Medicaid citizenship rule eased, but access concerns persist

Some physician groups say enforcement should be delayed until there are adequate and uniform guidelines.

By Amy Lynn Sorrel, AMNews staff. July 24/31, 2006.

The medical community is holding back sighs of relief over federal efforts to relax Medicaid's new proof-of-citizenship rules, fearing the mandate still could leave millions of the nation's low-income patients vulnerable to losing medical coverage.

The law, which took effect July 1, requires Medicaid patients, at the time of application or renewal, to prove that they are U.S. citizens or legal residents using a birth certificate, passport or other original identification records. Passed by Congress in February as part of the Deficit Reduction Act, the measure is intended to prevent undocumented immigrants from receiving Medicaid benefits.

But the potential impact has stirred up criticism, with many medical professionals and patient advocacy groups fearing that eligible patients will be confused and possibly dropped because they cannot produce the necessary paperwork. Citizenship was previously a condition for Medicaid; however, proof was only mandatory when that status was doubtful.

Shortly after a class-action lawsuit was filed June 28 challenging the law, the Centers for Medicare & Medicaid Services announced that elderly and disabled patients receiving Medicare or Supplemental Security Income would be exempt from the requirement because they already had to document their status. The new rules also outlined alternatives that states could use as verification, including electronic data matches with other government agencies, or, in rare circumstances, a written affidavit by two other citizens, one of whom must be unrelated to the applicant.