In order to receive Medical Assistance (MA), applicants must be U.S. citizens, U.S. nationals or certain lawfully present noncitizens. See the MA Immigration Status policy for more information.

U.S. Citizen

A U.S. citizen is someone who is born in the U.S. (including U.S. territories, except for American Samoa) or who was born outside the U.S. and who either:

  • Was naturalized as a U.S. citizen

  • Derived citizenship through the naturalization of their parent(s)

  • Derived citizenship through adoption by U.S. citizen parents, provided certain conditions are met

  • Acquired citizenship at birth because he or she was born to U.S. citizen parent(s)

  • Became a U.S. citizen by operation of law

U.S. National

A U.S. national is someone who is a U.S. citizen or owes permanent allegiance to the U.S. With extremely limited exceptions, all noncitizen U.S. nationals are people born in American Samoa or people born abroad with one or more American Samoan parents under certain conditions.


Citizenship may be verified electronically at the time of application. Applicants and enrollees whose U.S. citizenship or U.S. national status cannot be verified electronically must provide proofs.

Eligibility is approved for applicants who meet all other eligibility criteria and attest to meeting the citizenship eligibility requirement. A person approved for MA without verification of their citizenship status has a reasonable opportunity to provide proof. A notice is sent to the enrollee to indicate they have 90 days, plus 5 days for mailing, from the date of the notice to provide proof. Coverage is ended with a 10-day advance notice if the person fails to cooperate with the verification process.

The county, tribal or state servicing agency must help applicants and enrollees obtain required proofs.

Once citizenship is verified, county, tribal and state servicing agencies cannot request proof again, unless an agency possesses inconsistent information regarding a person’s citizenship.

Verification of Citizenship

Applicants and enrollees who must provide proof when citizenship cannot be electronically verified can submit a copy of one of the following to verify U.S. citizenship:

  • U.S. passport

  • Certificate of Naturalization

  • Certificate of Citizenship

  • PASS card

  • Tribal enrollment or membership card, or certificate of degree of Indian blood issued by a federally recognized Indian tribe

Applicants and enrollees can also verify citizenship by submitting a copy of one document from each of the following two lists:

  • List 1

    • Birth certificate or other birth document from the U.S. Department of State

    • U.S. citizen ID card

    • American Indian card (I-872) from the U.S. Department of Homeland Security

    • Final U.S. adoption papers

    • Papers showing U.S. government employment before June 1976

    • Official military record of service showing U.S.  place of birth

    • Hospital record showing birth in the U. S.

    • Insurance company record showing U. S. as the place of birth

    • Federal or state census record showing U.S. citizenship or U.S. place of birth

    • Medical records from a clinic, doctor or hospital showing U. S. as the place of birth. Records must be from within the last five years

    • A statement signed by a doctor or midwife who was at the birth. Statement must be from within the last five years.

    • Institutional admission papers showing the U. S. as the place of birth. Papers must be from within the last five years.

  • List 2

    • State driver’s license or state ID card with picture

    • School ID card with picture

    • Military ID card or draft record

    • For a child under age 16:

      • School records including report card

      • Clinic, doctor or hospital records

      • Daycare records

Exemptions from the Citizenship Verification Requirement

The following people are exempt from the U.S. citizenship verification requirement:

  • People enrolled in or entitled to enroll in Medicare. The Social Security Administration (SSA) has already verified citizenship and identity for these people.

  • People who receive or previously received Supplemental Security Income (SSI)

  • People who receive or previously received Retirement, Survivors or Disability Insurance (RSDI) benefits due to disability (also known as SSDI). This does not include people who receive RSDI retirement or survivor’s insurance benefits. They are not exempt from this requirement unless they meet another condition for exemption (such as enrollment in Medicare).

  • Children who receive Northstar

  • Auto newborns and children previously enrolled as auto newborns

Legal Citations

Code of Federal Regulations, title 42, section 435.406

Code of Federal Regulations, title 42, section 435.945

Code of Federal Regulations, title 42, section 435.949

Code of Federal Regulations, title 42, section 435.952

Patient Protection and Affordable Care Act, Public Law 111-148, section 1441