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Subtitle B—Reducing Barriers to 
Enrollment 
SEC. 211. VERIFICATION OF DECLARATION OF CITIZENSHIP 
OR NATIONALITY FOR PURPOSES OF ELIGI-
BILITY FOR MEDICAID AND CHIP. 
(a) ALTERNATIVE STATE PROCESS FOR VERIFICATION 
OF DECLARATION OF CITIZENSHIP OR NATIONALITY FOR 
PURPOSES OF ELIGIBILITY FOR MEDICAID.— 
(1) ALTERNATIVE TO DOCUMENTATION REQUIRE-
MENT.— 
(A) IN GENERAL.—Section 1902 (42 U.S.C. 
1396a), as amended by section 203(c), is amend-
ed— 
(i) in subsection (a)(46)— 
(I) 
by 
inserting 
‘‘(A)’’ 
after 
‘‘(46)’’; 
(II) by adding ‘‘and’’ after the 
semicolon; and 
(III) by adding at the end the fol-
lowing new subparagraph: 
‘‘(B) provide, with respect to an individual de-
claring to be a citizen or national of the United 
States for purposes of establishing eligibility under 
this title, that the State shall satisfy the requirements 
of—
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‘‘(i) section 1903(x); or 
‘‘(ii) subsection (ee);’’; and 
(ii) by adding at the end the following 
new subsection: 
‘‘(ee)(1) For purposes of subsection (a)(46)(B)(ii), the 
requirements of this subsection with respect to an indi-
vidual declaring to be a citizen or national of the United 
States for purposes of establishing eligibility under this 
title, are, in lieu of requiring the individual to present sat-
isfactory documentary evidence of citizenship or nationality 
under section 1903(x) (if the individual is not described in 
paragraph (2) of that section), as follows: 
‘‘(A) The State submits the name and social se-
curity number of the individual to the Commissioner 
of Social Security as part of the program established 
under paragraph (2). 
‘‘(B) If the State receives notice from the Com-
missioner of Social Security that the name or social 
security number, or the declaration of citizenship or 
nationality, of the individual is inconsistent with in-
formation in the records maintained by the Commis-
sioner— 
‘‘(i) the State makes a reasonable effort to 
identify and address the causes of such inconsist-
ency, including through typographical or other
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clerical errors, by contacting the individual to 
confirm the accuracy of the name or social secu-
rity number submitted or declaration of citizen-
ship or nationality and by taking such addi-
tional actions as the Secretary, through regula-
tion or other guidance, or the State may iden-
tify, and continues to provide the individual 
with medical assistance while making such effort; 
and 
‘‘(ii) in the case such inconsistency is not 
resolved under clause (i), the State— 
‘‘(I) notifies the individual of such 
fact; 
‘‘(II) provides the individual with a 
period of 90 days from the date on which 
the notice required under subclause (I) is 
received by the individual to either present 
satisfactory documentary evidence of citi-
zenship or nationality (as defined in section 
1903(x)(3)) or resolve the inconsistency with 
the Commissioner of Social Security (and 
continues to provide the individual with 
medical assistance during such 90-day pe-
riod); and
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‘‘(III) disenrolls the individual from 
the State plan under this title within 30 
days after the end of such 90-day period if 
no such documentary evidence is presented 
or if such inconsistency is not resolved. 
‘‘(2)(A) Each State electing to satisfy the requirements 
of this subsection for purposes of section 1902(a)(46)(B) 
shall establish a program under which the State submits 
at least monthly to the Commissioner of Social Security 
for comparison of the name and social security number, of 
each individual newly enrolled in the State plan under this 
title that month who is not described in section 1903(x)(2) 
and who declares to be a United States citizen or national, 
with information in records maintained by the Commis-
sioner. 
‘‘(B) In establishing the State program under this 
paragraph, the State may enter into an agreement with the 
Commissioner of Social Security— 
‘‘(i) to provide, through an on-line system or oth-
erwise, for the electronic submission of, and response 
to, the information submitted under subparagraph 
(A) for an individual enrolled in the State plan 
under this title who declares to be citizen or national 
on at least a monthly basis; or
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‘‘(ii) to provide for a determination of the con-
sistency of the information submitted with the infor-
mation maintained in the records of the Commis-
sioner through such other method as agreed to by the 
State and the Commissioner and approved by the 
Secretary, provided that such method is no more bur-
densome for individuals to comply with than any 
burdens that may apply under a method described in 
clause (i). 
‘‘(C) The program established under this paragraph 
shall provide that, in the case of any individual who is re-
quired to submit a social security number to the State 
under subparagraph (A) and who is unable to provide the 
State with such number, shall be provided with at least the 
reasonable opportunity to present satisfactory documentary 
evidence of citizenship or nationality (as defined in section 
1903(x)(3)) as is provided under clauses (i) and (ii) of sec-
tion 1137(d)(4)(A) to an individual for the submittal to the 
State of evidence indicating a satisfactory immigration sta-
tus. 
‘‘(3)(A) The State agency implementing the plan ap-
proved under this title shall, at such times and in such form 
as the Secretary may specify, provide information on the 
percentage each month that the inconsistent submissions 
bears to the total submissions made for comparison for such
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month. For purposes of this subparagraph, a name, social 
security number, or declaration of citizenship or nation-
ality of an individual shall be treated as inconsistent and 
included in the determination of such percentage only if— 
‘‘(i) the information submitted by the individual 
is not consistent with information in records main-
tained by the Commissioner of Social Security; 
‘‘(ii) the inconsistency is not resolved by the 
State; 
‘‘(iii) the individual was provided with a rea-
sonable period of time to resolve the inconsistency 
with the Commissioner of Social Security or provide 
satisfactory documentation of citizenship status and 
did not successfully resolve such inconsistency; and 
‘‘(iv) payment has been made for an item or 
service furnished to the individual under this title. 
‘‘(B) If, for any fiscal year, the average monthly per-
centage determined under subparagraph (A) is greater than 
3 percent— 
‘‘(i) the State shall develop and adopt a correc-
tive plan to review its procedures for verifying the 
identities of individuals seeking to enroll in the State 
plan under this title and to identify and implement 
changes in such procedures to improve their accuracy; 
and
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‘‘(ii) pay to the Secretary an amount equal to 
the amount which bears the same ratio to the total 
payments under the State plan for the fiscal year for 
providing medical assistance to individuals who pro-
vided inconsistent information as the number of indi-
viduals with inconsistent information in excess of 3 
percent of such total submitted bears to the total num-
ber of individuals with inconsistent information. 
‘‘(C) The Secretary may waive, in certain limited 
cases, all or part of the payment under subparagraph 
(B)(ii) if the State is unable to reach the allowable error 
rate despite a good faith effort by such State. 
‘‘(D) Subparagraphs (A) and (B) shall not apply to 
a State for a fiscal year if there is an agreement described 
in paragraph (2)(B) in effect as of the close of the fiscal 
year that provides for the submission on a real-time basis 
of the information described in such paragraph. 
‘‘(4) Nothing in this subsection shall affect the rights 
of any individual under this title to appeal any 
disenrollment from a State plan.’’. 
(B) COSTS OF IMPLEMENTING AND MAIN-
TAINING
SYSTEM.—Section 
1903(a)(3) 
(42 
U.S.C. 1396b(a)(3)) is amended— 
(i) by striking ‘‘plus’’ at the end of 
subparagraph (E) and inserting ‘‘and’’, and