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The Deficit Reduction Act's (DRA) Citizenship Documentation Requirements for Medicaid Through the Eyes of State Officials in December 2006 and January 2007

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Publisher(s): Health Management Associates

Author(s): E. Ellis; L. Duchon

Topic: Health (Health services administration)

Type: Report


The Deficit Reduction Act (DRA) of 2005 attempted to reduce the federal budget deficit by implementing changes in a wide range of federal programs including Medicaid. One of these changes (effective July 2006) requires Medicaid recipients and future applicants to prove their citizenship and identity by providing original documentation. In this study, Health Management Associates interviewed 60 state officials from Medicaid-only programs or combined Medicaid and State Children's Health Insurance Program (SCHIP) to determine the effect of the new regulation on enrollment levels. Officials from 77 percent of participating states indicated that the documentation requirements either have or will affect their efforts to simplify the enrollment forms and procedures. In particular, officials from 26 states indicated that the new regulation had limited or would limit mail-in, fax, or telephone applications. Officials from 56 percent of states expect the DRA provision to adversely affect enrollment levels in Medicaid, though three states anticipated these effects to be short term. Only 33 percent of officials expected a negative effect on SCHIP numbers. Just over half of officials in states for which coordination between Medicaid and SCHIP is relevant indicated that the rule had or would affect efforts to improve coordination.

States are in various stages of implementing the rule, which means its ultimate impact is unknown and continued monitoring will be necessary.