citizenship) is also detailed in federal regulations.[9] Before the implementation of the DRA, many states used liberalized verification rules for identity to facilitate eligibility for homeless populations.[10] Despite the general retreat from the more permissive identity document requirements, the Centers for Medicare and Medicaid’s recently published rules allow states some measure of flexibility, and the regulations specifically allow the use of corrections records as identity documents.[11]
To confirm that the federal policy is carried out in local agency practice, it may be advantageous for jail and prison officials to meet with state Medicaid agency staff and (1) share with the Medicaid agency samples of corrections records and (2) request that the Medicaid agency issue new policy guidance to its eligibility staff (and update its Policy Manual) about the acceptability of such records as identity documents.
- SSI/SSDI
SSA’s policy regarding the confirmation of SSI applicants’ identity is available from the Program Operations Manual System SI 00601.062: Verifying Claimant Identity.[12] As per this policy, applicants will be required to answer a series of questions related to identity when meeting with SSA officials. Assuming applicants can answer these questions, they may not need to provide identification documents such as a birth certificate or driver’s license at least during the initial interview.
