New Requirements to Document Citizenship & Identity Become Effective
September 1, 2006 for Medicaid:

New Provision Passed as a Part of the Deficit Reduction Act:

(7/06) Due to provisions of the Deficit Reduction Act signed into law by President Bush on February 8, 2006, new requirements to document citizenship and identity become effective September 1, 2006 in North Carolina for citizens of all ages applying for or renewing their Medicaid coverage. This documentation will only need to be provided one time. CMS-Published Guidelines for implementation of these provisions were released on June 9, 2006 in the form of a CMS Medicaid Fact Sheet and Dear State Medicaid Director Letter. Guidance is posted on the CMS Web Site at http://www.cms.hhs.gov/. Go to menu on right under "Citizenship Guidelines for Medicaid Eligibility." North Carolina Division of Medical Assistance issued a Dear County Director of Social Services Letter on June 16th which includes an insert for July Medicaid cards and a list of acceptable documents to establish citizenship and identity: http://www.dhhs.state.nc.us/dma/dcdss/061606IDdocs.pdf

Clarification is being sought on several issues that are not addressed in this guidance by Families USA. To access information on their web site go to http://www.familiesusa.org and click on "Medicaid and Children's Health" and then "Medicaid Alert".

Documentary Evidence:

There are two types of documentation that are required as a part of this new law:

• Documentation of citizenship.

• Documentation of identity.

The Centers for Medicare and Medicaid Services (CMS) guidance establishes four levels of citizenship documentation, ranking them in a "hierarchy of reliability." The guidance requires states to seek the highest-level evidence available and designates the primary and secondary levels of documentation as the most reliable.

• "Primary evidence" includes a U.S. Passport, a Certificate of Naturalization, or a Certificate of U.S. Citizenship. Presentation of one of these documents is considered proof of citizenship and identity. However, the majority of Medicaid clients will not have any of these primary documents.

Documentation of Citizenship:

The secondary, tertiary and fourth levels of documentation require that proof of citizenship and identity be documented separately.

• "Secondary evidence" includes a U.S. Birth Certificate or specified other records (e.g. Certification of Birth Abroad, a U.S. Citizen ID Card, a final adoption decree, etc.).

• "Third and fourth-level evidence" includes many non-governmental documents and is to be used only when other forms of documentation cannot be obtained.

Documentation of Identity

Examples of acceptable documentation to verify proof of identity include:

• A current state driver's license bearing the individual's photo.

• A State-issued identity card (through Department of Motor Vehicles) with the individual's photo.

• Certificate of Indian Blood or other U.S. American Indian/Alaska Native tribal document.

 Children age 16 or younger, who do not have the above documentation, may provide proof of identity in the following ways:

• School identification card with photograph.

• Military dependent identification card with photograph.

• School or daycare/nursery records showing date, place of birth and parent's name.

• Clinic, doctor or hospital record showing date of birth.

• Affadavit signed by parent or guardian.

You can make a difference!

For most children, the required documentation will be a U.S. Birth Certificate and a proof of identity from the above list.

• Tell families you serve about these new documentation requirements.

• Encourage families to obtain a Certified Copy of the Birth Certificate for each of their citizen children if they do not already have them. (Note: School-age children are required to provide a certified copy of their birth certificate when they enroll in public schools).

• Inform your community outreach partners to spread the word to families they serve.

In North Carolina, effective September 1, newly enrolling children cannot be determined eligible until this documentation has been provided. Federal law provides a "reasonable opportunity" for individuals who are reapplying to present satisfactory evidence of citizenship and identity "as long as he/she continuously shows a good faith effort." Caseworkers in local departments of social services will assist families, as appropriate, to identify what documents are acceptable and can assist families in their efforts to obtain these documents. If you or the families you serve have any questions, call your local department of social services or call the CARE-LINE, Information and Referral Service, at 1-800-662-7030.

Important: Eligibility for "qualified Immigrants" has not changed!

Eligibility policy for "qualified immigrants" has not changed. Documentation is still needed to verify their status. Individuals may be eligible if they have been in "qualified" immigrant status for 5 years or more OR if they have been granted refugee or asylum status. Undocumented immigrants are not eligible for Medicaid except in specific emergency situations.

Latest Update:

The Sargent Shriver National Center on Poverty Law has filed a class action suit that names the Secretary of HHS as defendant. The suit seeks to declare the new law unconstitutional and to enjoin the Administration from implementing it. The web link to the article is below:
http://www.familiesusa.org/resources/newsroom/press-releases/suit-challenges-new-law.html

Designed and maintained by the The North Carolina Healthy Start Foundation