Thursday, August 23, 2007

Impact of Medicaid Citizenship and Identity Requirements

We thought our members might be interested in the follow information and links to reports:

SUBJECT: Impact of Medicaid Citizenship and Identity Requirements

The following acronyms are used in this broadcast:
DMAS –Department of Medical Assistance Services
LDSS – Local Departments of Social Services

One year after the implementation of the federal Medicaid rule requiring documentation of United States citizenship and identification as a requirement for Medicaid eligibility, it appears that the rule has had the unintended consequence of creating barriers to Medicaid enrollment for eligible United States citizens. Proponents of the citizenship and identity requirement had originally believed that these requirements would prevent or limit non-citizens of the United States from accessing public financial assistance for medical services.

Reports from the states as well as the federal Government Accountability Office (GAO) indicate that Medicaid enrollment has declined dramatically nationwide due to the requirement, as apparently eligible individuals continue to experience difficulties securing needed documentation. In addition, many states that had initiated simplified Medicaid enrollment processes, such as encouraging the use of mail-in applications, find that these simplification procedures are no longer as effective. The requirement to provide original documentation of citizenship and identity has led to a significant increase in the numbers of individuals making apersonal visit to their local departments of social services.

The Department of Medical Assistance Services recently attributed a decrease in the enrollment of children in Virginia’s FAMIS PLUS and SCHIP Medicaid Expansion to the citizenship and identity requirements. Between July 1, 2006 (the implementation date of the new documentation requirements) and June 30, 2007, the program experienced a net reduction of 9,527 children. Enrollment of children in FAMIS, which is not currently impacted by the citizenship and identity requirements, is reported to have increased by 3,818 children during that same time period.

The Virginia Health Care Foundation (VHCF) has published a report on the impact of these new requirements entitled, “Unintended Consequences: The Impact of New Medicaid Citizenship Documentation Requirements on Virginia’s Children.” Parents surveyed for the report cited an approximate four month delay in obtaining Medicaid benefits for their children due to the barriers created by the citizenship and identity requirements. Parents also reported increased use of hospital emergency rooms for their children’s health care during that time. A survey taken by VHCF of parents who had applied for Medicaid for their children reported that 65% of noninsured children with a pending Medicaid application had some type of health care need that required medical attention while waiting to be enrolled in Medicaid.

The VHCF Report and the GAO Report can be found at the following websites: and, respectively.

You can help by relaying the impact of the citizenship and identity requirements and can be an important resource to their local governing bodies and public officials as dialogue continues within Virginia communities regarding individuals’ access to government services. We encourage you to share this information with your local government officials.

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