OHCA Policies and Rules

317:35-5-25. Citizenship/noncitizen status and identity verification requirements

[Revised 08-17-26]

(a) Citizenship/noncitizen status and identity verification requirements. Verification of citizenship/noncitizen status and identity is required for all adults and children approved for SoonerCare. An exception is individuals who are initially eligible for SoonerCare as deemed newborns; according to Section 1903(x) of the Social Security Act, they will not be required to further document citizenship or identity at any subsequent SoonerCare eligibility redetermination. They are considered to have provided satisfactory documentation of citizenship and identity by virtue of being born in the United States.

(1) The types of acceptable evidence that verify identity and citizenship include:

(A) United States (U.S.) passport;

(B) Certificate of Naturalization issued by U.S. Citizenship & Immigration Services (USCIS)(Form N-550 or N-570);

(D) Copy of the Medicare card or printout of a Beneficiary Earnings and Data Exchange (BENDEX) or State Data Exchange (SDX) screen showing receipt of Medicare benefits, Supplemental Security Income or disability benefits from the Social Security Administration; or

(E) Tribal membership card or Certificate of Degree of Indian Blood (CDIB) card, with a photograph of the individual.

(2) The types of acceptable evidence that verify citizenship but require additional steps to obtain satisfactory evidence of identity are listed in subparagraphs (A) and (B). Subparagraph (A) lists the most reliable forms of verification and is to be used before using items listed in (B). Subparagraph (B) lists those verifications that are less reliable forms of verification and are used only when the items in (A) are not attainable.

(A) Most reliable forms of citizenship verification are:

(i) A U.S. public Birth Certificate showing birth in one (1) of the fifty (50) states, the District of Columbia, Puerto Rico (on or after 1/13/1941), Guam (on or after 4/10/1899), the U.S. Virgin Islands (on or after 1/17/1917), American Samoa, Swain's Island, or the Northern Mariana Islands after 11/4/1986. For Puerto Ricans whose eligibility is being determined for the first time on or after October 1, 2010 and using a birth certificate to verify citizenship, the birth certificate must be a certified birth certificate issued by Puerto Rico on or after July 1, 2010;

(ii) A Consular Report of Birth Abroad of a U.S. citizen issued by the Department of Homeland Security or a Certification of Birth issued by the State Department (Form FS-240, FS-545 or DS-1350);

(iii) A U.S. Citizen Identification Card (Form I-179 or I-197);

(iv) A Northern Mariana Identification Card (Form I-873) (Issued by the former INS to a collectively naturalized citizen of the U.S. who was born in the Northern Mariana Islands before 11/3/1986);

(v) An American Indian Card issued by the Department of Homeland Security with the classification code "KIC" (Form I-872);

(vi) A final adoption decree showing the child's name and U.S. place of birth;

(vii) Evidence of U.S. Civil Service employment before 6/1/1976;

(viii) An Official U.S. Military Record of Service showing a U.S. place of birth (for example a DD-214);

(ix) Tribal membership card or Certificate of Degree of Indian Blood (CDIB) card, without a photograph of the individual, for Native Americans;

(x) Oklahoma voter registration card;

(xi) Other acceptable documentation as approved by OHCA; or

(xii) Other acceptable documentation to the same extent as described and communicated by the United States Citizenship and Immigration Service (USCIS) from time to time.

(B) Other less reliable forms of citizenship verification are:

(i) An extract of a hospital record on hospital letterhead established at the time of the person's birth that was created five (5) years before the initial application date and that indicates a U.S. place of birth. For children under sixteen (16) the evidence must have been created near the time of birth or five (5) years before the date of application;

(ii) Life, health, or other insurance record showing a U.S. place of birth that was created at least five (5) years before the initial application date and that indicates a U.S. place of birth;

(iii) Federal or state census record showing U.S. citizenship or a U.S. place of birth (generally for persons born 1900 through 1950). The census record must also show the applicant's/member's age; or

(iv) One (1) of the following items that show a U.S. place of birth and was created at least five (5) years before the application for SoonerCare. This evidence must be one (1) of the following and show a U.S. place of birth:

(I) Seneca Indian tribal census record;

(II) Bureau of Indian Affairs tribal census records of the Navajo Indians;

(III) U.S. State Vital Statistics official notification of birth registration;

(IV) An amended U.S. public birth record that is amended more than five (5) years after the person's birth; or

(V) Statement signed by the physician or midwife who was in attendance at the time of birth.

