8M Medicaid Beneficiaries Will Be Exempt From New Medicaid Proof-of-Citizenship Rules...

CMS Announces 8M Beneficiaries Will Be Exempt From New Medicaid Proof-of-Citizenship Rules, Proposes Alternatives for Documentation

[Jul 07, 2006]

CMS on Thursday announced that it will exempt people enrolled in the Supplemental Security Income or Medicare programs and other groups from regulations that took effect July 1 requiring Medicaid beneficiaries and applicants to provide proof of citizenship in order to receive benefits, the Washington Post reports (Levine, Washington Post, 7/7). Under the law, individuals seeking care through Medicaid must show proof of U.S. citizenship, such as a birth certificate, passport or other form of identification. The law's intent is to prevent undocumented immigrants from claiming to be citizens in order to receive benefits provided only to legal residents (Kaiser Daily Health Policy Report, 6/29). CMS Administrator Mark McClellan said that people receiving Medicare or SSI benefits would be exempt under the agency's new regulation because they already had to establish their citizenship when they enrolled in those programs. He estimated that about eight million of 55 million Medicaid beneficiaries would fall into those categories. McClellan also said states also could establish proof of citizenship by referencing records of state agencies that administer food stamps, child support and child protective services, as well as agencies that issue driver's licenses (Pear, New York Times, 7/7). In addition, individuals who make a "good faith effort" to prove their citizenship will not face loss of coverage. In rare cases, sworn affidavits from the beneficiary and at least one other person could be used when no documentation of citizenship can be found. The regulations will become final later this summer (Alonso-Zaldivar, Los Angles Times, 7/7).

'Scrivener's Error'
The New York Times notes that in an "unusual preamble to the new rule," CMS states that it believes Congress intended to exempt people in Medicare or SSI from the proof-of-citizenship rule. The original law states that the requirement "shall not apply to an alien who is eligible for medical assistance" if the person also is enrolled in one of the other programs. According to the CMS preamble, this language is "clearly a drafting error" in which Congress intended to use the word "citizen" but "actually used the term 'alien.'" CMS said it was correcting "a scrivener's error" with the new regulations (New York Times, 7/7).

Comments
"We want to make sure people eligible for Medicaid get their benefits, and we want to do it without imposing additional burdens on the states," McClellan said. "This recognizes the diversity of individuals and provides a range of ways citizenship status may be documented," he added. Ron Pollack, executive director of Families USA, said the new regulation "is a commendable development," but, he added, "Numerous other people who need health care the most -- such as foster children, the homeless and people victimized by a natural disaster -- may still lose Medicaid coverage and join the ranks of the uninsured, and that should be corrected" (Los Angeles Times, 7/7). A hearing will be held Friday in federal court in Chicago for a lawsuit in which advocacy groups are seeking to stop implementation of the new law on grounds that it is unconstitutional (Washington Post, 7/7).

North Carolina
In related news, North Carolina's Medicaid program will delay until September enforcement of new federal proof-of-citizenship requirements, the AP/Raleigh News & Observer reports (AP/Raleigh News & Observer, 7/6). Ohio and California previously announced plans to delay enforcement of the new rules (Kaiser Daily Health Policy Report, 6/23). Mark Benton, senior deputy director for the North Carolina Division of Medical Assistance, said the state was forced to delay implementing the new rules because CMS delivered instructions for doing so just three weeks before the start date. Benton said that until the state changes its rule in September, the previous policy of asking applicants whether they are U.S. citizens -- and not requiring documentation -- will remain in place. Leighton Ku, a health care analyst for the Center on Budget and Policy Priorities, said up to 10% of North Carolina's 1.5 million Medicaid beneficiaries do not have a birth certificate or passport (AP/Raleigh News & Observer, 7/6).

Dear Senator ,

As a native Californian and excellent customer of the Internal Revenue Service, I am writing to ask for your assistance. I have contacted the Immigration and Naturalization Service in an effort to determine the process for becoming an illegal alien and they referred me to you.

My reasons for wishing to change my status from U.S. Citizen to illegal alien stem from the bill which was recently passed by the Senate and for which you
voted. If my understanding of this bill's provisions is accurate, as an illegal alien who has been in the United States for five years, what I need to do to
become a citizen is to pay a $2,000 fine and income taxes for three of the last five years.

I know a good deal when I see one and I am anxious to get the process started before everyone figures it out. Simply put, those of us who have been here legally have had to pay taxes every year so I'm excited about the prospect of
avoiding two years of taxes in return for paying a $2,000 fine. Is there any way that I can apply to be illegal retroactively? This would yield an excellent result for me and my family because we paid heavy taxes in 2004 and 2005.

Another benefit in gaining illegal status would be that my daughter would receive preferential treatment relative to her law school applications.

If you would provide me with an outline of the process to become illegal(retroactively if possible) and copies of the necessary forms, I would be most appreciative. Thank you for your assistance.

Your Loyal Constituent,

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