Obtaining Documentation of Citizenship Status and Identity for Medicaid Enrollment Under the 2005 Deficit Reduction Act (DRA)
Beginning on July 1, 2006, most new Medicaid applicants and current Medicaid enrollees who renew their eligibility will be required to provide documentation to prove that they are U.S. citizens and to establish their identify (that is, that they are who they say they are). This requirement, however, does not apply to individuals with Medicare (also known as "dual eligibles"). In most states, the requirement also does not apply to people who receive Supplemental Security Income (SSI) benefits. People who receive Social Security Disability Insurance (SSDI) benefits, as well as foster children and children who receive adoption assistance, are also exempt from the requirement.
Currently, many states are exploring the possibility of using other means to verify the citizenship status of their Medicaid applicants and recipients, including using electronic data matches with other agencies. Check with your state Medicaid agency before requesting any of the documents listed below. In some cases, it might not be necessary. In addition, some states may choose to assist applicants and enrollees with obtaining the necessary documents and paying the associated costs.
What Documents Are Allowed under the New Legislation and Guidelines?
The Centers for Medicare and Medicaid Services (CMS), the federal agency overseeing the new requirements, has issued guidelines spelling out which documents may be used to prove citizenship status and identity. On July 2, 2007, CMS issued final regulations, which make some changes to the guidelines issued in 2006. Documents in Tier 1 (below) can be used to prove both citizenship and identity for purposes of Medicaid enrollment and/or renewal.
Tier 1 Documents (proof of both citizenship and identity)
Note: Naturalized citizens may now use Tier 2-4 documents or the affidavit process to prove citizenship and identity.
If the applicant cannot provide any of these documents from Tier 1, he or she must provide another document that proves citizenship (such as a U.S. birth certificate) in addition to a document that proves identity (such as a U.S. driver's license). The document for proving citizenship must come from the lists in Tiers 2, 3, and 4. The applicant must also produce an accepted form of photo ID or other document to establish identity.
Documents must be original or certified copies.
Notarized copies are not acceptable. |
What Should I Do If . . . ?
… if I cannot get any of the Tier 1-4 documents in a reasonable time?
… if I want to apply for a passport?
… if I need to obtain documents to prove citizenship?
… if I need to apply for a birth certificate in the U.S.?
… if I need to obtain an Extract of Hospital Record on hospital letterhead?
… if I want more information about the law or the CMS guidance?
Important Notes
- Receipt of Supplemental Security Income (SSI) is sufficient to prove citizenship for Medicaid beneficiaries in states that automatically provide Medicaid to SSI recipients. In the 11 states that do not automatically provide Medicaid to SSI recipients (CT, HI, IL, IN, MN, MO, NH, ND, OH, OK, VA), states can check the State Data Exchange report electronic files to verify the citizenship status of someone on SSI instead of demanding documentation from the beneficiary.
- Applicants and recipients have a right to state assistance should they need it. In particular, the guidance asserts that states should assist people who are homeless or who have mental illnesses or physical incapacities and who do not have someone else to act on their behalf. Bust states should help anyone who asks for help, even if he or she does not fall into one of these groups.
- Applicants and recipients must prove citizenship only once—they do not need to go through the process each time they renew their Medicaid coverage. But states should help anyone who asks, even if that person does not fall into one of these groups.
- States must give Medicaid recipients notice and an opportunity to appeal before terminating their Medicaid coverage.
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