CMS Issues Final Citizenship Guidelines for Medicaid Eligibility

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 and Medicaid Services (CMS). The final rule both expands the types of documentation that can be used to establish citizenship and formally exempts certain groups from the requirements.

“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,” Leslie V. Norwalk, Esq., acting administrator of CMS, said in a press release. “Our overriding goal is in ensuring that Medicaid dollars are being spent effectively on those who are qualified for coverage.”

Published in the 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.

Enacted as part of the Deficit Reduction Act of 2005, the new law requires that as of July 1, 2006, people applying for Medicaid, or renewing their eligibility, document their U.S. citizenship or legal immigration status.

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 people with specific knowledge of a beneficiary’s citizenship status who are also citizens. At least one of the people 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.

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