I 
110TH CONGRESS 
1ST SESSION H. R. 1878 
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 HOUSE OF REPRESENTATIVES 
APRIL 17, 2007 
Ms. CORRINE BROWN of Florida (for herself, Mr. CONYERS, and Mr. 
ETHERIDGE) introduced the following bill; which was referred to the 
Committee on Energy and Commerce 
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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. STATE OPTION TO REQUIRE CERTAIN INDIVID-
UALS TO PRESENT SATISFACTORY DOCUMEN-
TARY EVIDENCE OF PROOF OF CITIZENSHIP 
OR NATIONALITY FOR PURPOSES OF ELIGI-
BILITY FOR MEDICAID. 
(a) IN GENERAL.—Section 1902(a)(46) of the Social 
Security Act (42 U.S.C. 1396a(a)(46)) is amended— 
(1) by inserting ‘‘(A)’’ after ‘‘(46)’’; 
(2) by adding ‘‘and’’ after the semicolon; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(B) at the option of the State and subject to 
section 1903(x), require that, with respect to an in-
dividual (other than an individual described in sec-
tion 1903(x)(1)) who declares to be a citizen or na-
tional of the United States for purposes of estab-
lishing initial eligibility for medical assistance under 
this title (or, at State option, for purposes of renew-
ing or redetermining such eligibility to the extent 
that such satisfactory documentary evidence of citi-
zenship or nationality has not yet been presented), 
there is presented satisfactory documentary evidence 
of citizenship or nationality of the individual (using 
criteria determined by the State, which shall be no 
more restrictive than the criteria used by the Social 
Security Administration to determine citizenship, 
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and which shall accept as such evidence a document 
issued by a federally-recognized Indian tribe evidenc-
ing membership or enrollment in, or affiliation with, 
such tribe (such as a tribal enrollment card or cer-
tificate of degree of Indian blood, and, with respect 
to those federally-recognized Indian tribes located 
within States having an international border whose 
membership includes individuals who are not citizens 
of the United States, such other forms of docu-
mentation (including tribal documentation, if appro-
priate) that the Secretary, after consulting with such 
tribes, determines to be satisfactory documentary 
evidence of citizenship or nationality for purposes of 
satisfying the requirement of this subparagraph));’’. 
(b) LIMITATION ON WAIVER AUTHORITY.—Notwith-
standing any provision of section 1115 of the Social Secu-
rity Act (42 U.S.C. 1315), or any other provision of law, 
the Secretary of Health and Human Services may not 
waive the requirements of section 1902(a)(46)(B) of such 
Act (42 U.S.C. 1396a(a)(46)(B)) with respect to a State. 
(c) CONFORMING AMENDMENTS.—Section 1903 of 
such Act (42 U.S.C. 1396b) is amended— 
(1) in subsection (i)— 
(A) in paragraph (20), by adding ‘‘or’’ 
after the semicolon; 
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(B) in paragraph (21), by striking ‘‘; or’’ 
and inserting a period; and 
(C) by striking paragraph (22); and 
(2) in subsection (x) (as amended by section 
405(c)(1)(A) of division B of the Tax Relief and 
Health Care Act of 2006 (Public Law 109–432))— 
(A) by striking paragraphs (1) and (3); 
(B) by redesignating paragraph (2) as 
paragraph (1); 
(C) in paragraph (1), as so redesignated, 
by striking ‘‘paragraph (1)’’ and inserting ‘‘sec-
tion 1902(a)(46)(B)’’; and 
(D) by adding at the end the following new 
paragraph: 
‘‘(2) In the case of an individual declaring to be a 
citizen or national of the United States with respect to 
whom a State requires the presentation of satisfactory 
documentary evidence of citizenship or nationality under 
section 1902(a)(46)(B), the individual shall be provided 
at least the reasonable opportunity to present satisfactory 
documentary evidence of citizenship or nationality under 
this subsection as is provided under clauses (i) and (ii) 
of section 1137(d)(4)(A) to an individual for the submittal 
to the State of evidence indicating a satisfactory immigra-
tion status.’’. 
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SEC. 2. CLARIFICATION OF RULES FOR CHILDREN BORN IN 
THE UNITED STATES TO MOTHERS ELIGIBLE 
FOR MEDICAID. 
Section 1903(x) of such Act (42 U.S.C. 1396b(x)), 
as amended by section 1(c)(2), is amended— 
(1) in paragraph (1)— 
(A) in subparagraph (C), by striking ‘‘or’’ 
at the end; 
(B) by redesignating subparagraph (D) as 
subparagraph (E); and 
(C) by inserting after subparagraph (C) 
the following new subparagraph: 
‘‘(D) pursuant to the application of section 
1902(e)(4) (and, in the case of an individual who is 
eligible for medical assistance on such basis, the in-
dividual shall be deemed to have provided satisfac-
tory documentary evidence of citizenship or nation-
ality and shall not be required to provide further 
documentary evidence on any date that occurs dur-
ing or after the period in which the individual is eli-
gible for medical assistance on such basis); or’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(3) Nothing in subparagraph (A) or (B) of section 
1902(a)(46), the preceding paragraphs of this subsection, 
or the Deficit Reduction Act of 2005, including section 
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6036 of such Act, shall be construed as changing the re-
quirement of section 1902(e)(4) that a child born in the 
United States to an alien mother for whom medical assist-
ance for the delivery of such child is available as treatment 
of an emergency medical condition pursuant to subsection 
(v) shall be deemed eligible for medical assistance during 
the first year of such child’s life.’’. 
SEC. 3. EFFECTIVE DATE. 
(a) RETROACTIVE APPLICATION.—The amendments 
made by this Act shall take effect as if included in the 
enactment of the Deficit Reduction Act of 2005 (Public 
Law 109–171; 120 Stat. 4). 
(b) RESTORATION OF ELIGIBILITY.—In the case of 
an individual who, during the period that began on July 
1, 2006, and ends on the date of enactment of this Act, 
was determined to be ineligible for medical assistance 
under a State Medicaid program solely as a result of the 
application of subsections (i)(22) and (x) of section 1903 
of the Social Security Act (as in effect during such pe-
riod), but who would have been determined eligible for 
such assistance if such subsections, as amended by sec-
tions 1 and 2, had applied to the individual, a State may 
deem the individual to be eligible for such assistance as 
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of the date that the individual was determined to be ineli-
gible for such medical assistance on such basis. 
Æ 
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