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CMS Says It Doesn't Know When Guidance Will Be Ready on Documenting Medicaid Eligibility

APRIL 17, 2006 -- A little understood provision of the Deficit Reduction Act (PL 109-171) requires that U.S. citizens with Medicaid coverage document their eligibility for the program the next time they renew their enrollment, according to the draft version of a federal advisory to be issued to the states.

Critics of the provision predict that if left unchanged, it would cause many current Medicaid beneficiaries to lose their coverage.

Leighton Ku, an analyst with the liberal Center on Budget and Policy Priorities, said Monday there is a widespread misconception that the provision requiring documentation of citizenship and identity does not apply to existing beneficiaries. But since beneficiaries must re-certify their eligibility at least once a year and in many cases every six months, it will affect current beneficiaries as well at renewal time, he noted.

In a story Sunday calling attention to the impact of the requirement on current beneficiaries, the New York Times noted an estimate by the center that up to 5 million of the nation's 50 million Medicaid beneficiaries could lose coverage.

House Energy and Commerce Health Subcommittee Chairman Nathan Deal and Rep. Charlie Norwood, Republicans from Georgia, both championed the documentation requirements as a way to keep illegal immigrants from getting Medicaid coverage.

But the draft "guidance" letter prepared by the Centers for Medicare and Medicaid Services (CMS) for state Medicaid directors emphasizes that, effective July 1, "states must obtain documents establishing identity and citizenship from all Medicaid applicants." For current Medicaid beneficiaries, "states also must obtain documents establishing identity and citizenship at the time of the first redetermination of eligibility that occurs after July 1, 2006," the letter says.

Presentation of documentation should ordinarily be a one-time activity, the letter adds.

Critics of the provision say that in many cases Medicaid applicants or beneficiaries legitimately entitled to enroll in the program do not have birth certificates establishing citizenship. They note for example that elderly African Americans may have been born outside of hospitals and never had birth certificates, and that certain American Indians might not have such documentation. Similarly, applicants or beneficiaries may not have driver's licenses.

Although there are provisions for alternate forms of documentation, CMS has not yet clarified what those are, and the July 1 deadline is fast approaching, Ku said.

A CMS spokeswoman said the agency doesn't yet know when the final version of the guidance letter will be mailed to the states. The agency aims to apply the documentation requirement in a way that ensures deserving beneficiaries do not lose their coverage, she said. But the spokeswoman added that the law is "fairly prescriptive."

The draft letter notes that under the law, the Department of Health and Human Services (HHS) secretary must conduct an "outreach" campaign to notify beneficiaries and applicants of the documentation requirements. The letter says HHS has determined that states are in the best position to carry out those educational efforts.

To help, HHS will conduct teleconferences to train state agencies in conducting outreach programs and provide them with sample documents to send to Medicaid applicants and recipients, the letter adds. Those activities will begin in mid-April, according to the letter, but the spokeswoman said they have not yet begun.

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