States Request Flexibility in Medicaid Proof of Citizenship Law
The federal government is receiving requests from state officials and patient advocates for greater flexibility in the enforcement of a new law that will require Medicaid enrollees and applicants to confirm their citizenship beginning July 1, Knight Ridder/Arizona Daily Star reports (Pugh, Knight Ridder/Arizona Daily Star, 6/5).
The measure was included in the Deficit Reduction Act of 2005, which was signed into law by President Bush in February. Under the law, individuals seeking care through Medicaid as of July 1 will be required to show proof of U.S. citizenship -- such as a birth certificate, passport or another form of identification. The law's intent is to prevent undocumented immigrants from claiming to be citizens in order to receive benefits only provided to legal residents (California Healthline, 4/11).
The Congressional Budget Office estimated that the law will save $220 million between 2006 and 2010 and remove 35,000 people from Medicaid by 2015. However, some experts worry that eligible Medicaid enrollees who cannot provide the necessary documentation also stand to lose their coverage. In addition, state officials fear the law will create a large administrative burden and confuse beneficiaries (Knight Ridder/Arizona Daily Star, 6/5).
Critics say the new requirements could prove difficult "for children, older Americans and poor people born at home in rural areas who never received birth certificates," according to the New York Times. Jennifer Ng'andu, health policy expert at the Hispanic rights group National Council of La Raza, said, "The documentation requirements will cause confusion about eligibility and will put up barriers to enrollment" (Pear, New York Times, 6/5).
According to Knight Ridder/Arizona Daily Star, CMS is responsible for "raising public awareness about the new law and for drafting guidelines on what alternative documents ... can be used to validate citizenship and to prove identity." However, CMS has yet to take either action.
States are asking CMS to accept as many records as possible in determining citizenship and identity, including driving, birth and school records; military records; voter registration cards; and Indian tribal records. State officials also want to check Medicaid records electronically against records from other programs to simplify verification.
Stan Rosenstein, director of Medi-Cal, said he wants to use signed personal affidavits for young children and some adults on Medicaid who cannot provide the required documents. Rosenstein said, "We want to use as many alternative sources as possible to verify citizenship. We're very concerned about the impact of this on the citizens of California and the United States" (Knight Ridder/Arizona Daily Star, 6/5).
CMS Administrator Mark McClellan said, "We want to provide an effective way to document citizenship without placing excessive burdens on states or beneficiaries" (New York Times, 6/5). He added, "We know that for some people it's going to take a little time and we want to be able to account for that." McClellan said that implementation guidelines and support materials would be released soon. He added that CMS is working with state Medicaid officials on their requests for flexibility in accepting alternative documents and is also trying to allow additional time for people to find their records (Knight Ridder/Arizona Daily Star, 6/5).
In a letter to be released this week to state officials, the Bush administration says, "Self-attestation of citizenship and identity is no longer an acceptable practice." The letter continues, "An applicant or recipient who fails to cooperate with the state in presenting documentary evidence of citizenship may be denied or terminated" from the program. It also states, "Once citizenship has been proved, it need not be documented again."
According to the Times, the Bush administration "backed off" earlier plans to give states greater flexibility to accept affidavits after "House Republicans complained" (New York Times, 6/5).