National Alliance on Mental Illness
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March 8, 2006

For Consumers and Family Members:  New Documentation Requirements to Apply for or Stay on Medicaid

The Deficit Reduction Act was signed into law on February 8, 2006.  The bill includes new requirements for U.S. citizens currently on Medicaid or applying for Medicaid benefits. Starting in July of 2006, citizens applying for or being recertified as Medicaid eligible will be required to prove United States citizenship.  (There are already separate standards for immigrants on Medicaid.)  States recertify individuals every 6-12 months, so all Medicaid beneficiaries will go through this requirement before July 2007.

Depending on how this is implemented, it has the potential to create significant barriers to treatment for individuals who are currently or potentially eligible for Medicaid.  That is why NAMI will be urging the Center on Medicare and Medicaid Services (CMS) and the states to minimize administrative burdens on beneficiaries to the greatest extent possible.  The details of state-by-state implementation are still being worked out and the Secretary of Health and Human Services can also specify other documents and processes which will satisfy the requirement.  It is likely that the federal government will issue further guidance, but we don’t have this information yet.   

NAMI is advocating with CMS that individuals who receive Social Security or Medicare should be deemed to meet the requirements without having to provide additional documentation.  NAMI will also encourage its state leaders to advocate for state processes that will take the requirements away from the beneficiary.  For example, states could use information from other state programs and vital records.  We will also ask that states offer grace periods to those who need extra time getting their documents in order and that states pay the costs of getting additional documentation.  But as of this writing, we don’t know how the federal government and each state will choose to implement this program. 

We will provide updates as that information becomes available.  Individuals and family members may choose to wait for further information because so much is currently unknown about implementation.  But NAMI also wants to let families and consumers know that while other documents and processes may be identified later, the statute clearly indicates that it is sufficient if someone presents a valid U.S. passport or a U.S. birth certificate and state-issued identification.  A passport alone is enough, but if you are planning to use a birth certificate, the statute indicates that you will also need picture identification such as a driver’s license or a state identity card.  We hope that CMS also lets children use documents such as school identity cards, school records, or other methods to prove their identity, but these details are not yet clear.

Each individual consumer and family member must consider their personal situation and whether they want to wait for further information or move forward now.  We expect to have more information in the coming weeks, but we also recognize that assembling documents takes time.

Here is what you can do to prepare for the new requirements if you currently have or want to apply for Medicaid:

  1. Check if you or your family member has some proof of U.S. citizenship – such as a birth certificate or passport.  Some individuals with mental illness have obtained a birth certificate in order to apply for Social Security or transportation programs.  Check personal files and records and also check with case managers and other providers who may have such documents on record. 
  2. If the Medicaid applicant or recipient does not have a passport or birth certificate, you can either wait for further information from states and the federal government or you can move forward to request a copy of the birth certificate from the state where the individual was born.  You can go to and click on the state for information on how to order one.  There is usually a cost associated with obtaining a birth certificate - $10-20 in most states.  Obtaining birth certificates can take several weeks so individuals are encouraged to start the process four to six weeks in advance of the initial application or recertification. On a cautionary note, we suggest having a certified copy of your birth certificate and not a photo-copy as the statute is silent on what constitutes a valid birth certificate. The Deficit Reduction Act does not specify who should pay that cost, so ask your providers and state Medicaid agency about whether they can cover the fees.  If you pay the fee, retain any receipts in case your state decides to pay the cost.
  3. If you decide to proceed to get all of your documents, the statute indicates that an individual must also have a form of identification such as a driver’s license or a state-issued identification card along with the birth certificate.  Again, the federal government or states may issue guidance that does not require this document or only requires it for certain groups.

For a driver’s license or a state-issued identification card, check with your state.  Most commonly, these are issued by the department of motor vehicles, but each state is different.   Each state also has its own requirements.  There is a cost associated with these cards and the statute again does not indicate who should bear the cost.  Check to see if the state Medicaid agency can cover the cost of the fee.  Retain your receipts, but you may not be reimbursed.

As soon as we have further guidance from CMS, we will be providing you with additional information about steps you can take to address this important issue with your state.  At that time, it will be important to act quickly to promote state policies that will minimize the burden on Medicaid beneficiaries and applicants.