Deficit Reduction Act: 10/01/06 Regulations

September 20, 2006

The Deficit Reduction Act was designed to save the federal government money. Massachusetts hospitals and healthcare providers are about to make their first of many contributions to these savings as MassHealth prepares to deny coverage to otherwise qualified applicants. These denials will be based on non-compliance with the newly promulgated citizenship and identity verification requirements, the regulations for which were published earlier this week.

Since July 17, 2006, the Office of Medicaid has required that persons applying for or receiving MassHealth must verify their citizenship and identity or immigration status as required by the federal Deficit Reduction Act (DRA). Until now, the Office of Medicaid had offered no regulations of their own and has been applying rules based on federal guidance. Beginning this week, the state will rely on recently released emergency regulations, with a retroactive effective date of July 1, 2006.

You can now expect to see coverage denials for otherwise eligible MassHealth patients who do not submit their citizenship and identity documentation. The denials will site the newly issued regulations, which are available for download.

1. Do not guarantee a cross-match with the federal or state governmental agencies' data systems, which would meet these requirements,
2. Do not protect individuals who are otherwise eligible for Medicaid, including people with mental illness, cognitive disabilities, the homeless and others who may not be able to produce the required documents and
3. Do not keep coverage in place for people who are making a good faith effort to gather their documentation.

On a positive note, the regulations do not require the submission of originals. Like other verification requirements (such as paystubs, bank statements or health insurance cards) the regulations list what is acceptable and do not make any suggestion that copies may not be submitted by mail or fax.

Regarding Affidavits: The regulations define personal knowledge of the event of citizenship as knowing the date and place of birth. The regulations require the person signing the affidavit to verify his national status and identity not his citizenship and identity as CMS does. Furthermore, the regulations do not require that the affidavit be signed under the pain and penalties of perjury.

Regarding Identity: Massachusetts requires a current drivers license while CMS requires only a driver’s license.

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