Medicaid Citizenship Documentation Requirement

1. Medicaid Citizenship Documentation Requirement Presented by Elaine M. Ryan October 13, 2006

2. Federal Rule Highlights • Established a hierarchy of reliability for documentation • Only primary evidence documents can prove both citizenship and identity. • U.S. Passport, Certificate of Naturalization, and a Certificate of U.S. Citizenship • Secondary, third, and fourth level documents are accepted as evidence of citizenship and must be accompanied by acceptable evidence of identity

3. Highlights from the IFR • Alleviates the citizenship requirements for dually eligible SSI and Medicare populations • Expands options for data matching for identity to include cross matching from the following agencies: • food stamps, child support, motor vehicle, child protective services, or corrections • Only originals or copies certified by the issuing agency are acceptable • Affidavits should only be used in rare circumstances

4. Highlights from the APHSA Comment Letter • Exempt foster care youth, independent living youth, subsidized adoption Medicaid recipients, and individuals receiving Social Security Disability Income (SSDI) • Remove the “tiered” process • Expand the documents that are currently acceptable to prove citizenship and identity

5. Highlights from the APHSA/NASMD Comment Letter • Allow verification to be acceptable across state lines without holding states liable for federal penalty for failure to document citizenship a second time • Alter the language to treat applicants and recipients equally • During the reasonable opportunity period allow applicants who have declared to be citizens to qualify for Medicaid services

6. State Implementation • Over 30 states have issued policies and notified recipients • Over 20 states have notified providers • Several states have held training sessions, made systems changes, and held community meetings

7. Bell v. LeavittUnited States District Court, Northern District of Illinois • The motion for a preliminary injunction for children receiving or who will receive health coverage under Medicaid due to categorical eligibility through the Title IV-E program was not denied and was referred to the Magistrate Judge. A status hearing took place on October 5, 2006. • Plaintiff files on November 14, after which the magistrate will rule in writing. 

8. State Implementation • Over 30 states are using SDX and vital records as data matching sources • Over 15 states are using BENDEX, SAVE, Food Stamps, & TANF to conduct data matching • Over 25 states have indicated that vital records is the most effective data matching source • Over 20 states have indicated that SDX is the most effective data matching source

9. State Implementation • States are considering creating interstate agreements for the exchange of information but most states are in preliminary stages of this process • At least 20 states have defined the “reasonable opportunity period” • Definitions range from 24 days to 12 months with exceptions for good cause and extensions when necessary

10. State Implementation • At least 13 states have indicated that over 50% of clients have been able to provide the necessary documentation • At least 13 states have indicated that the percentage of re-determinations found ineligible due to their immigration status is less than 10% • At least 11 states have indicated that the percentage of new applicants who are unable to provide necessary documentation is less than 10%