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Requirements Issued for MA Citizenship and Identity Documentation
July 18, 2006

The Centers for Medicare and Medicaid Services (CMS) has issued interim final rules with a comment period for implementation of Citizenship Documentation Requirements for Medicaid established by the Federal Deficit Reduction Act. The interim final rule, effective July 6, is open to comment through August 11. PCPA members who wish to comment on the rule may submit comments to Betty Simmonds for compilation and submission to CMS or they can comment directly to CMS (www.cms.hhs.gov/eRulemaking). Instructions on electronic submission are available in the Federal Register. The complete rule is available through the Federal Register, Vol. 71, No. 133, July 12 issue
(http://a257.g.akamaitech.net/7/257/2422/01jan20061800/edocket.access.gpo.gov/2006/pdf/06-6033.pdf).

Guidance issued June 9 by CMS caused great concern that many individuals would be unable to produce the specified documentation and would lose or be unable to access Medicaid benefits. The interim final rule has allayed some of the concern by exempting citizens or nationals who are eligible for Medical Assistance and who are either entitled to benefits or enrolled in any parts of the Medicare program or who receive Supplemental Security Income benefits. It also permits states to use the Social Security Administration State Data Exchange to electronically verify that an individual has already been identified as a citizen. Furthermore, states may cross match other governmental, public assistance, law enforcement, or corrections agencies’ data systems to establish identity if the agency establishes and certifies true identity of individuals.

Pennsylvania has addressed the requirements for documentation of citizenship and identity through issuance of an Office of Income Maintenance (OIM) Operations Memorandum, Verifying Citizenship and Identity for Medicaid, to all county assistance offices (CAO) and a Medical Assistance (MA) Bulletin, Federal Medicaid Citizenship and Identity Eligibility Requirements. The MA bulletin is available on the Department of Public Welfare’s web site at www.dpw.state.pa.us/General/Bulletins/003673169.aspx?BulletinDetailId=1514. OIM expects that additional memoranda will be issued over the next few months as CMS refines its processes and litigation brought to enjoin implementation until additional consumer protections are established is resolved.

The Operations Memorandum explains that the Department of Public Welfare intends to assist all individuals applying for or currently receiving MA benefits to obtain the necessary documentation. If all other conditions of eligibility are met except documentation of citizenship and/or identity and the individual is cooperating with the CAO to obtain the
documentation, eligibility for MA will not be denied or terminated while issues are being resolved. It also identifies those to whom the citizenship and identity requirements do not apply. These include:

  • Individuals who are applying for or receiving General Assistance (GA) cash benefits and GA-related categories of Medicaid.
  • Pregnant women determined to be presumptively eligible (PS17) for Medicaid.
  • Individuals eligible for Supplemental Security Income (SSI) benefits either currently or in the past.
  • Individuals eligible for or receiving Medicare Part A and/or B.
  • Individuals who are applying for or receiving Temporary Assistance for Needy Families (TANF) cash benefits. (Note: Although it is not a requirement for TANF cash benefits, the CAO should ask for citizenship documents on all TANF cash applications, redeterminations, and renewals, but TANF cash cannot be denied or closed for failure to provide proof of citizenship.)

A DPW verification unit at OIM will obtain documentation for those individuals who cannot produce the necessary documents, using information obtained on the PA 1809 form that will be included with all applications for MA benefits. The verification unit will establish proof of identity through the Pennsylvania Department of Transportation.

The operations memorandum is effective July 24. The new citizenship and identity requirements do not apply to applications received prior to July 24 even if they are processed after this date. The MA bulletin (to be issued July 24 with implementation date of July 1) echoes language in the operations memorandum. It describes the types of documentation required and provides a copy of form PA 1809, Citizenship and Identity Information, to be used until all applications and the online Commonwealth of Pennsylvania Application for Social Services can be updated. It also instructs providers who assist individuals with MA applications to provide photocopies of the appropriate documents or, if the documents are not available, to assist individuals with completion of the PA 1809 and submit a copy of the completed form with the MA application to the CAO.

The National Council for Community Behavioral Healthcare developed a Citizenship Documentation Toolkit (www.nccbh.org/POLICY/Citizenship-Guidelines-Toolkit.pdf) and sample checklist (www.nccbh.org/POLICY/Checklist.pdf) for its membership that has been updated to reflect the requirements of the interim final rule. PCPA members may find these tools helpful in implementing the MA citizenship and identity requirements.

Please contact Betty Simmonds with questions.

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