New Publications Examine Citizenship Documentation in Medicaid

(Kaiser Foundation)

Among the changes to Medicaid included in the Deficit Reduction Act (DRA) of 2005 is a new federal requirement, effective July 1, 2006, that all U.S. citizens and nationals applying for or renewing Medicaid coverage provide documentation of their citizenship status.

The Kaiser Family Foundation’s Commission on Medicaid and the Uninsured (KCMU) has released a fact sheet on the new citizenship documentation requirements and a report examining New York’s experience with requiring citizenship documentation from their Medicaid applicants.

The DRA directs states to require all citizens applying for or renewing Medicaid coverage to document their citizenship. Although Medicaid has long required states to establish that applicants are U.S. citizens, only 4 states today (Georgia, Montana, New Hampshire and New York) require more than self-declaration of citizenship under penalty of perjury. In New York, for example, a birth certificate, baptismal record recorded within three months of birth, a U.S. passport, and a naturalization certificate are common acceptable forms of citizenship. There is some concern that the new federal documentation requirements will be costly and burdensome to states and place eligible Medicaid applicants and current enrollees at risk of losing services.

New York has required citizenship documentation for Medicaid eligibility since the mid-1970s. The report, Citizenship Documentation Requirements in the Deficit Reduction Act of 2005: Lessons from New York, provides valuable insights from New York’s thirty years of experience as many states begin documenting citizenship for the first time.

Specific lessons from New York’s experience include:

• New York’s documentation requirements have evolved over time and experience;
  
  
• The state has significant application assistance resources that may not exist in other states to help applicants meet their documentation requirements;
  
  
• Citizenship documentation is more often a barrier for certain special populations including the elderly, institutionalized, homeless, mentally ill and foster children;
  
  
• The state accepts copies of documents and utilizes electronic matching to promote efficiency;
  
  
• The state automatically enrolls newborns; and
  
  
• The state has linked the application, documentation, and eligibility determination rules and processes for several of its public benefit programs including Medicaid, Temporary Assistance for Needy Families (TANF), and Supplementary Security Income (SSI).

  
  

New York and other states are racing to adjust to the new federal requirements which take effect July 1, 2006. KCMU will continue to monitor this issue and other provisions in the DRA related to Medicaid. For further information, contact us at kcmu@kff.org .