The attached material has been prepared by the Center on Budget and Policy Priorities to assist you in your efforts to ensure that the new DRA citizenship documentation requirement is implemented in a way that is least harmful to Medicaid applicants and beneficiaries.

The new citizenship documentation requirement for Medicaid, contained in the Deficit Reduction Act, will take effect on July 1, 2006. As many of you know, this requirement applies not only to new applicants for Medicaid but also to existing beneficiaries when they seek to renew their eligibility. Millions of eligible citizens stand to have their Medicaid benefits denied or terminated if they cannot present "satisfactory documentary evidence of citizenship." States are now facing the enormous task of implementing the new citizenship documentation requirement for Medicaid. To date, CMS has not provided any guidance to states on how they should go about administering the new requirement and we do not know when guidance will be forthcoming. In the absence of guidance, state officials are left to interpret the citizenship documentation provisions of the DRA on their own.

With the July 1 implementation date fast approaching, it is critical for state organizations concerned about preserving access to Medicaid for eligible citizens to begin conversations with their state Medicaid officials aimed at ensuring that the requirement is implemented in a way that is least burdensome for Medicaid applicants and beneficiaries -- and for the state. We are providing the attached materials to offer suggestions that you -- along with other concerned stakeholders -- may wish to ask your state to consider. We also are providing additional technical information on some of the ideas presented. Background information on the implications of the new requirement for Medicaid applicants and beneficiaries are summarized in a recent analysis posted on the Center’s website at http://www.cbpp.org/4-20-06health.htm.

If you have any questions, or additional ideas, please contact Donna Cohen Ross (cohenross@cbpp.org), Leighton Ku (ku@cbpp.org) or Judy Solomon (Solomon@cbpp.org). We are eager to hear about your activities and about how your state is approcahing implementation of the citizenship documentation requirement.

We are planning to issue materials on other topics related to implementing the citizenship documentation reqirement soon -- so watch your email.

Thanks for your concern and dedicated efforts on this important matter.

-- The CBPP Team