New Medi-Cal Citizenship Regulations Not Likely to Be Ready for July 1 Implementation
[Posted 06/29/06]

A federal law becomes effective on July 1 requiring Medicaid enrollees and applicants to show proof of citizenship and identification to obtain benefits, but it is unlikely that counties, which administer the program, will be ready to implement the new requirements by that date, state and many county officials report.

Although the law was passed in February, it wasn't until June 9 that the federal Centers for Medicare & Medicaid Services (CMS) provided guidance to states on how the new law should be implemented. The law requires that Medicaid enrollees show proof of citizenship or legal residency status to enroll or continue to receive benefits. Because CMS was so late in providing its guidance, state officials have had little time to digest the new law and create a workable plan of action.

State officials say they are working as quickly as possible to implement the changes, but they have concerns about how the new law might impact the 6.8 million Medi-Cal recipients in California.

"California is moving forward with implementing this new law, and we're taking the necessary steps to ensure a full and responsible implementation," said Ken August, spokesman for the California Department of Health Services. "We will soon be working with counties and stakeholders to craft instructions to implement the law. These instructions should be issued in August."

CMA is concerned that many United States citizens applying for Medi-Cal will not have these documents in hand (or even at all). According to some estimates, as many as 3.2 to 4.6 million citizens may lose their Medicaid coverage because they cannot produce the necessary documentation. Of particular concern are those Medi-Cal beneficiaries in nursing homes, many of whom are disabled or incompetent.

Implementing the federal law in California also depends upon the passage of legislation that implements the state budget. Once state law is passed, the state, working with counties and stakeholders, will move quickly to issue instructions to counties on how to implement the new requirements.

After the state law is implemented, people who declare that they are citizens and are applying for Medi-Cal for the first time will need to produce documents showing they are United States citizens before they are able to receive benefits.

Current beneficiaries will need to provide documentation at the time of their annual redetermination. Renewing beneficiaries will not be denied benefits if they cannot immediately provide documentation, as long as they make a good faith effort to get the documents, state officials say. During this time, physicians will be reimbursed for services provided to these patients.

Physicians are advised to use point-of-service (POS) swipe card systems to verify a patient's eligibility. If the screen shows the patient is eligible, the state will pay for services provided to that patient. Physicians should print out the screen and keep a copy of the eligibility verification in the patient's chart.

Contact: Robin Flagg, 415-882-5110 or rflagg@cmanet.org.