Speech #1090101612

University based physicians are uniquely qualified to assume this task. Bringing the resources of academia and health care system together to serve the poor and medically needy will create new opportunities to develop strategies that can be used on a broader scale. Improved Enforcement of Documentation Requirements (Section 6082 of the Conference Agreement. no provision in the Senate Bill. and Section 3145 of the House Bill) Current Law To be eligible for the full range of benefits offered under Medicaid. an individual must be a citizen or national of the United States or a qualified alien (e.g.. a legal permanent resident. refugee. alien granted asylum or related relief) who meets all other Medicaid program eligibility criteria. Nonqualified aliens (e.g.. those who are unauthorized or illegally present. nonimmigrants admitted for a temporary purpose such as education or employment. shortterm parolees) who would otherwise be eligible for Medicaid except for their immigration status may only receive Medicaid care and services that are necessary for the treatment of an emergency medical condition and are not related to an organ transplant procedure. As a condition of an individuals eligibility for Medicaid benefits. Section 1137(d) of the Social Security Act requires a state to obtain a written declaration. under penalty of perjury. stating whether the individual is a citizen or national of the United States. If an individual declares that he or she is a citizen or national. the state is not required to obtain additional documentary evidence but may choose to do so. According to a 205 report from the Department of Health and Human Services Office of Inspector General. 46 states and the District of Columbia allow or sometimes allow selfdeclaration of United States citizenship. while four states require Medicaid applicants to submit documentary evidence to verify citizenship statements. If an individual declares that he or she is not a citizen or national. the individual must declare that he or she is a qualified alien and must present: (1) alien registration documentation or other proof of immigration registration from the Department of Homeland Securitys United States Citizenship and Immigration Services Bureau (DHS/USCIS. formerly the Immigration and Naturalization Service) or (2) other documents determined by the state to constitute reasonable evidence of satisfactory immigration status. If an individual presents DHS[USCIS documentation. the state must verify the individuals immigration status with DHS/USCIS through the automated Systematic Alien Verification for Entitlements (SAVE) system. or by using an alternative verification system approved by the Secretary of Health and Human Services. States receive 100% federal reimbursement for the operation of such systems. Senate Bill No provision. House Bill Under the House bill. states would be prohibited from receiving federal reimbursement for medical assistance provided under Medicaid to an individual who has not provided satisfactory documentary evidence of citizenship or nationality. Such evidence would include one of the following documents: * a United States passport: " Form N550 or N570 (Certificate of Naturalization). e Form N560 or N561 (Certificate of United States Citizenship). * such other document that the Secretary may specify. by regulation. that provides proof of United States citizenship or nationality and that provides a reliable means of documentation of personal identity. Satisfactory documentary evidence would also include a document from each of the following lists: * a certificate of birth in the United States: * Form FS545 or Form DS1350 (Certificate of Birth Abroad): e Form 197 (United States Citizen Identification Card): * Form FS240 (Report of Birth Abroad of a Citizen of the United States). or * such other document as the Secretary may specify (excluding a document specified by the Secretary as described above) that provides proof of United States citizenship or nationality. AND * any identity document described in section 274A(b)(l)(D) of the Immigration and Nationality Act: or * any other documentation of personal identity of such other type as the Secretary finds. by regulation. provides a reliable means of identification. The documentary requirements would not apply to an alien who is: (1) eligible for Medicaid and is entitled to or enrolled for Medicare benefits. (2) eligible for Medicaid on the basis of receiving Supplemental Security Income benefits. or (3) eligible for Medicaid on such other basis as the Secretary may specify under which satisfactory documentary evidence of citizenship or nationality had been previously presented. The provision would apply to determinations of initial eligibility for Medicaid made on or after July 1. 2006. and to redeterminations made after such date in the case of individuals for whom the new documentary requirements were not previously met. Conference Agreement The conference agreement follows the House bill. but allows a stateissued drivers license or other identity document described in section 274(A)(b)(1)(D) of the Immigration and Nationality Act as satisfactory evidence. but only if the state issuing the license or such document requires proof of U.S. citizenship before issuance or obtains a Social Security number from the applicant and verifies before certification that such number is valid and assigned to an applicant who is a citizen. Health Opportunity Accounts (Section 6083 of the Conference Agreement. no provision in the Senate Bill. and Section 3134 of the House Bill) Current Law Medicaid is a joint federalstate entitlement program that finances health care coverage for certain lowincome families. children. pregnant women. and individuals who are aged or disabled. To qualify for Medicaid. an individual must meet both categorical and financial eligibility requirements.