By
Each celebration of a new year
brings a renewed sense of optimism and 2010 offers tremendous promise in mitigating
the chilling impact of the citizenship documentation requirement imposed by the
2005 Deficit Reduction Act (DRA) on Medicaid. The citizenship documentation
requirement not only made it more difficult for eligible citizens to enroll in
Medicaid but states have also spent millions of dollars in administrative costs
to comply with the regulation. The title of a study by the Government
Accountability Office says
it well: "States
Reported that Citizenship Documentation Requirement Resulted in Enrollment
Declines for Eligible Citizens and Posed Administrative Burdens."
But hope is on the horizon. Beginning on day one of this new
decade, State Medicaid agencies can use an electronic data exchange with the
Social Security Administration (SSA) to verify citizenship in lieu of the
cumbersome and complex regulations that many believe went beyond the letter of
the law to implement the DRA requirement. According to friends at CMS, every
state has entered into new contracts with SSA enabling them to move forward
with the electronic data exchange. Early reports indicate that ten states
already have enhanced their systems and submitted transactions to SSA for
citizenship verification. This is indeed worth a round of fireworks or a toast
of the bubbly!
So the uptake is that it is no longer necessary for states
to require applicants to provide paperwork proving citizenship or nationality.
While we may need to be patient for states to implement the system changes
necessary to accommodate the new SSA data exchange, cost should not be a
barrier. The federal government is picking up 90% of the development and
implementation costs. A state's 10% share should quickly be offset in administrative
cost reductions, particularly considering that the data exchange builds upon an
existing system infrastructure under the State Verification and Exchange System
(SVES).
Coinciding with the launch of the SSA data exchange is the
release of the eleventh CHIPRA Letter to State Officials (SHO) from
the Center for Medicaid and State Operations (CMSO) providing guidance to
states in implementing the citizenship documentation provisions of the
Children's Health Insurance Program Reauthorization Act (CHIPRA):
- States must provide applicants with at least the same reasonable opportunity to submit satisfactory evidence of citizenship that immigrants are given to provide satisfactory immigration status.
- If applicants for Medicaid or CHIP have declared citizenship and have met all eligibility and verification requirements except citizenship documentation, states cannot delay, deny, reduce or terminate Medicaid or CHIP eligibility.
- Babies who are initially eligible for Medicaid or CHIP as "deemed newborns" are not required to submit documentation at anytime.
- Tribal enrollment or membership documents issued by a federally recognized Tribe must be accepted as verification of citizenship.
- Citizenship documentation requirements now apply to CHIP programs aligning requirements with both Medicaid and CHIP-funded Medicaid expansion programs.
Good news. Looks like the Obama Administration is putting commonsense to work to save time and money.
Thanks for this great update. So glad to be considered a friend!
Thanks for this timely summary. It looks like the only reason for states not to take up this option is the possibility of a payback penalty if there are too many expenditures for unverified citizens. The SHO explanation of the penalty is a little confusing --can you tell us more about it?
Hi Vicky, the way I understand it, an inconsistency that can be resolved will NOT count toward a state's error rate. That's a good thing! And it is only if the monthly average error rate in a federal fiscal year exceeds 3 percent that the state might incur a payback penalty. The SHO says "the state must reimburse CMS a certain amount of Medicaid or CHIP payments" but doesn't specify what that amount is. It is clear that the reimbursement would only apply to the percentage of inconsistencies above the 3% tolerance allowed. It is often the case that further detail and clarification comes in regulation. A SHO letter can only go so far. The statute seems to be a bit more specific so e-mail me if you want to talk about this directly.
Hopefully the appeal of an efficient system will compel states to adopt the SSA electronic match while the potential for payback penalty will give states an incentive to help applicants meet the documentation requirements when a match is not successful. And CMS can waive the penalty if a state is making good faith efforts.
By closely monitoring the experience of states participating, we can begin to identify the type of situations that are likely to result in an inconsistency. For example, SSA records are not likely to be up-to-date for a naturalized citizen who obtained their SS number before becoming a citizen. In cases such as these, we can suggest alternative processes to avoid inconsistencies.