Table 1, Assuring That Child Health Applications Do Not Deter Enrollment Among Eligible Children in Noncitizen Families

Assuring That Child Health Applications Do Not Deter
Enrollment Among Eligible Children in Noncitizen Families
Prepared for Covering Kids by
Michelle Cochran and Cindy Mann

This analysis considers whether the application reviewed appears to require an SSN from either a parent or a child in the household who is not applying for health coverage for themselves. It also considers whether the application requires information about citizenship or immigration status for parents or children in the home who are not applying for benefits.

SSNs. The first two columns in Table 1 review the questions in the application relating to SSNs. Column 1 reports whether the application requires the parent’s SSN if only the child is applying for coverage and Column 2 asks if children who are not applying for coverage are required to provide an SSN.

Citizenship. Column 3 reports whether the application requires information about the parent’s citizenship status if only children are applying for coverage and column 4 reports whether the application requires information on citizenship status for children who are not applying for coverage.

Many of the applications that require SSNs for parents or children who are non-applicants, and that require citizenship information for parents or children who are non-applicants also seek SSNs and citizenship information for other persons living in the household, including related and unrelated adults. Several applications ask a set of questions about a child’s absent parent, and sometimes these questions ask for the SSN of the absent parent. These questions raise a number of concerns about the way in which some states are pursuing medical support. For example, some applications do not appear to inform the person completing the application that if she has good cause for not providing information about the absent parent she need not supply the information requested. However, questions about absent parents, including requests for the absent parent’s SSN, are not analyzed in this report.

Applications reviewed. The child health applications reviewed here vary across states depending on the type of form a state uses to enroll children in Medicaid and, if applicable, a separate CHIP program.

The applications reviewed were in use in October/November, 1999. Since states are regularly revising their applications, it is possible that an application considered in this analysis has been revised or is under review. The applications reviewed are identified in the appendix to this report. Note, however, that some states do not code or date their applications.

Table 1
Citizenship and Social Security Number Questions in State Children's Health Applications
	Application Type	Column 1 Is a Social Security number required for a parent seeking coverage for a child only?	Column 2 Is a Social Security number required for siblings or other children in the household who are not seeking coverage?	Column 3 Is citizenship information required for a parent who is seeking coverage for a child only?	Column 4 Is citizenship information required for siblings or other children in the household who are not seeking coverage?
Alabama ¹	Joint	Yes	Yes	Yes	Yes
Alaska	Medicaid	No	No	No	No
Arizona ²	Joint	No	Medicaid: Yes CHIP: No	No	Medicaid: Yes CHIP: Yes
Arkansas	Medicaid	Yes	Yes	Yes	Yes
California ³	Joint	No	No	No	No
Colorado ⁴	Joint	Yes	Yes	Yes	Yes
Connecticut	Joint	Yes	Yes	No	Yes
Delaware ⁵	Joint	Yes	Yes	Yes	Yes
District of Columbia	Medicaid	No	No	No	No
Florida ⁶	Joint	Yes	See endnote 6	No	See endnote 6
Georgia⁷	Joint	Yes	See endnote 7	No	See endnote 7
Hawaii	Medicaid	Yes	Yes	Yes	Yes
Idaho	Medicaid	No	No	No	No
Illinois	Joint	No	No	No	No
Indiana ⁸	Medicaid	Adult completing form: No Other Adults: Yes	Yes	Adult completing form: No Other Adults: No	No
Iowa ⁹	Joint	No	Yes	No	Yes
Kansas ¹⁰	Joint	No	Yes	No	Yes
Kentucky	Medicaid	Yes	Yes	No	No
Louisiana ¹¹	Medicaid	Yes	Yes	No	No
Maine	Joint	Yes	Yes	No	Yes
Maryland ¹²	Medicaid	Yes	Yes	No	No
Massachusetts ¹³	Joint	Yes	Yes	Yes	Yes
Michigan ¹⁴	Joint	Yes	Yes	Yes	Yes
Minnesota	Medicaid	Yes	Yes	Yes	Yes
Mississippi	Medicaid	No	No	Yes	Yes
Missouri ¹⁵	Medicaid	Yes	Yes	No	No
Montana	Separate	Medicaid: Yes CHIP: No	Medicaid: Yes CHIP: No	Medicaid: Yes CHIP: No	Medicaid: Yes CHIP: No
Nebraska	Medicaid	Yes	Yes	Yes	Yes
Nevada ¹⁶	Separate	Medicaid: Yes CHIP: No	Medicaid: Yes CHIP: Yes	Medicaid: Yes CHIP: No	Medicaid: Yes CHIP: Yes
New Hampshire ¹⁷	Joint	Yes	Yes	Yes	Yes
New Jersey	Joint	Yes	Yes	No	No
New Mexico ¹⁸	Medicaid	Yes	Yes	Yes	Yes
New York ¹⁹	Joint (Pilot)	No	No	No	No
North Carolina	Joint	No	Yes	No	Yes
North Dakota ²⁰	Separate	Medicaid: Yes CHIP: No	Medicaid: Yes CHIP: Yes	Medicaid: Yes CHIP: No	Medicaid: Yes CHIP: Yes
Ohio	Medicaid	Yes	Yes	Yes	Yes
Oklahoma	Medicaid	Yes	Yes	Yes	Yes
Oregon ²¹	Joint	Yes	Yes	Yes	Yes
Pennsylvania ²²	Separate	Medicaid: Yes CHIP: Yes	Medicaid: Yes CHIP: No	Medicaid: Yes CHIP: No	Medicaid: Yes CHIP: No
Rhode Island	Medicaid	Yes	Yes	No	No
South Carolina	Medicaid	Yes	Yes	Yes	Yes
South Dakota	Medicaid	Yes	Yes	Yes	Yes
Tennessee	Medicaid	Yes	Yes	Yes	Yes
Texas ²³	Medicaid	Yes	Yes	Yes	Yes
Utah	Joint and Separate CHIP	Joint: Yes CHIP Only: Yes	Joint: Yes CHIP Only: Yes	Joint: Yes CHIP Only: No	Joint: Yes CHIP Only: No
Vermont	Medicaid	Yes	Yes	Yes	Yes
Virginia	Joint	Yes	Yes	Yes	Yes
Washington ²⁴	Medicaid	Yes	Yes	No	Yes
West Virginia	Joint	Yes	Yes	Yes	Yes
Wisconsin ²⁵	Joint	Yes	Yes	Yes	Yes
Wyoming	Joint	Yes	Yes	Yes	Yes

