Fleming & Curti, P.L.C. - Medicaid Citizenship Rules Likely to Reduce Care for Some

JUNE 12, 2006 VOLUME 13, NUMBER 50

Medicaid Citizenship Rules Likely to Reduce Care for Some

Last spring Congress narrowly passed a sweeping set of changes in an attempt to reduce the cost of the federal-state Medicaid program. One little-noticed change included in the new provisions may indeed have a big impact on the program’s cost—and critics fear it may do so by denying benefits to individuals who are actually entitled to receive services.

Medicaid long-term care services (provided in Arizona through the ALTCS program) are supposed to be available only to U.S. citizens and a very limited number of non-citizens who are properly in this country when they become ill. That rule has long been in place and does not change with the new law. It will, however, become more difficult to prove citizenship status.

Before, a citizen who could not produce a birth certificate, passport or naturalization papers had several options for demonstrating their citizenship status. Beginning next month, the acceptable methods of proof will be sharply limited. In most cases, the ALTCS applicant or recipient must produce one (in some cases two) of the following:

U.S. passport
Naturalization certificate
Certificate of citizenship
Birth certificate from the U.S., or one issued by the State Department if born abroad
Citizen ID card (last issued by INS in 1983)
"Religious record" (like a baptismal record)
Hospital record of birth
One of a handful of other official or semi-official records demonstrating the date and place of birth

Under previous rules, an ALTCS beneficiary who could not produce one of the approved documents evidencing citizenship could instead secure an affidavit signed by someone familiar with their circumstances attesting to their birthplace. That option will now be foreclosed.

In addition to new applicants, all existing ALTCS recipients will be required to comply with the new rules during their next annual renewal process. There is little doubt that some number of existing nursing home patients will be unable to produce documentation and will lose their ALTCS benefits—the open question is how many patients are likely to be affected.

The Arizona Health Care Cost Containment System (AHCCCS), which administers the ALTCS program, recognizes that the new eligibility rules may pose difficulties for participants. AHCCCS' website includes considerable information on the effect of the new law, and a list of "frequently asked questions" about citizenship rules as they apply to AHCCCS and ALTCS recipients.

Some elderly, possibly demented, nursing home patients now on the ALTCS rolls will almost certainly be unable to produce the appropriate documentation. It is unclear what will happen to those patients, though it seems likely that a significant share of the cost of nursing care will have to be absorbed by the nursing home industry itself. With new applications, the delays occasioned by the need to locate place of birth and secure official records will likely keep some deserving patients out of nursing homes or force the industry to absorb the costs of their care, as well.

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