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Medicaid News
Bush Administration Exempts Millions in Medicaid
from Proof of Citizenship
July 7, 2006 – Facing lawsuits and unhappy state
health officials, the Bush administration has backed off – at least a
little – on the requirement that took effect on July 1 that Medicaid
applicants provide proof of citizenship. In an announcement yesterday,
the Centers for Medicare and Medicaid said certain beneficiaries will be
exempted. It is estimated to include about eight million of the 55
million Medicaid users.
 CMS Announces 8M Beneficiaries
Will Be Exempt From New Medicaid Proof-of-Citizenship Rules, Proposes
Alternatives for Documentation
CMS on Thursday announced
that it will exempt people enrolled in the Supplemental Security Income
or Medicare programs and other groups from regulations that took effect
July 1 requiring Medicaid beneficiaries and applicants to provide proof
of citizenship in order to receive benefits, the
Washington Post reports
(Levine, Washington Post, 7/7).
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Medicaid News |
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Under the law, individuals seeking care through
Medicaid must show proof of U.S. citizenship, such as a birth
certificate, passport or other form of identification. The law's intent
is to prevent undocumented immigrants from claiming to be citizens in
order to receive benefits provided only to legal residents (Kaiser
Daily Health Policy Report, 6/29).
CMS Administrator Mark McClellan said that people
receiving Medicare or SSI benefits would be exempt under the agency's
new regulation because they already had to establish their citizenship
when they enrolled in those programs. He estimated that about eight
million of 55 million Medicaid beneficiaries would fall into those
categories.
McClellan also said states also could establish
proof of citizenship by referencing records of state agencies that
administer food stamps, child support and child protective services, as
well as agencies that issue driver's licenses (Pear,
New York Times, 7/7).
In addition, individuals who make a "good faith
effort" to prove their citizenship will not face loss of coverage. In
rare cases, sworn affidavits from the beneficiary and at least one other
person could be used when no documentation of citizenship can be found.
The regulations will become final later this summer (Alonso-Zaldivar,
Los Angles Times, 7/7).
'Scrivener's Error'
The New York Times notes that in an "unusual preamble to the new rule,"
CMS states that it believes Congress intended to exempt people in
Medicare or SSI from the proof-of-citizenship rule.
The original law states that the requirement "shall
not apply to an alien who is eligible for medical assistance" if the
person also is enrolled in one of the other programs.
According to the CMS preamble, this language is
"clearly a drafting error" in which Congress intended to use the word
"citizen" but "actually used the term 'alien.'" CMS said it was
correcting "a scrivener's error" with the new regulations (New York
Times, 7/7).
Comments
"We want to make sure people eligible for Medicaid get their benefits,
and we want to do it without imposing additional burdens on the states,"
McClellan said.
"This recognizes the diversity of individuals and
provides a range of ways citizenship status may be documented," he
added. Ron Pollack, executive director of
Families USA, said the
new regulation "is a commendable development," but, he added, "Numerous
other people who need health care the most -- such as foster children,
the homeless and people victimized by a natural disaster -- may still
lose Medicaid coverage and join the ranks of the uninsured, and that
should be corrected" (Los Angeles Times, 7/7).
A hearing will be held Friday in federal court in
Chicago for a lawsuit in which advocacy groups are seeking to stop
implementation of the new law on grounds that it is unconstitutional
(Washington Post, 7/7).
North Carolina
In related news, North Carolina's Medicaid program will delay until
September enforcement of new federal proof-of-citizenship requirements,
the
AP/Raleigh News & Observer
reports (AP/Raleigh News & Observer, 7/6). Ohio and California
previously announced plans to delay enforcement of the new rules (Kaiser
Daily Health Policy Report, 6/23).
Mark Benton, senior deputy director for the North
Carolina
Division of Medical Assistance,
said the state was forced to delay implementing the new rules because
CMS delivered instructions for doing so just three weeks before the
start date. Benton said that until the state changes its rule in
September, the previous policy of asking applicants whether they are
U.S. citizens -- and not requiring documentation -- will remain in
place.
Leighton Ku, a health care analyst for the
Center on Budget and Policy
Priorities, said up to 10% of North Carolina's 1.5 million
Medicaid beneficiaries do not have a birth certificate or passport
(AP/Raleigh News & Observer, 7/6).
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