Long-term services and supports (LTSS) manual

Exception to Rule (ETR) process due to inability to provide citizenship and/or verification

Revised Date: 
February 6, 2014

Purpose: This section is additional information for HCS cases if the applicant or recipient cannot provide evidence of U.S. citizenship or identity. An exception to rule can be requested in limited circumstances.

HCS ETR process due to citizenship or ID requirement

This section gives additional information on processes as the information indicated in the citizenship and identity requirements for medicaid.

If the applicant or recipient cannot provide evidence of U.S. citizenship or identity, an exception to rule (ETR) can be requested in limited circumstances. These are individuals that state they are a U.S. citizen but have been unable to provide verification.

Examples for an ETR include but are not limited to:

  • Amnesia or coma victim
  • Individual with a dire medical condition whose life will be in jeopardy without medical care.
  • An individual needing services provided by Home and Community Services (HCS).

New applications are denied if citizenship or identity documents cannot be provided and an ETR request has been denied. Pend the application if an ETR is appropriate.

For recipients where upon review, documentation for citizenship or ID have not been provided, keep the case open and request an ETR.

HCS ETRs:

Health Care Authority (HCA) has requested that All ETR requests from HCS will go through Lori Rolley at HCS Headquarters. HCS field staff will need to email Lori Rolley Lori.Rolley@dshs.wa.gov with the following information:

  • On subject line of email indicate "ETR citizenship/ID requirements".
  • Include the client name and client id in the text of the e mail.
  • Indicate whether the individual is at home, in residential or in a nursing home.

Lori will forward all ETR requests from HCS to the HCA policy representatives. A response from HCA will be forwarded back to the originator of the request.

Note:

Important: At each review, review citizenship and ID coding in ACES. Make sure the correct coding is updated in ACES.

For individuals that are receiving Medicare, SSI (or past SSI) or SSA disability based on their own disability. If there is no T1 or T2 document in the case record, indicate the citizenship coding as T4.

Note:

For disabled individuals in residential care facilities the facility administrator or director may submit affidavits attesting to the individual's identity.

The following are acceptable identity documents:

  • A current state driver license with the individual's picture.
  • A state identity card with individual's picture.
  • A US American Indian/Alaska Native tribal document.
  • Military identification card with individual's picture.

For disabled individuals in residential care facilities the facility administrator or director may submit affidavits attesting to the individual's identity.

Citizenship Central Unit (CCU)

Health Care Authority (HCA) Citizenship Central Unit (CCU) will obtain citizenship and/or identity documentation for applicants and recipients unable to provide proof.

For Adult applicants and recipients, age 19 or older (not pregnant) that need an out of state birth certificate, ID or may be able to provide a T3/T4 level verification of citizenship:

  1. Create a Document Management System (DMS) tickler type "OTHER"
    1. Set ready date to current date
    2. Subject "Out of State BC, ID or T3/T4" request
    3. Details need to state who the request is for and what is needed.
  2. Send the tickler to CCU pool (site127 @CCU) only when:
    1. You have a completed CIF document (all sections are complete or marked unknown)
    2. Individual does not have the required birth certificate or identity verification available (this must be documented on the CIF or staff must ask the individual and document in the narrative).
  3. If completed Citizenship Documentation and Identity Declaration form (DSHS 13-789) is not already in DMS fax a copy to the CCU.

For children and pregnant adults do not create a tickler or fax the declaration form. The CCU will continue to work children and pregnant adults from reports. Be sure you have approved citizenship and identity verification or a completed Citizenship Documentation and Identity Declaration form (DSHS 13-789) in DMS before approval or recertification.

Staff with questions regarding specific cases can contact the CCU by calling the Medical Assistance Customer Service Center:

By phone at 1-800-562-3022 and choosing option 5.

By mail at Mail Stop 45534, attention Citizenship Central Unit.

By fax at 360-664-2186.