Support Legislation to Repeal the Unworkable New Medicaid Documentation Requirement

Prior to the DRA, states could require citizens to provide documentary evidence of their citizenship status, but the federal government did not require states to do so.  Most states allowed applicants to attest under penalty of perjury that they were citizens, and each state had the authority to investigate any claim they thought was fraudulent and to require any documentation necessary to prove citizenship.

Under the DRA, this system is being replaced by one that is more administratively burdensome by requiring citizenship documents from the vast majority of applicants, a move that could prevent many otherwise eligible children and adults from obtaining necessary health care services.  Although recent regulations issued by Centers for Medicaid and Medicare Services (CMS) exempt citizens who receive Medicare or are enrolled in Medicaid because they receive Supplemental Security Income (SSI), 43 million people must still prove citizenship or face losing coverage.

Millions of Americans who are otherwise eligible for Medicaid could lose coverage.
As of July 1, 2006, section 6036 of the Deficit Reduction Act requires all U.S. citizens applying for or receiving Medicaid to provide a birth certificate, a passport, or another less common form of documentation.  According to the Center on Budget and Policy Priorities, about 910,000 U.S.-born adult Medicaid beneficiaries who do not have access to a birth certificate or passport are subject to the documentation requirements.  In addition, an estimated 1.4 to 2.8 million native-born children who lack a birth certificate and passport must prove citizenship under the provision.  Without this paperwork, millions of Americans who would otherwise be eligible for Medicaid could be denied coverage.

People who depend on Medicaid most will be most affected.
Section 6036 will disproportionately affect people who live in rural areas and were born outside a hospital, people who are displaced as a result of a natural or other disaster, people with disabilities who do not receive SSI, or low-income people who cannot afford the application fees to get a birth certificate or passport.  According to a recent survey commissioned by the Center on Budget and Policy Priorities, U.S.-born adults with incomes below $25,000 are almost twice as likely as adults with incomes above $25,000 to report not having a passport or birth certificate.  The most vulnerable Americans will be hurt most by this unnecessary provision.

Women who depend on Medicaid for their birth control will face gaps in coverage and may even choose to go without if the enrollment process is too difficult.
Medicaid is the largest source of public funding for family planning services, accounting for more than 60 percent of all publicly funded services.  Twenty-four states have expanded access to family planning through the Medicaid program, and a number of states have taken steps to make Medicaid enrollment for family planning services easier and more efficient to encourage women to participate in the program.  The new DRA documentation requirement undermines states' efforts to expand access to family planning and reduce the number of unintended pregnancies among low-income, vulnerable women by creating an enrollment barrier that may discourage women from seeking these vital services.  At the very least, new applicants may face significant gaps in family planning coverage while they are making a good faith effort to locate the required documentation.

The requirement will create new administrative costs and burdens.
According to the Inspector General of the Department of Health and Human Services (HHS), approximately 50 percent of state officials have reported that they would have to hire additional personnel to handle the increased workload if birth certificates or passports are required for Medicaid enrollment.  Verifying the citizenship status of nearly all Americans enrolled in Medicaid is not only unnecessary, but it will also create new administrative costs — money that could be far better spent providing health care services to low-income patients in desperate need. 

In the 109^th Congress, Senator Daniel Akaka and Delegate Donna Christian-Christensen introduced legislation (S. 2305/H.R. 5023) that would repeal the documentation provision in the Deficit Reduction Act and stop this burdensome and unnecessary requirement.  In the 110th, we will continue to push forward with these efforts to repeal this harmful Medicaid documentation requirement.