• Medicaid Citizenship Rule Eased
  • November 2, 2006
  • Law Firm: Buckingham, Doolittle & Burroughs, LLP - Akron Office
  • The Medicaid Citizenship Rule (the “Rule”), which took effect July 1, 2006, requires Medicaid patients to prove they are U.S. citizens or legal residents using a birth certificate, passport, or other original documentation records at the time of application or renewal of Medicaid benefits.  Prior to the enactment of the Rule, proof of citizenship was only mandatory when citizenship status was doubtful. 


    To continue to receive matching funds, each state must implement an effective process for assuring compliance with these citizenship documentation requirements.  Ohio addressed this requirement in Ohio Administrative Code Rule 5101:1-38-02, Medicaid Verification and Reporting Requirements, which includes new definitions and incorporates changes in the required documentation of citizenship for U.S. citizens and/or nationals. 


    Although the Rule was intended to prevent undocumented immigrants from receiving Medicaid benefits, its potential impact received strong criticism from medical professionals and patient advocates.  As a result, the Centers for Medicare and Medicaid Services (“CMS”) relaxed several of the Rule’s requirements, including exempting those beneficiaries already receiving Medicare or Supplemental Security Income from the requirement because they already had to document their status.  The modifications also include alternatives that states could use as verification. 


    Many medical professionals argue these modifications are not enough to ensure that at-risk patients receive the necessary medical care while they are looking for this documentation.  Beyond this concern, many physicians worry  how the Rule will impact their practices.  Physicians presented the following concerns to CMS:


    §         Physicians could end up providing uncompensated care because it is unclear whether they will be held harmless for treating patients believed to qualify for Medicaid.

    §         The Rule does not state whether certain waiver programs that allow physicians to take new patients on the spot, usually for preventative care, will be subject to documentation requirements.

    §         Physicians are concerned that they -could be responsible for a citizenship test at the point of care.


    CMS is expected to continue addressing implementation of the Rule, and it will be interesting to see if measures are taken to address these concerns.