CMS Releases Medicaid Proof-of-Citizenship Guidelines
CMS on Friday released new guidelines on proof-of-citizenship requirements for Medicaid beneficiaries and applicants, the Richmond Times-Dispatch reports (McKelway, Richmond Times-Dispatch, 6/10).
The guidelines, which will take effect on July 1, allow the use of passports, birth certificates, certificates of naturalization, final adoption decrees, a U.S. citizenship identification card, an extract of a hospital birth record and medical or nursing home admission records that indicate a place of birth to establish proof of citizenship for Medicaid beneficiaries and applicants. According to CMS, written affidavits from two individuals, one of whom is not related to the Medicaid beneficiary or applicant, that attest to citizenship "may be used only in rare circumstances when the state is unable to secure evidence of citizenship from another listing."
Individuals who provide such affidavits have to prove their own citizenship and are subject to prosecution for perjury, according to CMS. CMS also said that "a second affidavit from the applicant ... or other knowledgeable individual explaining why documentary evidence does not or cannot be readily obtained must also be requested" (Reichard, CQ HealthBeat, 6/9).
The guidelines allow the use of school records that indicate a date and place of birth, a school ID card with a photograph or day care and nursery school records to establish proof of citizenship for children. CMS said that current Medicaid beneficiaries "should not lose benefits during the period in which they are undertaking a good-faith effort" to establish proof of citizenship.
The guidelines likely will limit access to health care for "poor residents who never obtained birth certificates or have lost identification papers," with "especially difficult situations" likely for immigrants who "cannot show legal residency papers or whose American-born children do not have documentation," the Times-Dispatch reports (Richmond Times-Dispatch, 6/10). Health care advocates maintain that the guidelines will exclude a significant number of eligible Medicaid beneficiaries and applicants from the program and recommended less restrictive use of affidavits to establish proof of citizenship (CQ HealthBeat, 6/9).
California health officials on Tuesday said they are postponing the enforcement of the law until guidelines were released.
Stan Rosenstein, deputy director of medical care services in the Department of Health Services, said California likely will draft and issue rules for county social service agencies by mid-summer after the state obtains federal guidance on the rule (California Healthline, 6/7).
In related news, the Washington Post on Monday examined how state Medicaid programs "are moving aggressively" to add fees, restrict benefits and establish "incentives for patients to take responsibility for their health" under new flexibility authorized by the Deficit Reduction Act enacted earlier this year.
For example, West Virginia on July 1 will begin to require Medicaid beneficiaries to sign a "member agreement" -- under which they agree not to miss physician appointments, visit the emergency department only for emergencies and take prescribed medications -- to continue to receive full benefits.
Kentucky plans to separate the state Medicaid population into four groups based on age and quality of health, with different benefits provided for each group.
In addition, Florida in September will privatize the state Medicaid program in two counties and require beneficiaries to select from one of 19 health plans.
Ray Scheppach, executive director of the National Governors Association, said that states also have begun to implement "additional copays and small reductions in benefits" to prevent "pushing hundreds of thousands of women and children off the rolls."
However, Ron Pollack, executive director of Families USA, said, "Low-income individuals are increasingly going to be put at far greater risk of not receiving critically important services that they used to receive" (Goldstein, Washington Post, 6/12).