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Michigan’s Implementation of the DRA Citizenship and Identity Verification Requirement for all Medicaid Applicants and Recipients to Begin April 1, 2007

MPLP Spring 2007 Elder Law Section Newsletter Article

                Issue 33, Spring 2007

Michigan’s Implementation of the DRA Citizenship and Identity Verification Requirement for all Medicaid Applicants and Recipients to Begin April 1, 2007

The Deficit Reduction Act of 2005 required all states to verify citizenship and identity for Medicaid recipients and applicants as of July 1, 2006.  Michigan has delayed implementation of this requirement and made efforts to devise a policy that will limit inappropriate denials and terminations of benefits.  However, the policy is likely to cause hardship and, in other states in which the requirement has already been implemented, thousands of recipients have been dropped from the rolls because of their inability to provide necessary documentation.

Applicants or recipients who receive Medicare, SSI, SSDI, or are in foster care receiving Title IV-E foster care or adoption assistance payments or child welfare services under Title IV-B are exempt from having to provide proof of citizenship or identity. In addition, applicants or recipients born in Michigan may not have to provide documentation.  DHS will run electronic cross checks with vital records to determine  if applicants and recipients  were born in Michigan.   If so, these individuals will not have to show any further proof of identity or citizenship and the state will create an electronic file for them to prove their citizenship status.  It is not clear how often DHS will run this cross check so it may not help all applicants who were in fact born in Michigan.  DCH estimates that 60-70 percent of Medicaid applicants and recipients were born in Michigan and will be protected in this way.

DHS will incorporate training on this new requirement into intensive training for new workers and on-going training for current workers during the next year although there will be no specific classroom training on this issue before the policy is implemented.  Advocates are concerned that the failure to provide targeted training on this issue will lead to unnecessary terminations and denials.

Although DHS workers have an obligation to assist applicants or recipients in obtaining documentation, no funds are available to pay for documentation clients need but cannot themselves afford to obtain.  This may prove a significant barrier to some applicants and recipients. Fortunately, DHS workers will accept copies of original documents, a policy the federal government may not condone.

DHS intends to have rather generous grace periods for recipients who are making good faith efforts to obtain documentation in recognition of the fact that obtaining documentation can be a lengthy process.  However, Medicaid applicants will not be able to qualify for Medicaid until they produce the documentation, regardless of how long it takes to procure it.

It is particularly disturbing that eligible applicants and recipients may be denied Medicaid because they are unable to comply with this requirement since there is substantial evidence that eligibility errors or fraudulent claims for public assistance very rarely involve citizenship issues.  For example, in the Food Assistance Program for the most recently completed 18  months of reviews (April 2005-September 2006), there was one citizenship  error.  The citizenship error caused a $33  mispayment.   In the Medicaid Program for the most recently completed 18 months of reviews (October 2004-March 2006), there was also only one citizenship error.  The citizenship error caused a $3,405 mispayment.   Moreover, shortly before the passage of the Deficit Reduction Act, the Department of Health and Human Services’ Office of Inspector General (OIG) found no substantial evidence that immigrants unlawfully obtain Medicaid by falsely claiming citizenship.  Because of the cost, difficulty, and burden this requirement will impose on both Medicaid applicants and recipients and states, some observers think it is possible that the new Democratic Congress might repeal this provision.

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