Citizenship often not checked for Medicaid

A majority of states don’t verify claims of U.S. citizenship by those seeking Medicaid, which creates the potential for illegal aliens to access the health care program, an inspector general’s report has found.

“The quality assurance checks aren’t there. That’s how we see it,” said Jodi Nudelman, an acting regional inspector general for the Department of Health and Human Services. “And it’s our sense the people may not be aware of that.”

Federal law says that, with a few exceptions, a person must be a citizen to receive Medicaid benefits. States can accept a signed declaration as proof of U.S. citizenship. Forty-six states and the District do.

Only Montana, New York, New Hampshire and Texas require applicants to submit documents verifying citizenship.

One reason the federal government allows for self-declaration of citizenship with Medicaid is that doing so speeds access to health care.

In a letter last month to Dr. Mark McClellan, administrator of the federal Center for Medicare and Medicaid Services (CMS), HHS Inspector General Daniel R. Levinson wrote that CMS “has encouraged the practice of self-declaration in an effort to simplify Medicaid application procedures.”

The report last month from the inspector general’s office noted that a 1986 federal law requires applications for Medicaid to include “a declaration in writing, under penalty of perjury … stating whether the individual is a citizen or national of the United States.”

“While the policy to allow applicants to self-declare citizenship can result in rapid enrollment, it can also result in inaccurate eligibility determinations for applicants who provide false citizenship statements,” the inspector general’s report said.

Of the states that allow self-declaration of citizenship before accessing Medicaid, 27 did not conduct subsequent auditing that would verify an applicant’s statements were true.

The inspector general’s report does not address to what extent there is a problem with illegal aliens accessing Medicaid, only that the potential exists. Only one state, Oregon, has conducted an audit to determine how often “noncitizens” gained access to Medicaid.

Oregon’s secretary of state reviewed a sample of 812 applications in 2002 and found that 25 were not citizens. The state estimated that it would cost an additional $2 million if 1 percent of the Medicaid rolls are not citizens.

CMS officials agreed that states should have systems in place to ensure the citizenship of applicants. However, it also noted that the report raises only a potential problem.

“The report does not find particular problems regarding false allegations of citizenship, nor are we aware of any,” CMS officials replied.

In some cases, newly arrived legal immigrants, as well as illegal aliens, can lawfully access Medicaid, but such coverage is limited to emergency care.

The inspector general’s office asked Medicaid directors in the District and in the states that allow self-declaration of citizenship “their reasons for not requiring evidence of U.S. citizenship,” the report said.

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