Letter to Department of Health and Human Services Secretary Mike Leavitt

6/29/06

The Honorable Mike Leavitt
Secretary
Department of Health and Human Services
200 Independence Ave S.W., Room 615 F
Washington, DC 20201

Dear Secretary Leavitt:

We are writing to express our deep concern that Medicaid beneficiaries will be unfairly denied access to services for which they are eligible as a result of the guidance issued to state Medicaid agencies on June 9, 2006.

With such little time left before the implementation deadline, the guidelines are too restrictive and will place an undue burden on Medicaid beneficiaries in verifying their citizenship. State Medicaid agencies, many of which are facing fiscal challenges will have to expend substantial resources to administer these requirements imposed by the Deficit Reduction Act. States simply have not had enough time to prepare for the implementation of the requirements. This is unfair to states, will result in confusion among beneficiaries and administrators, and will increase the likelihood of people being unfairly denied access to care. More time is needed so that workable final regulations can be developed.

Before moving forward with implementation, the Centers for Medicare and Medicaid Services (CMS) should ensure that states have sufficient time to administer this policy change in a manner that assures uninterrupted coverage for all who are eligible for Medicaid. CMS should issue revised final regulations that can be implemented and be less of a burden for beneficiaries and state Medicaid agencies. After which, CMS must engage in outreach activities so that beneficiaries and Medicaid agencies know what is required of them before the rules go into effect.

Beneficiaries who make good faith efforts to comply with the documentation requirements should not be denied access to Medicaid. It would be extremely harmful to the health and well-being of beneficiaries to deny access to health care due to the difficulty in obtaining the necessary documentation. Additional guidance should be issued clarifying that Medicaid benefits should not be cut off while they are attempting to comply with the new rules. Many of our constituents are likely to have a difficult time complying with the new requirement because they do not have a passport or a birth certificate and it may take some time to acquire the additional required documentation.

The new citizenship documentation should not be applied to children that are automatically eligible for Medicaid as recipients of Title IV-E Foster Care and Adoption Assistance. The documentation requirements should not be applied to Supplemental Security Income (SSI) applicants and recipients. If they are burdened with these additional requirements, any documentation of the identity and citizenship used by the Social Security Administration should be acceptable for Medicaid purposes.

Computer matches should be permitted to electronically document citizenship without requiring beneficiaries to first present documentation. This will help ease the burden imposed on beneficiaries and Medicaid Administrators. These requirements are an unfunded mandate on the States and more needs to be done to prevent states from having to commit even more resources to comply with the documentation requirements.

CMS should accept additional citizenship documents as verification of citizenship to further reduce the burden on beneficiaries. Tribal enrollment card, Bureau of Indian Affairs identification card, or certificates of degree of Indian blood should be permitted to verify citizenship. Religious records recorded in the first three months of birth are acceptable secondary evidence for obtaining a Social Security number and should be permitted to verify citizenship.

We are also concerned that the requirement to submit certified or original copies of documents from issuing agencies will present additional problems for beneficiaries to comply with the new requirements. Obtaining these documents may be costly and difficult to obtain for working families.

Medicaid is an essential health care safety net for more than 50 million U.S. citizens. CMS has an obligation to help ease the citizenship verification process to ensure that beneficiaries are not unfairly denied access to care. We look forward to continuing to work with you on this matter. Thank you for your consideration.

http://murray.senate.gov/news.cfm?id=258154