1. Alabama’s application requests a SSN for all household members and states that the question can be left blank if the SSN is not available. The parent is asked for an SSN twice; the first request states that a SSN need not be supplied if unavailable. Alabama specifically asks if anyone in the household is an "illegal alien."

2. Arizona’s application instructs the person completing the form to list the information requested in section 2 (which asks for SSNs and citizenship status) for all children in the home even if the child is not applying for coverage although in that part of section 2 where the SSN would be entered the form states, "SSN (required for Medicaid only)." In addition, a statement not referenced in the application (found on the back page of application) notes that SSNs are required only for individuals approved for Medicaid. The application also asks for proof of citizenship or immigrant status for any child who was not born in the United States, although an additional statement not referenced in the application (found on the cover page of application) instructs the person completing the form to attach proof of citizenship for any child who was not born in the United States and wants health insurance.

3. California’s application also states in the application instruction that information on immigrant status is confidential and that the program "can not and will not" provide immigration information to the INS.

4. Colorado’s "Application Checklist" states that a SSN is required for each individual applying for benefits but this information is not referenced in the part of the application that asks for SSNs.

5. Delaware’s application, in the "Rights and Responsibility" section, states that a SSN must be supplied for "each person applying." It also instructs the person completing the form to give the SSN "of anyone whose income affects whether or not I am eligible for medical assistance." These statements may mean that a SSN is not required from a child who is not applying for benefits (since the income of a child who is not applying for benefits should not affect the eligibility of other household members) but is required for a parent regardless of whether the parent is applying for benefits for herself (since the parent’s income does not affect eligibility). It is not likely, however, that this distinction would be understood by most applicants. In any event, these statements are not cross referenced in the part of the application that asks for a SSN.

6. Florida’s application is somewhat unclear as to whether it is asking only for information about children who are applying for coverage. It states that "If you are applying for more than three children, attach another piece of paper" which might suggest that information only about children applying for benefits needs to be included, but it does not state this directly.

7. Georgia’s PeachCare application can serve as an application for either PeachCare or Medicaid; for purposes of this analysis, it is considered to be a joint application. Like Florida, Georgia’s application is somewhat unclear as to whether it is asking only for information about children who are applying for coverage. It states that "If there are more than three children in the household for whom you wish to apply, please attach a separate sheet" which might suggest that information only about children applying for benefits needs to be included, but it does not state this directly. Moreover, if it were to be read this way, there would be no other place in the application where other family members would be listed (information on the number of family members is necessary to determine financial eligibility).

