California Department of Social Services - State Hearings Division
Notes from the Training Bureau - May 1, 2003

The MC13 form is entitled Statement of Citizenship, Alienage and Immigration Status. It is not necessary for counties to obtain the MC13 from a Medi-Cal applicant if the applicant declares that he/she is a U.S.citizen or national and declares his/her place of birth on any form signed under penalty of perjury during the Medi-Cal application process.

For Medi-Cal eligibility purposes, a person who was born in any of the 50 states, the District of Columbia, Puerto Rico, Guam, the Virgin Islands or the Northern Mariana Islands is a U.S. citizen. Persons born in American Samoa or Swain's Island are U.S. nationals.

If an applicant declares he/she is a U.S. citizen or national on some other Medi-Cal form, but declares a birthplace outside of locations listed in the above paragraph, counties are required to verify citizenship or national status in accord with Title 22, CCR §50301.1.