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CMS ISSUES FINAL CITIZENSHIP GUIDELINES FOR MEDICAID ELIGIBILITY

CMS ISSUES FINAL CITIZENSHIP GUIDELINES FOR MEDICAID ELIGIBILITY
DOCUMENTATION EXPANDED, GROUPS EXEMPTED

Establishing citizenship for Medicaid eligibility will be easier for states and program applicants under final regulations implementing the new law, issued by the Centers for Medicare & Medicaid Services (CMS) today.

            Today’s final rule both expands the types of documentation that can be used to establish citizenship and formally exempts certain groups from the requirements.  The changes reflect over 1,400 public comments received after publication of the citizenship interim final rule on July 1, 2006, as well as changes enacted as part of the Tax Relief and Health Care Act of 2006.

            “We recognize the diversity of beneficiaries served by Medicaid and these new guidelines provide for a range of ways that citizenship status and personal identity may be documented,” said Leslie V. Norwalk, Esq., acting administrator of CMS. “Our overriding goal is in ensuring that Medicaid dollars are being spent effectively on those who are qualified for coverage.”  

            Published in today’s Federal Register, the final rule codifies earlier guidance issued to states that exempts children in foster care as well as individuals enrolled in Medicare, individuals who receive Supplemental Security Income , and those who receive Social Security Disability Insurance.  The rule also makes final a CMS policy change that will extend Medicaid benefits for up to the first year of life to a newborn child whose mother was receiving Medicaid on the date of his or her birth, regardless of the mother’s immigration status.  Announcement of CMS’ policy with respect to newborn “deeming” was first made in March.

            Enacted as part of the Deficit Reduction Act of 2005 (DRA), the new law requires that as of July 1, 2006, persons applying for Medicaid, or renewing their eligibility, document their citizenship.  United States citizenship or legal immigration status has always been a requirement for Medicaid eligibility, but prior to the DRA states could accept a person’s statement of citizenship as sufficient.  The new law is designed to ensure that beneficiaries who are citizens have documented such status without imposing undue burdens on them or the states.  The new law does not apply to applicants and recipients who are legal immigrants. Such individuals continue to provide documentation of their immigration status as previously required.

            The law requires that a person provide both evidence of citizenship and identity.  In many cases, a single document, such as a passport, will be enough to establish both citizenship and identity. However, if secondary documentation is used, such as a birth certificate, the individual will also need evidence of their identity. Once citizenship has been proven, it need not be documented again with each eligibility renewal unless later evidence raises a question.

            If other forms of citizenship documentation cannot be obtained, documentation may be provided by a written affidavit, signed under penalty of perjury by the applicant or recipient and by two additional individuals with specific knowledge of a beneficiary’s citizenship status who are also citizens. At least one of the individuals cannot be related to the applicant or recipient.  Affidavits can only be used in rare circumstances.

            Additional types of documentation, such as school records, may be used to document identity for children.  Current beneficiaries should not lose benefits during the period in which they are undertaking a good-faith effort to provide documentation to the state.