1. 1 Medicaid Citizenship Documentation Requirement Presented by Elaine M. Ryan October 13, 2006

2. 2 Federal Rule Highlights Established a hierarchy of reliability for documentation Established a hierarchy of reliability for documentation Only primary evidence documents can prove both citizenship and identity. Only primary evidence documents can prove both citizenship and identity. –U.S. Passport, Certificate of Naturalization, and a Certificate of U.S. Citizenship Secondary, third, and fourth level documents are accepted as evidence of citizenship and must be accompanied by acceptable evidence of identity Secondary, third, and fourth level documents are accepted as evidence of citizenship and must be accompanied by acceptable evidence of identity

3. 3 Highlights from the IFR Alleviates the citizenship requirements for dually eligible SSI and Medicare populations Alleviates the citizenship requirements for dually eligible SSI and Medicare populations Expands options for data matching for identity to include cross matching from the following agencies: Expands options for data matching for identity to include cross matching from the following agencies: –food stamps, child support, motor vehicle, child protective services, or corrections Only originals or copies certified by the issuing agency are acceptable Only originals or copies certified by the issuing agency are acceptable Affidavits should only be used in rare circumstances Affidavits should only be used in rare circumstances

4. 4 Highlights from the APHSA Comment Letter Exempt foster care youth, independent living youth, subsidized adoption Medicaid recipients, and individuals receiving Social Security Disability Income (SSDI) Exempt foster care youth, independent living youth, subsidized adoption Medicaid recipients, and individuals receiving Social Security Disability Income (SSDI) Remove the “tiered” process Remove the “tiered” process Expand the documents that are currently acceptable to prove citizenship and identity Expand the documents that are currently acceptable to prove citizenship and identity

5. 5 Highlights from the APHSA/NASMD Comment Letter Allow verification to be acceptable across state lines without holding states liable for federal penalty for failure to document citizenship a second time Allow verification to be acceptable across state lines without holding states liable for federal penalty for failure to document citizenship a second time Alter the language to treat applicants and recipients equally Alter the language to treat applicants and recipients equally During the reasonable opportunity period allow applicants who have declared to be citizens to qualify for Medicaid services During the reasonable opportunity period allow applicants who have declared to be citizens to qualify for Medicaid services

6. 6 State Implementation Over 30 states have issued policies and notified recipients Over 30 states have issued policies and notified recipients Over 20 states have notified providers Over 20 states have notified providers Several states have held training sessions, made systems changes, and held community meetings Several states have held training sessions, made systems changes, and held community meetings

7. 7 Bell v. Leavitt United States District Court, Northern District of Illinois The motion for a preliminary injunction for children receiving or who will receive health coverage under Medicaid due to categorical eligibility through the Title IV-E program was not denied and was referred to the Magistrate Judge. A status hearing took place on October 5, 2006. The motion for a preliminary injunction for children receiving or who will receive health coverage under Medicaid due to categorical eligibility through the Title IV-E program was not denied and was referred to the Magistrate Judge. A status hearing took place on October 5, 2006. Plaintiff files on November 14, after which the magistrate will rule in writing. Plaintiff files on November 14, after which the magistrate will rule in writing.

8. 8 State Implementation Over 30 states are using SDX and vital records as data matching sources Over 30 states are using SDX and vital records as data matching sources Over 15 states are using BENDEX, SAVE, Food Stamps, & TANF to conduct data matching Over 15 states are using BENDEX, SAVE, Food Stamps, & TANF to conduct data matching Over 25 states have indicated that vital records is the most effective data matching source Over 25 states have indicated that vital records is the most effective data matching source Over 20 states have indicated that SDX is the most effective data matching source Over 20 states have indicated that SDX is the most effective data matching source

9. 9 State Implementation States are considering creating interstate agreements for the exchange of information but most states are in preliminary stages of this process States are considering creating interstate agreements for the exchange of information but most states are in preliminary stages of this process At least 20 states have defined the “reasonable opportunity period” At least 20 states have defined the “reasonable opportunity period” –Definitions range from 24 days to 12 months with exceptions for good cause and extensions when necessary

10. 10 State Implementation At least 13 states have indicated that over 50% of clients have been able to provide the necessary documentation At least 13 states have indicated that over 50% of clients have been able to provide the necessary documentation At least 13 states have indicated that the percentage of re-determinations found ineligible due to their immigration status is less than 10% At least 13 states have indicated that the percentage of re-determinations found ineligible due to their immigration status is less than 10% At least 11 states have indicated that the percentage of new applicants who are unable to provide necessary documentation is less than 10% At least 11 states have indicated that the percentage of new applicants who are unable to provide necessary documentation is less than 10%