Medicaid Citizenship Status and Personal Identity

June 13, 2006

HHS issued guidelines for states to implement a new requirement, effective July 1, that persons applying for Medicaid document their citizenship. The new documentation requirement is mandated by Section 6036 of the Deficit Reduction Act of 2005 (DRA) and is intended to ensure that Medicaid beneficiaries are citizens without imposing undue burdens on them or the states. Today's guidance letter to state Medicaid officials will be followed by federal regulations that will appear in the Federal Register.

Recognizing the diversity of beneficiaries served by Medicaid, the guidelines provide for a range of ways that citizenship status and personal identity may be documented. If other forms of documentation cannot be obtained, documentation may be provided by a written affidavit, signed under penalty of perjury, from two citizens, one of whom cannot be related to the applicant or recipient, who have specific knowledge of a beneficiary's citizenship status. Affidavits can only be used in rare circumstances. Additional types of documentation, such as school records, may be used 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.

American citizenship or legal immigration status has always been a requirement for Medicaid eligibility, however, beneficiaries could assert their citizenship status by checking a box on a form. The DRA requires actual documentary evidence before Medicaid eligibility is granted or renewed beginning July 1. The provision requires that a person provide both evidence of citizenship and identity. In many cases, a single document will be enough to establish both citizenship and identity such as a passport. 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.

For more information, please see the copies of the State Medicaid Director letter (Adobe Acrobat PDF) and a Fact Sheet (Adobe Acrobat PDF).