On June 9, 2006 the Centers for Medicare and Medicaid Services (CMS) issued guidelines for state Medicaid programs to implement a new citizenship documentation requirement. The requirement is part of the Deficit Reduction Act of 2005 (DRA) enacted on February 8, 2006 (Public Law 109-171). The documentation provision was intended by its sponsors to deter illegal immigrants from fraudulently enrolling in Medicaid and ensure that federal Medicaid funding is spent on U.S. citizens and certain qualified immigrants. The new requirement has led to concerns among some state officials and advocates that the documentation provisions may be a barrier to enrollment and result in a reduction in Medicaid coverage.
Effective July 1, 2006, individuals claiming U.S. citizenship and applying for Medicaid eligibility determination or re-determination will be required to provide certain types of documentation of their citizenship. The recently released guidelines outline several categories of acceptable documentary evidence. State Medicaid programs will be required to first seek documentation of citizenship through U.S. Passports, Certificates of Naturalization, or Certificates of U.S. Citizenship. If these forms of documentation are unavailable, states should look to secondary and tertiary forms of documentation including U.S. birth certificates, U.S. Citizen I.D. cards, and hospital or insurance records of birth. The guidelines allow for states to accept written affidavits “in rare circumstances” when the state is unable to obtain proof of citizenship through other means.
States will be required to assure compliance with the citizenship documentation guidelines in order to obtain federal Medicaid matching funds. States will receive the regular 50 percent federal match for administrative costs related to implementing this new requirement. CMS intends to provide training sessions and technical assistance to state officials and to work closely with states to educate Medicaid enrollees and the general public about the changes.
Additional information on the new citizenship documentation requirement in the DRA is available at http://www.cms.hhs.gov/MedicaidEligibility/05_ProofofCitizenship.asp#TopOfPage.
