Emergence of Documentary Requirements for Medicaid Eligibility

Since 1986, the Immigration Reform and Control Act ( P.L. 99-603 ) has mandated Medicaid to have applicants declare under penalty of perjury that they are citizens or nationals of the United States (or that they are aliens in a satisfactory immigrant status). Subsequently §432 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 ( P.L. 104-193 ) stated that the Secretary of Health and Human Services must establish procedures for persons applying for federal public benefits to "provide proof of citizenship in a fair and nondiscriminatory manner." States could accept self-declaration of citizenship for Medicaid, although some chose to require additional supporting evidence. 109 - 171 ) and modified by the Tax Relief and Health Care Act of 2006 ( P.L. 109 - 432 ). This requirement, found in §1903(x) of the Social Security Act (SSA), lists 4 documents that meet the statutory requirements: a U.S. Passport, a Certificate of Naturalization, a Certificate of United States Citizenship, or a state-issued driver's license or other identity document for which the state has verified the citizenship of the holder. Additional documents that can be used in tandem to meet the citizenship requirement include birth certificates and other documents the Secretary of Health and Human Services designates by regulation. The citizenship documentation requirement in §1903(x) of the Social Security Act does not specifically apply to the State Children's Health Insurance Program (SCHIP). Legislative Activity in 111th Congress

One of the first pieces of legislation taken up by the 111 th Congress— H.R. 2 , the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA 2009)—contains an alternative option to the current documentary requirements of § 1903(x) of the SSA to establish citizenship for Medicaid eligibility. 2 , and President Barack Obama signed CHIPRA 2009 into law as P.L. 111-3)

Section 211 of CHIPRA 2009 (enacted as P.L. Under the §211 option, the name and SSN of an applicant could be submitted to the Commissioner of SSA . The Commissioner would check the information received from the states against the SSA database and determine whether the name and SSN match and whether the SSA database shows that the applicant is a citizen. If the SSA cannot confirm the applicant's name, SSN and citizenship, the applicant would have to either resolve the inconsistency or provide satisfactory documentary evidence of citizenship as defined in §1903(x)(3), or else be disenrolled. Section 211(c) of CHIPRA 2009would provide that the Medicaid citizenship documentation requirements currently required under Section 1903(x), and as amended by the provisions of §211 of CHIPRA 2009, would apply to SCHIP, Title XXI of the Social Security Act.
Since 1986, the Immigration Reform and Control Act (P.L. 99-603) has mandated Medicaid to have applicants declare under penalty of perjury that they are citizens or nationals of the United States (or that they are aliens in a satisfactory immigration status). Subsequently, §432 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L. 104-193) stated that the Secretary of Health and Human Services must establish procedures for persons applying for federal public benefits to "provide proof of citizenship in a fair and nondiscriminatory manner." States could accept self-declaration of citizenship for Medicaid, although some chose to require additional supporting evidence.
The Deficit Reduction Act of 2005 (P.L. 109-171), as amended by the Tax Relief and Health Care Act of 2006 (P.L. 109-432) enacted §1903(x) of the Social Security Act, which requires states to obtain satisfactory documentation of citizenship to determine eligibility for Medicaid. There are 4 documents that meet the statutory requirements: a U.S. Passport, a Certificate of Naturalization, a Certificate of United States Citizenship, or a state-issued drivers license or other identity document for which the state has verified the citizenship of the holder. Additional documents that can be used in tandem to meet the citizenship requirements include birth certificates and other documents the Secretary of Health and Human Services designates by regulation.
One of the first pieces of legislation taken up by the 111th Congress—H.R. 2 and S. 275, the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA 2009)—contains a provision, § 211, that would give states an alternative to the documents required to establish U.S. citizenship for Medicaid. Under the §211 data matching option, the name and social security number (SSN) of an applicant could be submitted to the Commissioner of Social Security Administration (SSA). The Commissioner would check the information received from the states against the SSA database and determine whether the name and SSN match and whether the SSA database shows that the applicant is a citizen. If the SSA cannot confirm the applicant's name, SSN and citizenship, the applicant would have to either resolve the inconsistency or provide satisfactory documentary evidence of citizenship as defined in § 1903(x)(3), or else be disenrolled. Section 211(c) of CHIPRA 2009 would provide that the Medicaid citizenship documentation requirements currently required under Section 1903(x), and as amended by the provisions of §211 of CHIPRA 2009, would apply to the State Children's Health Insurance Program (SCHIP), Title XXI of the Social Security Act.
On February 4, 2009, President Barack Obama signed CHIPRA 2009, which includes §211, into law as P.L. 111-3.
This report will be updated to reflect legislative activity.