Citizenship documentation requirements in the Deficit Reduction Act of 2005: lessons from New York
- Collection:
- Health Policy and Services Research
- Author(s):
- Boozang, Patricia, author Dutton, Melinda, author Hudman, Julie, author
- Contributor(s):
- Henry J. Kaiser Family Foundation, issuing body. Kaiser Commission on Medicaid and the Uninsured, issuing body.
- Publication:
- Washington, DC : Kaiser Commission on Medicaid and the Uninsured, June 2006
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Eligibility Determination Medicaid New York United States
- Genre(s):
- Technical Report
- Abstract:
- The Deficit Reduction Act of 2005 (DRA) amends federal Medicaid statute to require that all United States citizens applying for or renewing Medicaid coverage present “satisfactory documentary evidence” of their citizenship. This new citizenship documentation requirement goes into effect on July 1, 2006 and will impact an estimated 50 million U.S. citizens receiving Medicaid benefits as well as many more seeking to apply. States that do not comply risk losing federal matching funds. Documentation requirements for qualified aliens remained unchanged. With the effective date for this new requirement less than one month away, states are grappling with the policy and program implications of its implementation. On June 9, 2006, the Centers for Medicare and Medicaid Services (CMS) issued a letter to State Medicaid Directors providing interim guidance on implementation of the DRA citizenship documentation requirement. The interim guidance outlines a complex system of citizenship documentation for the Medicaid program, including a four-tier “hierarchy of reliability of citizenship documents” that states are required to apply to new Medicaid applications as well as renewals. The interim guidance will serve as the basis for final regulations implementing the DRA citizenship documentation requirement. State officials and others are raising myriad concerns that implementation of this requirement will prove both costly and burdensome to states, and place eligible Medicaid applicants and beneficiaries at risk of losing services. Indeed, the acceptable forms of citizenship documentation under the DRA are proscriptive and the system by which states are mandated to obtain these documents is complicated at best. New York State is one of at least four states in the nation that already requires documentation of citizenship for Medicaid applicants (the others are Georgia, Montana and New Hampshire), and the only state with significant implementation experience. The interim guidance notes that New York has required documentation of citizenship in Medicaid for many years without “undue hardship to either applicants or the state,” and indicates that the DRA requirements “mirror” New York’s rules. In fact, there are significant differences between New York’s requirements and those of the DRA which if not addressed in final regulation would undeniably create hardship to both the state and its Medicaid applicants and beneficiaries. New York’s citizenship documentation requirement has been in place since at least the mid-1970s, and provides a solid base of experience that can inform development of federal guidance with respect to DRA implementation, as well as planning in state Medicaid programs that will be documenting citizenship for the first time. Drawing on legal research, interviews with Medicaid officials, and a roundtable discussion with front-line enrollers who provide Medicaid application assistance, this report provides an in-depth assessment of the New York State Medicaid program experience with citizenship documentation and potential conflicts between New York’s process and DRA citizenship documentation requirements as articulated by CMS to date.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY license. (More information)
- Extent:
- 1 online resource (1 PDF file (ii, 23 pages))
- NLM Unique ID:
- 101290060 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/101290060