National Alliance on Mental Illness
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May 19, 2006

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

The Deficit Reduction Act was recently signed into law.  The bill includes new requirements for anyone currently on Medicaid or applying for Medicaid benefits. Starting July 1, 2006, anyone applying for or being recertified as Medicaid eligible will be required to prove United States citizenship.  States recertify individuals every 6-12 months, so all Medicaid beneficiaries will go through this requirement before July 2007. 

To date, the Centers for Medicare and Medicaid Services (CMS) has not provided any guidance to states regarding implementation and we do not know when such information will be released by the agency.  We will provide updated information as soon as CMS guidance is available.

Since the deadline for implementation, however, is less than two months away, we wanted to make advocates aware of the provisions and suggest that you begin talking with your states to ensure that state officials do not choose a very strict reading of the law that may make it difficult for people with mental illness to comply.

The Center on Budget and Policy Priorities (CBPP) has produced some detailed policy briefs that have information on advocacy strategies, documents that states should allow as sufficient proof of citizenship and computer matching of existing records that states could use to avoid burdening individuals.  These documents are also included on NAMI’s website and will be very helpful in preparing for meetings with state officials.

The CBPP documents include the following (these documents are available below as PDF files):

1) DRA Citizen Documentation Requirement for Medicaid: Working with your state on implementation

2) Documents That Could be Used to Prove Citizenship and/or Identity for Medicaid

3) States Can Use Procedures that Minimize Burdens on Applicants and Beneficiaries

4) States Can Use Computer Matching of Existing Records to Document Citizenship in Medicaid

Advocacy Strategies:

1) Find out who is working on this issue in your state. Get involved with existing coalitions or start one –  The documentation requirements affect all Medicaid beneficiaries.  Many of you have been working with other health advocates on Medicaid reform issues.  Use those coalitions to begin a dialogue with state officials.

2) Request a meeting with State Medicaid and/or Mental Health Officials –  Meet with the state Medicaid agency because they will be implementing this requirement. Use your judgment about who else in state government will be your allies. We include mental health officials because in some states they have a good relationship with the Medicaid agency and may be helpful. 

Find out whether state officials have thought about these requirements and what they are considering.   Urge them to make the documentation requirements as consumer friendly as possible. If your Medicaid agency is slow to respond to requests for a meeting or clarification and/or fails to take steps to ease the burden on recipients or applicants, consider whether state legislators can be helpful in getting the agency’s attention.

3) Offer to help – Talk with them about how they can best convey information to individuals with mental illness.  Offer to work with them on outreach to NAMI members.  Create an ongoing relationship where you can provide feedback on forms, procedures, outreach materials, etc.

4) Provide suggestions  –  Offer some specific ideas. The documents from the Center on Budget offer some concrete suggestions.  Some examples include:

  • Outreach efforts must provide clear instructions on what people need to produce to satisfy the requirement.  Outreach efforts should include peer and family support groups, clubhouses, churches, and other social organizations.  The state should ensure that providers in your area are aware of these new provisions, including community mental health centers, mental health agencies, public health clinics, and others.
  • Advocate with your state to waive the processing fees or pay for any cost involved with compliance with this requirement.  Explain that individuals with mental illness have very little disposable income and are already stretched by necessities such as rent, food, co-pays, etc.  For example, a report from the Technical Assistance Collaborative, Priced Out in 2004, shows that 96% of an individual’s SSI check would be needed to pay the average rental on a studio or efficiency apartment in this country.
  • Urge your state to allow a reasonable opportunity for individuals to provide their proof of citizenship and provide presumptive eligibility for applicants and current beneficiaries while they are seeking their documents.  This will ensure that individuals get needed treatment during the waiting period between requesting and receiving documents.  Explain that for individuals with mental illness, any disruption in treatment can lead to dire consequences, including involvement with law enforcement, hospitalization, emergency room visits, and even death.
  • Ask your state to seek citizenship verification from computer matches and other programs to relieve the burden on the beneficiary.  This could include using information from programs that may already require such documentation (Supplemental Security Income –SSI, TANF or foster care) or matching up data from the state’s vital records office with the Medicaid rolls.
  • Suggest that the state use the broadest possible list of documents to prove citizenship and identity, including those that have been used by the Department of Justice and the Social Security Administration for this purpose. 

Related Files

DRA Citizen Documentation Requirement for Medicaid: Working with your State on Implementation (PDF File)
Documents That Could be Used to Prove Citizenship and/or Identity for Medicaid (PDF File)
States Can Use Procedures that Minimize Burdens on Applicants & Beneficiaries (PDF File)
States Can Use Computer Matching of Existing Records to Document Citizenship in Medicaid (PDF File)