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Press Releease: Medicaid ID Rule Could Put Health Coverage At Risk For 3 To 5 Million U.S. Citizens Starting July 1

State-by-State Data Show Millions To Be Affected

A new rule requiring U.S. citizens to prove their citizenship when applying for or renewing Medicaid benefits is expected to jeopardize coverage for several million qualified citizens, from elderly people in nursing homes to foster children, according to a national survey conducted by the Center on Budget and Policy Priorities, a Washington-based research group.

The rule, which takes effect July 1, requires native-born citizens to produce a passport or birth certificate (except in rare cases) to begin or continue Medicaid coverage. Its main effect “is likely to impede or delay coverage for millions of eligible U.S. citizens,” said Judith Solomon of the Center.

Three to five million Medicaid beneficiaries — including between 1.4 million and 2.7 million children — could see their coverage jeopardized because they do not have a U.S. passport or U.S. birth certificate in their possession, according to data from a nationally representative survey. The survey, conducted between January 12 and 16 by the Opinion Research Corporation, was commissioned by the Center. (See

State-by-state figures for the total number of citizens who are covered by Medicaid and thus would be required to prove their citizenship are available in a Center report. (See

The new documentation rule is part of the Deficit Reduction Act (DRA), enacted in February 2006. Details of the DRA’s implementation became public June 9, when the Centers for Medicare & Medicaid Services (CMS) at the U.S. Department of Health and Human Services issued guidance to state Medicaid agencies explaining the requirement and what individuals and states must do to comply with it.

In an analysis of the guidance, the Center found that the documentation requirement could have detrimental impacts on a range of qualified U.S. citizens, some of whom have already had their citizenship verified by the Social Security Administration (See

An elderly U.S. citizen who has Alzheimer’s and resides in a nursing home might lose Medicaid coverage that pays for her care because her birth certificate cannot be located or she lacks a driver’s license.

  • A child who is a U.S. citizen and is placed in foster care because his mother is incarcerated or has disappeared or died may not receive Medicaid coverage for the health services he needs because a certified birth certificate cannot be located in his records.
  • A low-income U.S. citizen who is diagnosed with breast cancer and otherwise qualifies for Medicaid may be delayed in receiving treatment for a number of weeks while she waits for a certified copy of her birth certificate.
  • An elderly African American woman who was never issued a birth certificate (many elderly African Americans were born at home and never received a birth certificate because their parents did not have access to a hospital due to racial discrimination, especially if they were born in the South in the early decades of the last century) and who has no living family members who could attest to her birth in the United States may lose Medicaid coverage.

The new rule does not affect legal permanent-resident immigrants who qualify for Medicaid. (Certain categories of legal immigrants can qualify.) These individuals must continue to meet existing, stringent documentation requirements. Nearly four million people fit into this category out of a total Medicaid population of over 50 million.