(3) Acceptable evidence of identity that must accompany citizenship evidence listed in (A) and (B) of paragraph (2) of this subsection includes:

(A) A driver's license issued by a U.S. state or territory with either a photograph of the individual or other identifying information such as name, age, sex, race, height, weight, or eye color;

(B) A school identification card with a photograph of the individual;

(C) An identification card issued by federal, state, or local government with the same information included on driver's licenses;

(D) A U.S. military card or draft record;

(E) A U.S. military dependent's identification card;

(F) A Native American Tribal document including Certificate of Degree of Indian Blood, or other U.S. American Indian/Alaska Native Tribal document with a photograph of the individual or other personal identifying information;

(G) A U.S. Coast Guard Merchant Mariner card;

(H) A state court order placing a child in custody as reported by the OKDHS;

(I) For children under sixteen (16), school records may include nursery or daycare records;

(J) If none of the verification items on the list are available, an affidavit may be used for children under sixteen (16). An affidavit is only acceptable if it is signed under penalty of perjury by a parent or guardian stating the date and place of the birth of the child and cannot be used if an affidavit for citizenship was provided.

(b) Reasonable opportunity to obtain verification.

(1) The state provides Medicaid to citizens and nationals of the United States and certain noncitizens, including during a reasonable opportunity period pending verification of citizenship, national status, or immigrations status. The reasonable opportunity period begins on the date the notice of reasonable opportunity is received by the individual and extends at minimum ninety (90) days. Receipt by the individual is deemed to occur five (5) days after the date on the notice, unless the individual shows that the notice was not received in the five-day period. The state provides an extension of the reasonable opportunity period if the individual subject to verification is making a good faith effort to resolve any inconsistencies or obtain any necessary documentation, or the state needs more time to complete the verification process. The state begins to furnish benefits to otherwise eligible individuals on the date of application containing the declaration of citizenship or immigration status and throughout the reasonable opportunity period.

(2) The following methods of verification are the least reliable forms of verification and should only be used as a last resort:

(A) Institutional admission papers from a nursing facility, skilled care facility or other institution. Admission papers generally show biographical information for the person including place of birth; the record can be used to establish U.S. citizenship when it shows a U.S. place of birth;

(B) Medical (clinic, doctor, or hospital) record created at least five (5) years before the initial application date that indicates a U.S. place of birth. For children under the age of sixteen (16), the document must have been created near the time of birth. Medical records generally show biographical information for the person including place of birth; the record can be used to establish U.S. citizenship when it shows a U.S. place of birth. An immunization record is not considered a medical record for purposes of establishing U.S. citizenship;

(C) Written affidavit. Affidavits are only used in rare circumstances. If the verification requirements need to be met through affidavits, the following rules apply:

(i) There must be at least two (2) affidavits by two (2) individuals who have personal knowledge of the event(s) establishing the applicant's/member's claim of citizenship;

(ii) At least one (1) of the individuals making the affidavit cannot be related to the applicant/member;

(iii) In order for the affidavit to be acceptable, the persons making them must be able to provide proof of their own citizenship and identity;

(iv) If the individual(s) making the affidavit has information which explains why evidence establishing the applicant's/member's claim of citizenship does not exist or cannot be readily obtained, the affidavit must contain this information as well;

(v) The State must obtain a separate affidavit from the applicant/member or other knowledgeable individual (guardian or representative) explaining why the evidence does not exist or cannot be obtained; and

(vi) The affidavits must be signed under penalty of perjury.

