1. Meeting the Citizenship Documentation Requirement for Medicaid and CHIP Early Experience with the SSA Data Match Option Donna Cohen Ross Senior Advisor Office of External Affairs/CMS Donna.CohenRoss@cms.hhs.gov 202-260-0509

2. Citizenship Documentation Requirement A DRA requirement enacted in 2006: –U.S. citizens applying for Medicaid must present proof of citizenship and identity –Extended to CHIP in CHIPRA Some groups exempt from requirement (Medicare beneficiaries, foster children) Children, parents, pregnant women most affected

3. States Identified Impact on Medicaid States that tracked enrollment and costs reported: –Main effect was to delay or deny Medicaid to substantial numbers of eligible U.S. citizens –Administrative costs increased –Identified virtually no undocumented immigrants applying for or receiving Medicaid inappropriately

4. CHIPRA Included Cit Doc Changes Effective Upon Enactment: –States must provide benefits while applicants get reasonable opportunity to present documents –Infants born to mothers on Medicaid exempt, including at 12 month renewal –Tribal documents can satisfy proof of both citizenship and identity

5. CHIPRA Provides New SSA Data Match Option Effective January 1, 2010 Builds on State Verification and Exchange System (SVES) that states use to verify SSNs –Now provides match with citizenship field in Numident database Match is to substantiate claim of US citizenship (No match does not mean applicant is not a citizen.) All states have agreements to allow matching

6. Experience of Early Adopters As of 5/17/2010, 28 states are fully utilizing data exchange or testing States report need for new programming, but may not need enhanced administrative matching funds Batch process – overnight response “Successful match” rate generally high (94% and up reported) States finding administrative advantages SSA helping to resolve any problems

7. No Match? What to Do ? Protocol for states to rectify problems and resubmit to SSA Some U.S. citizens not found in SSA database, e.g. naturalized citizens Applicants get reasonable opportunity to document citizenship via other means Vital records matches and individualized assistance still needed