II 

111TH CONGRESS 

1ST SESSION S. 228 

To amend title XIX of the Social Security Act to permit States, at their 

option, to require certain individuals to present satisfactory documentary 

evidence of proof of citizenship or nationality for purposes of eligibility 

for Medicaid, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

JANUARY 13, 2009 

Mr. BINGAMAN (for himself and Mr. AKAKA) introduced the following bill; 

which was read twice and referred to the Committee on Finance 

A BILL 

To amend title XIX of the Social Security Act to permit 

States, at their option, to require certain individuals 

to present satisfactory documentary evidence of proof 

of citizenship or nationality for purposes of eligibility 

for Medicaid, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 


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1 SECTION 1. STATE OPTION TO REQUIRE CERTAIN INDIVID2 UALS TO PRESENT SATISFACTORY DOCUMEN3 TARY EVIDENCE OF PROOF OF CITIZENSHIP 

4 OR NATIONALITY FOR PURPOSES OF ELIGI5 BILITY FOR MEDICAID. 

6 (a) IN GENERAL.—Section 1902(a)(46) of the Social 

7 Security Act (42 U.S.C. 1396a(a)(46)) is amended— 

8 (1) by inserting ‘‘(A)’’ after ‘‘(46)’’; 

9 (2) by adding ‘‘and’’ after the semicolon; and 

10 (3) by adding at the end the following new sub11 paragraph: 

12 ‘‘(B) at the option of the State and subject to 

13 section 1903(x), require that, with respect to an in14 dividual (other than an individual described in sec15 tion 1903(x)(1)) who declares to be a citizen or na16 tional of the United States for purposes of estab17 lishing initial eligibility for medical assistance under 

18 this title (or, at State option, for purposes of renew19 ing or redetermining such eligibility to the extent 

20 that such satisfactory documentary evidence of citi21 zenship or nationality has not yet been presented), 

22 there is presented satisfactory documentary evidence 

23 of citizenship or nationality of the individual (using 

24 criteria determined by the State, which shall be no 

25 more restrictive than the criteria used by the Social 

26 Security Administration to determine citizenship, 


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1 and which shall accept as such evidence a document 

2 issued by a federally recognized Indian tribe evidenc3 ing membership or enrollment in, or affiliation with, 

4 such tribe (such as a tribal enrollment card or cer5 tificate of degree of Indian blood, and, with respect 

6 to those federally recognized Indian tribes located 

7 within States having an international border whose 

8 membership includes individuals who are not citizens 

9 of the United States, such other forms of docu10 mentation (including tribal documentation, if appro11 priate) that the Secretary, after consulting with such 

12 tribes, determines to be satisfactory documentary 

13 evidence of citizenship or nationality for purposes of 

14 satisfying the requirement of this subparagraph));’’. 

15 (b) LIMITATION ON WAIVER AUTHORITY.—Notwith16 standing any provision of section 1115 of the Social Secu17 rity Act (42 U.S.C. 1315), or any other provision of law, 

18 the Secretary of Health and Human Services may not 

19 waive the requirements of section 1902(a)(46)(B) of such 

20 Act (42 U.S.C. 1396a(a)(46)(B)) with respect to a State. 

21 (c) CONFORMING AMENDMENTS.—Section 1903 of 

22 such Act (42 U.S.C. 1396b) is amended— 

23 (1) in subsection (i)— 

24 (A) in paragraph (20), by adding ‘‘or’’ 

25 after the semicolon; 


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1 (B) in paragraph (21), by striking ‘‘; or’’ 

2 and inserting a period; and 

3 (C) by striking paragraph (22); and 

4 (2) in subsection (x)— 

5 (A) by striking paragraphs (1) and (3); 

6 (B) by redesignating paragraph (2) as 

7 paragraph (1); 

8 (C) in paragraph (1), as so redesignated, 

9 by striking ‘‘paragraph (1)’’ and inserting ‘‘sec10 tion 1902(a)(46)(B)’’; and 

11 (D) by adding at the end the following new 

12 paragraph: 

13 ‘‘(2) In the case of an individual declaring to be a 

14 citizen or national of the United States with respect to 

15 whom a State requires the presentation of satisfactory 

16 documentary evidence of citizenship or nationality under 

17 section 1902(a)(46)(B), the individual shall be provided 

18 at least the reasonable opportunity to present satisfactory 

19 documentary evidence of citizenship or nationality under 

20 this subsection as is provided under clauses (i) and (ii) 

21 of section 1137(d)(4)(A) to an individual for the submittal 

22 to the State of evidence indicating a satisfactory immigra23 tion status.’’. 


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1 SEC. 2. CLARIFICATION OF RULES FOR CHILDREN BORN IN 

2 THE UNITED STATES TO MOTHERS ELIGIBLE 

3 FOR MEDICAID. 

4 Section 1903(x) of such Act (42 U.S.C. 1396b(x)), 

5 as amended by section 1(c)(2), is amended— 

6 (1) in paragraph (1)— 

7 (A) in subparagraph (C), by striking ‘‘or’’ 

8 at the end; 

9 (B) by redesignating subparagraph (D) as 

10 subparagraph (E); and 

11 (C) by inserting after subparagraph (C) 

12 the following new subparagraph: 

13 ‘‘(D) pursuant to the application of section 

14 1902(e)(4) (and, in the case of an individual who is 

15 eligible for medical assistance on such basis, the in16 dividual shall be deemed to have provided satisfac17 tory documentary evidence of citizenship or nation18 ality and shall not be required to provide further 

19 documentary evidence on any date that occurs dur20 ing or after the period in which the individual is eli21 gible for medical assistance on such basis); or’’; and 

22 (2) by adding at the end the following new 

23 paragraph: 

24 ‘‘(3) Nothing in subparagraph (A) or (B) of section 

25 1902(a)(46), the preceding paragraphs of this subsection, 

26 or the Deficit Reduction Act of 2005, including section 


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1 6036 of such Act, shall be construed as changing the re2 quirement of section 1902(e)(4) that a child born in the 

3 United States to an alien mother for whom medical assist4 ance for the delivery of such child is available as treatment 

5 of an emergency medical condition pursuant to subsection 

6 (v) shall be deemed eligible for medical assistance during 

7 the first year of such child’s life.’’. 

8 SEC. 3. EFFECTIVE DATE. 

9 (a) RETROACTIVE APPLICATION.—The amendments 

10 made by this Act shall take effect as if included in the 

11 enactment of the Deficit Reduction Act of 2005 (Public 

12 Law 109–171; 120 Stat. 4). 

13 (b) RESTORATION OF ELIGIBILITY.—In the case of 

14 an individual who, during the period that began on July 

15 1, 2006, and ends on the date of enactment of this Act, 

16 was determined to be ineligible for medical assistance 

17 under a State Medicaid program solely as a result of the 

18 application of subsections (i)(22) and (x) of section 1903 

19 of the Social Security Act (as in effect during such pe20 riod), but who would have been determined eligible for 

21 such assistance if such subsections, as amended by sec22 tions 1 and 2, had applied to the individual, a State may 

23 deem the individual to be eligible for such assistance as 


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1 of the date that the individual was determined to be ineli2 gible for such medical assistance on such basis. 

Æ 


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