New Medicaid Citizenship Requirements

June 14, 2006

American citizenship or legal immigration status has always been a requirement for Medicaid eligibility, however, until now beneficiaries were allowed to verify their U.S. citizenship status through a self- declaration checkbox on the Medicaid application form. The Federal Deficit Reduction Act of 2005 changed this. It imposes a requirement that all states review documentary evidence of U.S. citizenship before Medicaid eligibility is granted or renewed for any beneficiary declaring U. S. citizenship. The mandate takes effect July 1, 2006.

Please note: This provision affects all Medicaid beneficiaries making a declaration of U. S. citizenship, whether or not they are immigrants.

The mandate has two parts. It requires verification of citizenship and of identity. HFI is extremely concerned that many low-income U.S. citizens do not have passports or birth certificates readily available and may lose Medicaid coverage as a result of this new law. Many individuals who are eligible for Medicaid, including people with mental illness, cognitive disabilities, the homeless and others may not be able to produce these kinds of documents.

These regulations apply to new applicants and those members who are redetermined through the eligibility review form (ERV) process. This is a one-time requirement and once the state/member has proven citizenship they need not do so again.

To establish U.S. Citizenship the document must show:

• A U.S. place of birth, or
• That a person is a U.S. citizen

The guidance adopts a hierarchical approach already in use by other federal programs. Documentary evidence of citizenship and identity is sought first from a list of primary documents. If an applicant or recipient presents evidence from the list of primary documents, no other information is required. When such evidence cannot be obtained, the state will look to the next tier of acceptable forms of evidence. Please look for more information regarding this from HFI in the next few business days.

States are required to implement an effective process for assuring compliance with these regulations to obtain Federal matching funds, and effective compliance will be part of the Medicaid program integrity monitoring. CMS plans to publish regulations that would exercise this authority. In particular, audit processes will track the extent to which states rely on lower (third and fourth level) categories of documentation, and on affidavits, with the expectation that such categories would be used relatively infrequently and less over time as state processes and beneficiary documentation improves.

To establish identity:

The provision requires that a person provide evidence of both citizenship and identity. In few cases, a single primary document (such as a passport or naturalization papers) will be enough to establish both citizenship and identity. However, most cases will require the use of a secondary document, such as a birth certificate. With a secondary document the individual will also need to provide evidence of their identity. The good news is that once citizenship and identity have been proven they need not be documented again with each eligibility renewal unless later evidence raises a question.

Please note: Driver's license documentation to establish both citizenship and identification cannot be used in Massachusetts.

Even though we are convinced that MassHealth is taking every available step to minimize the hardship associated with this burdensome federal mandate, we at HFI strongly believes that this provision will result in inappropriate denials or delays in Medicaid coverage for large numbers of citizens whose personal circumstances may render them unable to secure this documentation.

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