(c) Noncitizen eligibility. SoonerCare services are provided to noncitizens only as described in this subsection, if the individual meets all other applicable eligibility requirements, including but not limited to residency requirements, and the relevant immigration status or category is verified by federally approved means. Effective October 1, 2026, full SoonerCare benefits for noncitizens are limited to individuals for whom federal financial participation is available under Section 1903(v)(5) of the Social Security Act and other applicable federal law.

(1) Noncitizens eligible for full SoonerCare benefits. Beginning October 1, 2026, a noncitizen is eligible for full SoonerCare benefits without a five-year waiting period only if the individual is:

(A) a Cuban or Haitian entrant, as defined by federal law;

(B) a Compact of Free Association migrant lawfully residing in the United States in accordance with federal law; or

(C) a lawfully admitted permanent resident who is not subject to the five-year waiting period or who is exempt from that waiting period under applicable federal law.

(2) Noncitizens eligible for full SoonerCare benefits after the five-year waiting period. Beginning October 1, 2026, a lawfully admitted permanent resident who is subject to the five-year waiting period is eligible for full SoonerCare benefits only after satisfying the applicable waiting period and all other eligibility requirements under federal and state law.

(3) Noncitizens ineligible for full SoonerCare benefits. Beginning October 1, 2026, a noncitizen who is not described in paragraph (1) or (2) of this subsection is not eligible for full SoonerCare benefits, except to the extent coverage is expressly authorized by federal law. Such individuals may be eligible for emergency Medicaid if otherwise eligible under subsection (e) of this section. This paragraph includes, but is not limited to, a noncitizen whose verified immigration status or category is any of the following and who is not otherwise described in paragraph (1) or (2) of this subsection:

(A) a refugee admitted under section 207 of the Immigration and Nationality Act;

(B) an individual granted asylum under section 208 of the Immigration and Nationality Act;

(D) a noncitizen granted withholding of deportation or withholding of removal;

(E) a noncitizen granted conditional entry prior to April 1, 1980;

(F) a noncitizen who, or whose parent or child, has been battered or subjected to extreme cruelty, as described by federal law;

(G) a noncitizen granted nonimmigrant status as a victim of trafficking, a noncitizen with a pending application that sets forth a prima facie case for such status, or a victim of a severe form of trafficking in persons and qualifying family members, as described by federal law;

(H) an Amerasian immigrant;

(I) a lawfully residing veteran, active-duty servicemember, or qualifying family member whose eligibility is based solely on that status and who is not otherwise described in paragraph (1) or (2) of this subsection;

(J) an American Indian born in Canada or an American Indian who is a member of a federally recognized tribe, if the individual is not a United States citizen and is not otherwise described in paragraph (1) or (2) of this subsection;

(K) a certain Afghan parolee described by federal law;

(L) a certain Ukrainian parolee described by federal law; or

(M) any other lawfully residing noncitizen not otherwise described in paragraph (1) or (2) of this subsection.

(4) Unauthorized resident noncitizens. An unauthorized resident noncitizen is not eligible for full SoonerCare benefits and may receive emergency Medicaid only, if otherwise eligible.

(d) Continuing conformance with federal law. Notwithstanding any other provision of this section, eligibility of noncitizens for full SoonerCare benefits, any applicable waiting period, and the availability of emergency Medicaid shall be determined in accordance with applicable federal law, as amended from time to time, and federal financial participation shall be claimed only to the extent permitted by federal law.

(e) Emergency Medicaid. Emergency Medicaid means medical assistance provided to a noncitizen under Title XIX for care and services necessary for the treatment of an emergency medical condition, as defined by Section 1903(v)(3) of the Social Security Act, including labor and delivery but not related to an organ transplant procedure, if the noncitizen otherwise meets eligibility requirements under the state plan, including but not limited to residency requirements.

Disclaimer. The OHCA rules found on this Web site are unofficial. The official rules are published by the Oklahoma Secretary of State Office of Administrative Rules as Title 317 of the Oklahoma Administrative Code. To order an official copy of these rules, contact the Office of Administrative Rules at (405) 521-4911.