8. Indiana’s application does not ask for a SSN or citizenship information for the person completing the application unless she is applying for coverage for herself (the application covers children and pregnant women). It does, however, request SSNs be provided for all other persons in the household whether or not they are applying for coverage for themselves.

9. Iowa’s Hawk-I application can be used to apply for Medicaid; for purposes of this analysis it is considered a joint application.

10. The Kansas application asks that a SSN be provided for all children in the home if the child has a SSN. A statement at the end of the application that is not referenced in the section of the application requesting SSNs says, "I understand that I may have to provide or apply for a Social Security Number of the children for whom I am applying."

11. At the point in the application where the citizenship question is asked, Louisiana’s application refers to a statement appearing elsewhere in the application that only those applying for coverage are required to answer the citizenship question.

12. Maryland’s application states on a cover page and again at the end of the application that "you must give the Social Security number of any person who wants to be eligible for the Maryland Children’s Health Program." This statement might suggest that persons who do not seek coverage need not provide a SSN, but in any event this statement is not referenced in the part of the application where SSNs are requested.

13. Massachusetts’ application ask for SSNs for all household members "if one has been issued." It asks about citizenship of all members of the family (page 1 of the application) although elsewhere in the application (in the "Immigration" section on page 3) it asks about citizenship and immigration status only for persons applying for benefits.

14. Michigan’s application asks for SSNs and citizenship status "for each child in the household" although it instructs the applicant to attach a separate sheet of paper "if applying for more than two children."

15. Missouri’s application includes the following at the end of the application: "I agree that I must provide Social Security Numbers of all persons applying for MC+ as required by law." While this statement implies that SSNs are not required for those individuals not applying for coverage, it does not say so directly and, in any event, it is not referenced in that part of the application which asks for SSNs.

16. The Nevada Medicaid application reviewed is for Medicaid, food stamps, and cash assistance.

17. New Hampshire’s cover page to its application states that "federal laws require each person applying for medical assistance to provide his or her Social Security Number to DHS to be eligible." This statement is not referenced in the section of the application where SSNs are requested; the application asks for SSNs from all adults and all children "who live with you."

18. New Mexico’s application also asks if anyone living in the home is an illegal alien.

19. New York is piloting a new joint application, which is the application reviewed here. The application section requesting SSNs refers to the "Rights and Responsibilities" section. This section states "Social Security numbers are not required of legally responsible adults or any other person residing in the Medicaid applicants’ household who is not applying for Medicaid."

20. The North Dakota Medicaid "Application for Assistance" reviewed here is for Medicaid and food stamps. North Dakota’s CHIP application requires SSNs and citizenship information for all children in the household. Additionally, the person completing the application is required to sign a statement saying, "I certify that the children listed on this application are U.S. citizens or lawful immigrants." Because of this statement, families with a child who is eligible for coverage may feel they cannot complete this application if they have a child in the household who is not a lawful immigrant even if they are not applying for coverage for that child.

21. Oregon’s application states, "When you apply for benefits, you must give proof of the Social Security Number for all household members. Federal rules require this."

22. Pennsylvania’s Medicaid application states at the end in the "Client Responsibility" section that "you must provide a Social Security Number (SSN) for each person for whom you are applying." This statement is not referenced in the section of the application that asks for SSNs. Pennsylvania CHIP applicants have a choice of four health plans and each uses a different application. CHIP application information in this chart is based on the Caring Foundation for Children application.

23. The Texas application reviewed here is for Medicaid, cash assistance and food stamps. Texas’ application, in addition to asking about citizenship status and SSNs for non-applicants, states "Your alien status may be verified by INS." It also asks if household members are illegal aliens.

24. The Washington application asks if each family member, other than the parent(s), is a U.S. citizen without regard to whether the family member is applying for coverage. If a family member is not a citizen, the person completing the form is referred to "Attachment A." This attachment requires further information on immigration status but states that the information is needed only for "persons applying for medical benefits."

25. Wisconsin’s application states on the cover page that "the Social Security Act requires each individual applicant or recipient of aid to provide their Social Security Number (SSN) as a condition of eligibility." This statement does not clarify who is considered an "applicant" for purposes of the SSN requirement, and, in any event, it is not cross referenced in the section of the application that asks for SSNs for all household members.