Medicaid’s new rules start July 1

Thursday, June 15, 2006 | 7:18 a.m.

New citizenship guidelines for Medicaid eligibility have state officials scrambling to disseminate information and ensure proper staffing levels by the July 1 deadline.

The list of documents recognized as proof of citizenship was released Friday by the Health and Human Services Department, less than a month before the new rules take effect.

"This could create a huge staffing problem," said Bruce McAnnany, deputy administrator for the Nevada Division for Aging Services. "The guidelines seem to imply that if these documents are not available that it's the Medicaid office's responsibility to assist and try to get these documents or affidavits. I don't think they gave enough forethought to this for sure."

Medicaid is a state-federal program that provides medical care for low-income citizens. In Nevada, the Welfare Division oversees the program, which covers about 172,000 people.

The changes in eligibility verification are part of the Federal Deficit Reduction Act of 2005 that was signed into law in February. The purpose of the changes is to prevent illegal immigrants from receiving government-sponsored health care.

Among groups that might face obstacles meeting the requirements are American Indians and blacks born in the South.

Some documents included in the guidelines are specifically designed to accommodate these groups, but officials say they fall short.

Richard Arnold, director of the Las Vegas Indian Center and a Southern Paiute, said even the most liberal definition of citizenship allowed in the guidelines would be difficult for some Nevadans, including those who are not Indians, to produce.

A sworn affidavit from witnesses could be accepted as documentation of a last resort, but older residents, particularly those born in remote areas, may have outlived or lost touch with any witnesses, he said.

Older blacks in the South were often born at home because segregation laws limited access to hospitals. As a result, they face similar challenges providing proof of birth.

Only three documents, a U.S. passport, a certificate of naturalization or a certificate of U.S. citizenship are acceptable by themselves as proof of identification and citizenship, according to Jack Cheevers of the Health and Human Services' Centers for Medicare and Medicaid Services.

In the absence of any of these, there is one list of other documents for identification and another to prove citizenship. One document from each list is required.

Both lists are prioritized, or tiered, and officials must exhaust all of the possibilities from one tier before considering a document from subsequent tiers.

Residents already on Medicare will not be expected to provide proof until their annual re-evaluation. In addition, the legislation allows these recipients to remain eligible for Medicaid benefits as long as they make a continued good-faith effort to obtain documentation.

New applicants are not so lucky. They must provide the documentation before they are approved.

"It's no different than anyone else who has to meet an eligibility requirement and can't provide that verification," said Sherry Haar, a program specialist with Welfare and Supportive Services. "This now is just one of those items that is an eligibility requirement."

Haar said she sympathizes with people who, through no fault of their own, will not be able to provide the documentation. She also said that she did not know what, if any, alternatives would be available to them.

State officials said even with the late start, they are confident local Medicaid agencies will have the information they need by the deadline. They said, however, that it may take a little longer for ancillary private and public social service providers to get the information.

Officials acknowledge the lack of specific information regarding the guidelines added to the confusion.

As the deadline approached, officials nationwide began offering partial lists, based on available information and inaccurate or incomplete document lists have appeared in the media.

Haar said people at all levels were simply trying to provide the most accurate information as it became available.

"There was no definitive answer out there," Haar said. "We believe this list is the definitive answer."