# Presentation: 241223

## IMPROVED ENFORCEMENT OF DOCUMENTATION REQUIREMENTS

**Centers for Medicare & Medicaid Services**
**March 2007**

## Major points you will learn about the new law

- To whom does the new law apply.
- Who is exempt from the new law.
- Acceptable Documents and Processes to establish citizenship.

## Pre-Section 6036 Law

- Previously, Medicaid applicants and recipients of Medicaid who have _declared_ under Section 1137(d) of the Social Security Act that they are citizens of the U.S. were not required to document their declaration

## Section 6036

- Section 6036 of the Deficit Reduction Act of 2005 (Pub. L. No 109-171) adds a new subsection (x) to Section 1903 of the Social Security Act
- New law - effective July 1, 2006
- Requires individuals declaring that they are a U.S. citizen to provide satisfactory documentary evidence of citizenship or nationality when initially applying for Medicaid or upon a recipient’s first Medicaid redetermination on or after July 1, 2006.

## Section 6036

- This law does not apply to aliens who, under section 1137 of the Act, have declared to be Qualified Aliens in a satisfactory immigration status.
- Since 1988 such applicants have had their immigration status documented and verified with Homeland Security through the SAVE system

## Section 6036

- Law specifies many of the documents that may be used to prove citizenship.
- Also provides that the Secretary can establish additional documents through regulations.

## Section 6036

- CMS developed a hierarchical approach to documentation
- If an individual cannot produce documentation from the primary list of evidence, individuals can produce a document from the second, third or fourth list of documentary evidence to prove citizenship and a document from the fifth list to show identity

## Section 6036

**Additional documents are NOT required for:**
- Individuals also enrolled in Medicare
- Individuals also receiving Supplemental Security Income (SSI)
- Individuals presumptively eligible (Secs. 1920, 1920A, and 1920B until individuals make declaration of citizenship)
- Deemed Newborns—Documentation will occur at first redetermination for children of citizens and qualified aliens.

## Section 6036

**The best way to prove citizenship and identity is primary documentation:**
- U.S. passport;
- Certificate of Naturalization (DHS Forms N-550 or N-570);
- Certificate of U.S. Citizenship (DHS Forms N-560 or N-561)

## Section 6036

**To prove citizenship:**
- A birth certificate;
- A Report or Certification of Birth Abroad of a U.S. citizen (form FS-240 or FS-545)
- A U.S. Citizenship I.D. Card (DHS I-197)
- Adoption Papers
- Military Record showing birth in the U.S.
- Affidavit – in rare circumstances only

## Section 6036

- States without agreements with SSA may substitute a check of the SSI file the State receives to meet the requirements of section 6036.
- States may also use a data match with vital statistics to establish citizenship of an applicant or recipient.

## Section 6036

**To prove identity:**
- Current State driver’s license or State identity card,
- School identification card
- Federal, State or local government identification card
- U.S. military identification card
- At the State’s option, cross matches with Federal or State governmental, public assistance, law enforcement or corrections agency’s data system if the agency establishes and certifies true identity of individuals

## Section 6036

**Special Identity Rules for Children under 16:**
- School records including nursery or daycare record
- Affidavit signed under penalty of perjury by parent or guardian stating date and place of birth
- Affidavit cannot be used if affidavit for citizenship was provided

## Section 6036

**Special Populations Needing Assistance – homeless, amnesia victims, long term care individuals, etc.**
- States MUST assist individuals to secure satisfactory documentary evidence of citizenship if individuals are unable to comply with the requirement

## Section 6036

**Also applies to:**
- Title IV-E Children in foster care or receiving adoption assistance – not required to declare citizenship for IV-E but now must have in their Medicaid file a declaration of citizenship and documentary evidence of the citizenship
- All Section 1115 demonstrations including Family Planning programs and individuals covered by virtue of Section 1115(a)(2) authority – a.k.a. cost not otherwise matchable - expansion populations
- SCHIP populations enrolled in Medicaid

## Section 6036

- A reasonable opportunity to prove both citizenship and identity is provided as long as individuals are showing a good faith effort to produce the documents
- Documents must be originals or certified copies from the issuing agency
- Documents cannot be photocopies or notarized copies

## Section 6036

**1903 Provision Regarding FFP:**
- States will receive the administrative match rate of 50% for costs they incur to implement this section.
- No FFP for months State does not require presentation of documentation of citizenship by applicants or recipients

## Section 6036

**Outreach Plan**
- Law specified that an outreach plan must be developed to inform individuals about the requirement
- CMS has launched an outreach program to educate states and interested groups about the new requirement
- Outreach efforts include presentations to interested groups and materials that States may use to help applicants and recipients understand the requirement

## Section 6036

**Outreach Plan - continued**
- Talking points, questions and answers, a sample press release, drop-in article and lists of acceptable documents posted to the CMS website
- Working with States to help them reach out to their current Medicaid enrollees and the general public outlining the new rules
- Training sessions with state officials including regular telephone consultations providing technical assistance
- Speakers at national conferences such as tribal organizations and advocacy groups for minority communities.

## Section 6036

- CMS issued an Interim Final Rule with Comment on July 12
- Regulation specifically solicits comments in four areas:
- Are additional documentation necessary– if so, what types?
- What additional data matches would be useful?
- Have too many documents been allowed in light of the exemption for Medicare and SSI?
- How should state’s share information with the Federal government if there is fraud and abuse?

## Section 6036

- 	For more information about the citizenship documentation requirement, go to: _[http://www.cms.hhs.gov/MedicaidEligibility/05_ProofofCitizenship.asp#](http://www.cms.hhs.gov/MedicaidEligibility/05_ProofofCitizenship.asp)_
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